右美托咪定给药对急性肾损伤危重患者预后的影响:倾向评分匹配分析。

IF 1.1 4区医学 Q3 UROLOGY & NEPHROLOGY

Clinical nephrology Pub Date : 2023-07-01 DOI:10.5414/CN111041

Aixiang Yang, Jing Yang, Biying Zhou, Jinxian Qian, Liyang Jiang, Zhuo Jiang, Guoyuan Lu

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引用次数: 0

摘要

目的:评价右美托咪定(DEX)对重症急性肾损伤(AKI)患者预后的影响。材料和方法:数据从重症监护医学信息市场III数据库(MIMIC III)中提取，采用倾向评分匹配(PSM)分析(1:3)、Cox比例风险模型、线性回归和logistic回归模型评估右美托咪唑对临床结局的影响。结果:经PSM后，324对患者配用DEX与未配用DEX。DEX给药与住院死亡率降低相关(风险比0.287;95% ci 0.151 - 0.542;p < 0.001)和90天死亡率(HR 0.344;95% ci 0.221 - 0.534;p < 0.001)，并且还与ICU住院时间(4.54(3.13,7.72)比5.24 (3.15,10.91)，p < 0.001)和住院时间(11.63(8.02,16.79)比12.09 (7.83,20.44)，p = 0.002)缩短相关。亚组分析显示，上述关联仅存在于轻度和中度AKI亚组中，而不存在于重度AKI亚组中。然而，给药DEX与肾功能恢复无关(HR 1.199;95% ci 0.851 - 1.688;P = 0.300)。结论:DEX可改善轻中度AKI危重患者的预后，是一种较好的镇静选择。

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Effects of dexmedetomidine administration on outcomes in critically ill patients with acute kidney injury: A propensity score-matching analysis.

Purpose: To evaluate the effects of dexmedetomidine (DEX) on outcomes of critically ill patients with acute kidney injury (AKI).

Materials and methods: Data were extracted from the Medical Information Mart for Intensive Care III database (MIMIC III). Propensity score matching (PSM) analysis (1 : 3), Cox proportional hazards model, linear regression and logistic regression model were used to assess the effect of DEX on clinical outcomes.

Results: After PSM, 324 pairs of patients were matched between the patients with DEX administration and those without. DEX administration was associated with decreased in-hospital mortality (hazard ratio (HR) 0.287; 95% CI 0.151 - 0.542; p < 0.001) and 90-day mortality (HR 0.344; 95% CI 0.221 - 0.534; p < 0.001), and it was also associated with reduced length of stay (LOS) in ICU (4.54 (3.13,7.72) vs. 5.24 (3.15,10.91), p < 0.001) and LOS in hospital (11.63 (8.02,16.79) vs 12.09 (7.83,20.44), p = 0.002). Subgroup analysis showed that the above associations existed only in the mild and moderate AKI subgroups, but not in the severe AKI subgroup. Nevertheless, DEX administration was not associated with recovery of renal function (HR 1.199; 95% CI 0.851 - 1.688; p = 0.300).

Conclusion: DEX administration improved outcomes in critically ill patients with mild and moderate AKI and could be a good choice of sedation.

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来源期刊

Clinical nephrology 医学-泌尿学与肾脏学

CiteScore

2.10

自引率

9.10%

发文量

138

审稿时长

4-8 weeks

期刊介绍： Clinical Nephrology appears monthly and publishes manuscripts containing original material with emphasis on the following topics: prophylaxis, pathophysiology, immunology, diagnosis, therapy, experimental approaches and dialysis and transplantation.