早期肝素治疗对患有固体恶性瘤相关性败血症患者的结果的影响:边缘结构模型因果分析
Jia-Jia Huang1,2, Ji-Zhen Cai3, Zhi-Peng Zhou1
1Department of Infection and Critical Care Medicine, Shenzhen Second People's Hospital and First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China.
Frontiers in pharmacology
|December 20, 2023
概括
早期的肝素治疗显著改善了患有固体恶性瘤和败血症的重症患者的结局,降低了重症监护病房死亡率和血栓形成. 这些益处在患有消化系统癌症的患者中尤为明显.
科学领域:
- 关键护理医学 关键护理医学
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 肝素的抗转移性质是已知的,但它对固体恶性病患者的败血症结果的影响尚不清楚.
- 固体恶性瘤患者的败血症存在复杂的挑战,死亡率高.
- 了解肝素的作用对于优化治疗策略至关重要.
研究的目的:
- 调查早期氨酸治疗对患有固体恶性瘤和败血症的重症患者的结局的影响.
- 确定肝素是否可以降低重症监护室 (ICU) 死亡率,血栓形成和医院死亡率.
- 为了确定特定的癌症类型,可能从肝素治疗中获益最多.
主要方法:
- 使用密集护理医疗信息中心 (MIMIC) -IV数据库进行回顾性队列研究.
- 包括患有固体恶性瘤和败血症的重症患者.
- 统计分析包括倾向得分匹配 (PSM),边缘结构考克斯模型 (MSCM) 和考克斯比例危险模型来控制混变量.
主要成果:
- 与非肝素使用相比,肝素使用与显著降低ICU死亡率 (HR 0.61),血栓形成率 (HR 0.42) 和医院死亡率 (HR 0.70) 相联系.
- 此外,MSCM进一步证实了肝素在降低ICU死亡率方面的有效性 (HR 0.48).
- 分层分析表明,肝素在患有消化系统癌症的患者中具有显著的益处 (HR 0.33).
结论:
- 早期的肝素治疗与患有固体恶性瘤和败血症的重症患者的改善结果有关.
- 在这种患者群体中,肝素显著降低了ICU死亡率,血栓形成和医院死亡率.
- 肝素的积极作用在患有消化系统癌症的患者中尤为显著,需要进一步研究.
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