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之前在ARDS中发现的炎症亚表型与重症监护室出院时的死亡率有关:前性观察性研究的二次分析
Marleen A Slim1,2, Rombout B E van Amstel3, Lieuwe D J Bos3
1Center for Experimental and Molecular Medicine, Amsterdam University Medical Center, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.a.slim@amsterdamumc.nl.
Critical care (London, England)
|May 7, 2024
概括
患有高炎症亚表型的ICU幸存者在出院时面临更高的死亡率. 识别这些炎症概况有助于预测重症患者在重症监护室停留后的结果.
科学领域:
- 关键护理医学 关键护理医学
- 免疫学 免疫学 免疫学
- 生物标志物研究 生物标志物研究
背景情况:
- 重症监护室 (ICU) 的幸存者在出院后面临着较高的死亡风险.
- 在急性呼吸窘迫综合征 (ARDS) 患者中发现的炎症子类型预测了结果.
- 这些子类型是基于诸如中白素-8,蛋白C和二碳酸盐之类的生物标志物,具有预后价值.
研究的目的:
- 调查在ARDS患者中发现的炎症亚表型是否与更广泛的重症患者在ICU出院时的结果有关.
- 确定这些子类型对短期和长期死亡率的预后意义.
- 探索将现有的亚表型模型应用于一般ICU幸存者的实用性.
主要方法:
- 在两个荷兰ICU进行前性观察队列研究 (2011-2014) 的二次分析.
- 活着从ICU出院的患者被分类为子类型,使用基于血生物标志物的验证模型.
- 隐性类分析 (LCA) 被用作子类型识别的灵敏度分析.
主要成果:
- 在1483名ICU幸存者中,有可用的生物标志物,6%被分配到高炎症亚表型和94%的低炎症亚表型.
- 超炎症亚表型患者表现出更严重的器官功能障碍 (SOFA评分) 和显著更高的30天 (21%对11%) 和一年 (48%对28%) 的死亡率.
- LCA确定了两类,其中第1类 (与高炎症亚表型在很大程度上重叠) 显示死亡率明显更高.
结论:
- 在ICU出院时被归类为高炎症亚表型的患者在凝血,内皮激活和炎症方面表现出显著的异常.
- 这种超炎症状态与出院后长达一年的死亡率增加有关.
- 在ICU出院时的亚类型识别可以识别患有较高不良结果风险的重症患者.
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