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持续的脏替代疗法剂量和严重病患者的死亡率:使用边缘结构模型的回顾性队列研究
Maria Luiza Medeiros Faria1, Alexandre Braga Libório2
1Medical Program, Universidade de Fortaleza-UNIFOR, Fortaleza, Ceará, Brazil.
Shock (Augusta, Ga.)
|August 26, 2024
概括
持续置换疗法 (CKRT) 剂量可能没有下一个不安全的极限,当调整时间依赖的变量. 最初的低CKRT剂量显示出更高的死亡率,但随着适当的调整,这种关联消失了,这表明个性化剂量是关键.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 关键护理医学 关键护理医学
- 生物统计学 生物统计学
背景情况:
- 持续置换疗法 (CKRT) 对血液动力学不稳定的急性损伤 (AKI) 患者至关重要.
- 最佳CKRT剂量仍在争论中,特别是低剂量治疗对患者结果的影响.
研究的目的:
- 研究AKI患者低CKRT剂量与90天死亡率之间的关联.
- 评估方法方法,包括边缘结构模型对这种协会的影响.
主要方法:
- 使用MIMIC-IV数据库对接受CKRT>24小时的成年患者进行分析.
- 采用边际结构模型 (MSM) 来解释时间依赖的混.
- 根据CKRT剂量值 (13和20毫升/公斤/小时) 分类患者.
主要成果:
- 最初的分析显示,CKRT剂量<13mL/kg/h (HR:1.70) 的90天死亡率更高.
- 在使用MSM对时间依赖变量进行调整后,CKRT剂量在13或20mL/kg/h值时与90天死亡率没有显著相关.
- 在调整后,没有发现递送的CKRT剂量 (5-40毫升/千克/小时) 与90天死亡率之间有显著的关联.
结论:
- 方法方法对CKRT剂量与死亡率之间观察到的关联有重大影响.
- 对CKRT剂量的个性化调整可能会否定对不安全剂量的最终下限.
- 虽然最初与较高的死亡率有关,但当适当考虑时间依赖因素时,低CKRT剂量失去意义.
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