在替代疗法期间使用血管压缩剂与死亡率的关联
Javier A Neyra1, Jorge Echeverri2, Daniel Bronson-Lowe3
1University of Alabama at Birmingham, Birmingham, AL, USA.
Journal of critical care
|May 8, 2025
概括
在开始替代疗法 (RRT) 后使用血管压缩剂与急性损伤 (AKI) 严重病患者的住院死亡率较高有关. 风险随着使用更多的血管压缩剂而增加,无论RRT类型 (CRRT或IHD).
科学领域:
- 腎病學和重症醫療醫學 腎病學和重症醫學
- 临床结果研究研究
- 在急性疾病中进行药理干预.
背景情况:
- 急性损伤 (AKI) 是重症患者常见的并发症.
- 对于严重的AKI,置换疗法 (RRT) 通常是必要的.
- 血管压缩剂在接受AKI的RRT患者中的作用尚不清楚.
研究的目的:
- 调查血管压缩剂使用在RRT启动后和住院死亡率之间的关联.
- 为了在不同的RRT方式中比较这一关联:连续RRT (CRRT) 和间歇性血液透析 (IHD).
- 为了确定使用的血管压缩剂的数量是否影响死亡风险.
主要方法:
- 使用Premier Inc. (PINC) 人工智能医疗数据库 (2018年1月 - 2021年6月) 的观察性研究.
- 包括重症成年患者,患有需要CRRT的AKI (n=7660) 或IHD (n=13,222).
- 提取了RRT开始前后3天内血管压缩剂使用的数据;进行了风险调整分析.
主要成果:
- 在RRT开始后,血管压缩剂暴露与CRRT (aHR,1.69) 和IHD (aHR,1.72) 的风险调整住院死亡率增加有显著的关联.
- 观察到一种剂量依赖的关系:随着使用的血管抑制剂的数量 (1,2,或3) 的增加,死亡风险逐渐增加.
- 对于CRRT,对1,2,3型血管压缩剂的调整后危险比分分别为1.50,1.94和2.06.
- 对于IHD,对1,2,3型血管压缩剂的调整后危险比分分别为1.57,2.20和2.32.
结论:
- 在RRT开始后的3天内使用血管压缩剂与AKI患者的住院死亡率较高独立相关.
- 这种关联适用于CRRT和IHD模式.
- 这些发现表明,在接受RRT的重症AKI患者中,对血管压缩剂管理的仔细考虑至关重要.
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