【罂粟摘要】血管升压药剂量对感染性休克预后作用的时间敏感性分析
血管升压药剂量对感染性休克预后作用的时间敏感性分析
贵州医科大学 高鸿教授课题组
翻译：吴学艳 编辑：佟睿 审校：曹莹
目前尚不清楚血管升压药的剂量和死亡率之间的关系是否受给药时间的影响；我们旨在研究每日平均血管升压药剂量预防感染性休克是否可行。进行了一项单中心回顾性队列研究。试验纳入2016年4月-2019年7月期间在英国伯明翰伊丽莎白女王医院重症监护病房住院的被诊断为感染性休克患者；主要衡量标准是患者90天的死亡率。将升压药剂量定义为感染性休克前四天每天记录的去甲肾上腺素等效剂量(所有升压药和正性肌力药等量恒速输注)；根据血管加压素剂量的五分位数将患者分组，并计算患者的90天死亡率；检查受试者工作特征曲线和曲线下的面积，以判断预后能力。共有844名患者因感染性休克入院，90天的死亡率为43%(n=358)。在最初四天，93%幸存患者的中位血管升压药剂量减少，56%的死亡患者的中位血管加压药剂量增加，与给定血管加压药剂量五分之一相关的死亡率在感染性休克的连续天数中增加。从第1天到第4天，受测者工作特征曲线下的面积中位数抗血管加压药物剂量与死亡率的比值增加(0.67 vs 0.86,p<0.0001)。到第4天，每日中位数加压素剂量>0.05μg.kg-1·min-1,对死亡率的敏感性和特异性为80%；随着休克持续时间的延长，。从第1天到第4天，受测者操作人员特征曲线下的面积中位数抗血管加压药物剂量与死亡率的比值增加(0.67 vs. 0.86, p < 0.0001)。第4天，血压中位值> 0.05 μg.kg-1·min-1，对死亡率的敏感性和特异性为80%。随着休克持续时间的延长，血管升压剂的预后效用显著提高。长期服用小剂量的升压药物与高归因死亡率相关。
A time-sensitive analysis of the prognostic utility of vasopressor dose in septic shock
It is unclear whether the association between vasopressor dose and mortality is affected by duration of administration. We examined whether prognostication in septic shock is feasible through the use of daily median vasopressor doses. We undertook a single-centre retrospective cohort study. We included patients with a diagnosis of septic shock admitted to the intensive care unit at Queen Elizabeth Hospital, Birmingham, UK,between April 2016 and July 2019. The primary outcome measure was 90-day mortality. We defined vasopressor dose as the median norepinephrine equivalent dose (equivalent infusion rates of all vasopressors and inotropes) recorded for each day, for the first four days of septic shock. We divided patients into groups by vasopressor dose quintiles and calculated their 90-day mortality rate. We examined area under the receiver operator characteristic curves for prognostic ability. In total, 844 patients were admitted with septic shock and had a 90-day mortality of 43% (n = 358). Over the first four days, median vasopressor dose decreased in 93% of survivors and increased in 56% of non-survivors. The mortality rate associated with a given vasopressor dose quintile increased on sequential days of septic shock. The area under the receiver operator characteristic curves of daily median vasopressor dose against mortality increased from day 1 to day 4 (0.67 vs. 0.86, p < 0.0001). By day 4, a median daily vasopressor dose > 0.05 μg.kg-1.min-1 had an 80% sensitivity and specificity for mortality.The prognostic utility of vasopressor dose improved considerably with shock duration. Prolonged administration of small vasopressor doses was associated with a high attributable mortality.
翻译：吴学艳 编辑：佟睿 审校：曹莹
贵州医科大学 高鸿教授课题组