Effects of the Incidence Density of Fever (IDF) on Patients Resuscitated From In-Hospital Cardiac Arrest: A Mediation Analysis
Effects of the Incidence Density of Fever (IDF) on Patients Resuscitated From In-Hospital Cardiac Arrest: A Mediation Analysis
复制标题
发热发生密度 (IDF) 对院内心脏骤停复苏患者的影响：中介分析
DOI：
10.3389/fmed.2020.00086
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发表时间：
2020-03-25
影响因子：
3.9
通讯作者：
Cui，Derong
中科院分区：
文献类型：
--
作者：
Hu，Yue;Guo，Yong;Cui，Derong
目的：探讨影响院内心脏骤停(IHCA)存活率的因素，并探讨发热发病密度(IDF)是否起到中介作用。方法：收集2011-2017年间存活超过48h的IHCA患者的资料。IDF定义为发热持续时间除以住院时间，持续发热定义为发热持续5天以上，早期发热定义为在IHCA的前2天内首次发病。对可能与IDF相关的临床变量进行线性回归分析，对与生存率相关的可能临床变量进行单变量和多变量分析。IDF作为危险因素对生存的间接影响的中介被调查。结果：在我们的回顾性研究中，IDF的中位数为0，四分位数范围从0到0.42。长期发热占16%(97/605)，早期发热占17.2%(104/605)。直线回归分析结果显示，胸片阳性、中心静脉置管阳性、格拉斯哥昏迷评分≤-8与IDF相关。IDF(OR：0.36，95%CI，0.13~0.97，P=0.04)、长期发热(调整后OR=0.13，95%CI，0.06~0.29，P<；胸片阳性(OR：0.001.6 7，95%CI，0.46~0.98，P=0.0 4)、中心静脉置管(OR：0.5 4，95%CI，0.34~0.89，P=0.0 1)、气管插管(OR：0.47，95%CI，0.33~0.69，P<；0.001)与调整后出院转归有关。此外，胸片阳性通过IDF作为媒介对生存结局的影响为19%，IDF介导的中心静脉导管的间接影响占总效应的10%。结论：IDF较高、持续发热、胸片阳性、使用中心静脉导管和气管插管降低了这些患者的存活率，而阳性胸片和使用中心静脉导管对生存结果的不利影响部分是通过IDF介导的。
Objective: The aim of this research was to study the factors contributing to the survival rate of in-hospital cardiac arrest (IHCA) and to determine whether the incidence density of fever (IDF) acts as a mediator. Methods: Data from patients with IHCA who survived more than 48 h were collected from 2011 to 2017. IDF was defined as the fever duration divided by the hospitalization duration, prolonged fever was defined as fever lasting for more than 5 days, and early fever was defined as an initial onset within the first 2 days of IHCA. Possible clinical variables associated with IDF were examined by linear regression, and possible clinical variables associated with survival rate were examined by univariate and multivariate analyses. IDF was investigated as a mediator of the indirect effects of the risk factors on survival. Results: In our retrospective study, the median IDF was 0, with an interquartile range from 0 to 0.42. Prolonged fever was noted in 16% (97/605) of the total, and early fever was noted in 17.2% (104/605) of the total. Linear regression results showed that positive chest X-ray, central venous catheter and Glasgow Coma Score (GCS) ≤ 8 were related to IDF. The IDF (OR: 0.36, 95% CI, 0.13–0.97, P = 0.04), prolonged fever (adjusted OR = 0.13, 95% CI, 0.06–0.29, P < 0.001), positive chest X-ray (OR: 0.67, 95% CI, 0.46–0.98, P = 0.04), central venous catheter placement (OR: 0.54, 95% CI, 0.34–0.89, P = 0.01), and endotracheal intubation (OR: 0.47, 95% CI, 0.33–0.69, P < 0.001) were also related to the negative outcome of hospital discharge after adjustment. Additionally, positive chest X-ray had a 19% effect on survival outcome through IDF as a mediator, and the indirect effect of central venous catheter mediated by IDF accounted for 10% of the total. Conclusions: A higher IDF, prolonged fever, a positive chest X-ray, the use of a central venous catheter and endotracheal intubation reduced the survival rate of these patients, and the detrimental impacts of a positive chest X-ray and the use of a central venous catheter on survival outcomes were partially mediated by IDF.