A propensity score-matching analysis of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker exposure on in-hospital mortality in patients with acute respiratory failure.
A propensity score-matching analysis of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker exposure on in-hospital mortality in patients with acute respiratory failure.
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血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂暴露对急性呼吸衰竭患者院内死亡率的倾向评分匹配分析
作者：
探讨院前ACEI和ARB暴露对ARF患者预后的影响。单中心回顾性队列研究。重症监护医学信息市场III（MIMIC-III）数据库。入组符合ICD-9编码急性呼吸衰竭的患者。主要暴露是ACEI和ARB的院前暴露。主要结局为院内死亡率。进行多因素logistic回归分析，以确定ACEI/ARB暴露对死亡率的独立影响。采用倾向评分匹配（PSM）方法减少混杂因素的偏倚。采用亚组分析和敏感性分析检验结论的稳定性。入组了5335例成人ARF患者。PSM前后ACEI/ARB暴露患者的死亡率显著降低，调整后的OR为0.56（95%CI 0.43-0.72）。在亚组分析中，ACEI/ARB在年轻亚组中失去了保护作用，但未发现ACEI/ARB暴露与年龄之间存在显著的交互作用（p = 0.082）。E值的点估计值和95%下限分别为2.97和2.12。在敏感性分析中，ACEI/ARB暴露在ARDS队列中表现出类似的效果，但在MIMIC-IV数据库中没有发现显着差异，这可能是由于ACEI/ARB组的样本量较小所致。在急性呼吸衰竭患者中，院前ACEI/ARB暴露与更好的结局相关，并作为一个独立因素。ACEI/ARB与ARF预后的关系值得进一步研究。
To explore the impact of pre‐hospital ACEI and ARB exposure on the prognosis of ARF patients. A single‐center retrospective cohort study. Medical Information Mart for Intensive Care‐III (MIMIC‐III) database. The patients meeting ICD‐9 code of acute respiratory failure were enrolled. The primary exposure was the pre‐hospital exposure of ACEI and ARB. The primary outcome was in‐hospital mortality. Multiple logistic regression analysis was conducted to determine the independent effect of ACEI/ARB exposure on mortality. Propensity score matching (PSM) method was adopted to reduce bias of the confounders. Subgroup analysis and sensitivity analysis were used to test the stability of the conclusion. 5335 adult ARF patients were enrolled. Mortality was significantly decreased in patients with ACEI/ARB exposure before and after PSM, and the adjusted odds ratio (OR) of ACEI/ARB exposure was 0.56 (95% CI 0.43–0.72). In the subgroup analysis, ACEI/ARB lost its protective effect in young subgroup, but no significant interaction was found between ACEI/ARB exposure and age (p = 0.082). The point estimation and lower 95% limit of E‐value was 2.97 and 2.12. In sensitivity analysis, ACEI/ARB exposure showed similar effect in ARDS cohort, but no significantly difference was found in the MIMIC‐IV database, which may be explained by small sample size of the ACEI/ARB group. Among patients with acute respiratory failure, pre‐hospital ACEI/ARB exposure was associated with better outcomes and acted as an independent factor. The relationship between ACEI/ARB and prognosis of ARF is worth investigating further.
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影响因子：
9.6
作者：
Kreuter, Michael;Lederer, David J.;Cottin, Vincent
通讯作者：
Cottin, Vincent
影响因子：
1.8
作者：
Kim, Joohae;Choi, Sun Mi;Lee, Sang-Min
通讯作者：
Lee, Sang-Min
影响因子：
9.8
作者：
Johnson AE;Pollard TJ;Shen L;Lehman LW;Feng M;Ghassemi M;Moody B;Szolovits P;Celi LA;Mark RG
通讯作者：
Mark RG
影响因子：
7.3
作者：
Hamming, I;Timens, W;van Goor, H
通讯作者：
van Goor, H
影响因子：
9.6
作者：
Behrendt, CE
通讯作者：
Behrendt, CE