The Association of an Alpha-2 Adrenergic Receptor Agonist and Mortality in Patients With COVID-19.
The Association of an Alpha-2 Adrenergic Receptor Agonist and Mortality in Patients With COVID-19.
复制标题
DOI：
10.3389/fmed.2021.797647
复制
发表时间：
2021
影响因子：
3.9
通讯作者：
Balk RA
中科院分区：
文献类型：
--
作者：
Hamilton JL;Vashi M;Kishen EB;Fogg LF;Wimmer MA;Balk RA
需要治疗以降低2019冠状病毒病（COVID-19）死亡率。α 2肾上腺素能受体（α2 AR）激动剂可抑制免疫细胞和炎症反应，并通过生理呼吸参数改善氧合。因此，α2 AR激动剂可能有效降低COVID-19中与炎症过度和急性呼吸衰竭相关的死亡率。右美托咪定（DEX）是一种用于镇静的α2 AR激动剂。我们对2020年3月1日至2020年7月30日期间在拉什大学健康系统医院接受COVID-19治疗并需要有创机械通气和镇静的成人（n = 214）进行了回顾性分析。我们评估了DEX使用与插管后28天死亡率的关系。总体而言，接受DEX的队列的28天死亡率为27.0%，而未接受DEX的队列为64.5%（相对风险降低58.2%; 95% CI 42.4-69.6）。多变量考克斯回归分析显示，使用DEX与28天死亡率降低相关（aHR 0.19; 95% CI 0.10-0.33; p < 0.001）。调整DEX暴露的时间变化也表明，DEX与28天死亡率降低相关（aHR 0.51; 95% CI 0.28-0.95; p = 0.03）。在插管后3.4天内开始使用DEX，与28天死亡率降低相关（aHR 0.25; 95% CI 0.13-0.50; p < 0.001），而晚些时候使用DEX则无关（aHR 0.64; 95% CI 0.27-1.50; p = 0.30）。这些结果表明，α2 AR激动剂可能会降低COVID-19患者的死亡率。需要随机对照试验来证实这一观察结果。
There is a need for treatments to reduce coronavirus disease 2019 (COVID-19) mortality. Alpha-2 adrenergic receptor (α2 AR) agonists can dampen immune cell and inflammatory responses as well as improve oxygenation through physiologic respiratory parameters. Therefore, α2 AR agonists may be effective in reducing mortality related to hyperinflammation and acute respiratory failure in COVID-19. Dexmedetomidine (DEX) is an α2 AR agonist used for sedation. We performed a retrospective analysis of adults at Rush University System for Health hospitals between March 1, 2020 and July 30, 2020 with COVID-19 requiring invasive mechanical ventilation and sedation (n = 214). We evaluated the association of DEX use and 28-day mortality from time of intubation. Overall, 28-day mortality in the cohort receiving DEX was 27.0% as compared to 64.5% in the cohort that did not receive DEX (relative risk reduction 58.2%; 95% CI 42.4–69.6). Use of DEX was associated with reduced 28-day mortality on multivariable Cox regression analysis (aHR 0.19; 95% CI 0.10–0.33; p < 0.001). Adjusting for time-varying exposure to DEX also demonstrated that DEX was associated with reduced 28-day mortality (aHR 0.51; 95% CI 0.28–0.95; p = 0.03). Earlier DEX use, initiated <3.4 days from intubation, was associated with reduced 28-day mortality (aHR 0.25; 95% CI 0.13–0.50; p < 0.001) while later DEX use was not (aHR 0.64; 95% CI 0.27–1.50; p = 0.30). These results suggest an α2 AR agonist might reduce mortality in patients with COVID-19. Randomized controlled trials are needed to confirm this observation.
登录
查看更多内容
影响因子：
11.4
作者：
Chen CX;Wang JJ;Li H;Yuan LT;Gale RP;Liang Y
通讯作者：
Liang Y
影响因子：
4.3
作者：
Marra, Annachiara;Ely, E. Wesley;Patel, Mayur B.
通讯作者：
Patel, Mayur B.
影响因子：
4.6
作者：
Matsui K;Ozawa M;Kiso M;Yamashita M;Maekawa T;Kubota M;Sugano S;Kawaoka Y
通讯作者：
Kawaoka Y
影响因子：
4.4
作者：
Maria Herrera-Garcia, Ada;Jesus Dominguez-Luis, Maria;Diaz-Gonzalez, Federico
通讯作者：
Diaz-Gonzalez, Federico
影响因子：
1.5
作者：
Hyoju SK;Baral B;Jha PK
通讯作者：
Jha PK