Antiplatelet pretreatment and mortality in patients with severe sepsis: A secondary analysis from a multicenter, prospective survey of severe sepsis in Japan
Antiplatelet pretreatment and mortality in patients with severe sepsis: A secondary analysis from a multicenter, prospective survey of severe sepsis in Japan
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DOI：
10.1016/j.jcrc.2022.154015
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发表时间：
2022-03-26
影响因子：
3.7
通讯作者：
Kushimoto, Shigeki
中科院分区：
文献类型：
--
作者：
Kobayashi, Masakazu;Kudo, Daisuke;Kushimoto, Shigeki
目的：抗血小板药物可减轻脓毒症患者的炎症和凝血反应。本研究旨在探讨脓毒症前抗血小板治疗与脓毒症患者生存结局之间的关系。材料和方法：这是一个日本多中心注册数据集的二次分析。根据抗血小板药物治疗前的状态，将因严重脓毒症（脓毒症2级标准）而入住重症监护室的年龄>16岁的参与者进行二分。主要结局为住院死亡率。使用治疗加权逆概率（IPTW）对数据进行分析，并在多重插补后对使用抗血小板药物的既存治疗进行倾向评分。结果：分析了总计1184例符合条件的患者（2016-2017年）的数据。共有175例患者接受了抗血小板药物预治疗。IPTW后，患者的特征在组间平衡良好。接受抗血小板药物治疗的患者的住院死亡率明显低于未接受抗血小板药物治疗的患者（18.15% vs. 25.31%，差异：-7.86%，95%置信区间[CI]：-14.3至-1.4，p = 0.016）。在这项研究中，脓毒症发作前给予抗血小板药物治疗与院内死亡率降低相关。(c)2022爱思唯尔公司All rights reserved.
Purpose: Antiplatelet agents may attenuate inflammatory and coagulation responses in patients with sepsis. This study aimed to examine the association between pre-sepsis antiplatelet therapy and survival outcomes in patients with sepsis.Materials and methods: This was a secondary analysis of a Japanese multicenter registry dataset. Participants aged >16 years who were admitted to intensive care units for the treatment of severe sepsis (Sepsis 2 criteria) were dichotomized, according to their pretreatment status with antiplatelet agents. The primary outcome was in-hospital mortality. The data were analyzed using inverse probability of treatment weighting (IPTW) with a propensity score for pre-existing treatment using antiplatelet medication after multiple imputation.Results: Data from a total of 1184 eligible patients (2016-2017) were analyzed. A total of 175 patients were pretreated with antiplatelet medication. After IPTW, the patients' characteristics were well balanced between the groups. The in-hospital mortality rate among patients pretreated with antiplatelet medication was significantly lower than that among patients pretreatedwithout antiplatelet medication (18.15% vs. 25.31%, difference: -7.86%, 95% confidence interval [CI]: -14.3 to -1.4, p = 0.016).Conclusions: In this study, pretreatment with antiplatelet medication before the onset of sepsis was associated with decreased in-hospital mortality rates. (c) 2022 Elsevier Inc. All rights reserved.