Association Between Antipsychotic Agents and Risk of Acute Respiratory Failure in Patients With Chronic Obstructive Pulmonary Disease
Association Between Antipsychotic Agents and Risk of Acute Respiratory Failure in Patients With Chronic Obstructive Pulmonary Disease
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DOI：
10.1001/jamapsychiatry.2016.3793
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发表时间：
2017-03-01
期刊：
影响因子：
25.8
通讯作者：
Lin, Hui-Lan
中科院分区：
文献类型：
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作者：
Wang, Meng-Ting;Tsai, Chen-Liang;Lin, Hui-Lan
急性呼吸衰竭（ARF）是一种危及生命的事件，在病例报告中与抗精神病药物的使用有关，但这种关联缺乏基于人群的证据。对于慢性阻塞性肺疾病（COPD）患者的药物安全性问题，应特别关注，因为这些患者容易发生ARF，并且通常使用抗精神病药物进行治疗。和参与者一项基于人群的病例交叉研究分析了台湾全民健康保险研究数据库中所有COPD患者，2000年1月1日至2011年12月31日期间，在医院或急诊室新诊断为ARF，需要插管或机械通气的患者。既往有ARF、肺癌和心源性、创伤性或脓毒性ARF的患者被排除，以分析特发性ARF。初步研究于2013年11月1日至12月31日进行，完整数据分析于2015年10月15日至2016年11月8日进行。抗精神病药物的种类，给药途径和剂量也进行了检查。主要结果和措施ARF的风险。结果有5032例ARF患者（平均[SD]年龄，74.4 [9.9]岁; 3533名男性[70.2%]）61620例COPD患者。590例ARF患者（11.7%）在病例期间服用了至少一种抗精神病药物，而对照期间为443例（8.8%），相当于1.66倍（95%CI，1.34-2.05; P
IMPORTANCE Acute respiratory failure (ARF) is a life-threatening event that has been linked in case reports to antipsychotic use, but this association lacks population-based evidence. Particular attention should be focused on patients with chronic obstructive pulmonary disease (COPD) regarding this drug safety concern because these patients are prone to ARF and are commonly treated with antipsychotics.OBJECTIVE To determine whether the use of antipsychotics is associated with an increased risk of ARF in patients with COPD.DESIGN, SETTING, AND PARTICIPANTS A population-based case-crossover study analyzing the Taiwan National Health Insurance Research Database was conducted of all patients with COPD, who were newly diagnosed with ARF in hospital or emergency care settings necessitating intubation or mechanical ventilation from January 1, 2000, to December 31, 2011. Patients with prior ARF, lung cancer, and cardiogenic, traumatic, or septic ARF were excluded to analyze idiopathic ARF. The pilot study was conducted from November 1 to December 31, 2013, and full data analysis was performed from October 15, 2015, to November 8, 2016.EXPOSURES The use of antipsychotics was self-compared during days 1 to 14 (the risk period according to previous case reports) and days 75 to 88 (control period) preceding the ARF event or index date. The antipsychotic class, route of administration, and dose were also examined.MAIN OUTCOMES AND MEASURES Risk of ARF.RESULTS There were 5032 patients with ARF (mean [SD] age, 74.4 [9.9] years; 3533 males [70.2%]) among the 61 620 patients with COPD. Five hundred ninety patients with ARF (11.7%) filled at least 1 antipsychotic prescription during the case period compared with 443 (8.8%) during the control period, corresponding to a 1.66-fold (95% CI, 1.34-2.05; P