Loop Diuretics in Severe Bronchopulmonary Dysplasia: Cumulative Use and Associations with Mortality and Age at Discharge.
Loop Diuretics in Severe Bronchopulmonary Dysplasia: Cumulative Use and Associations with Mortality and Age at Discharge.
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DOI：
10.1016/j.jpeds.2020.10.073
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Lorch SA
中科院分区：
文献类型：
--
作者：
Bamat NA;Nelin TD;Eichenwald EC;Kirpalani H;Laughon MM;Jackson WM;Jensen EA;Gibbs KA;Lorch SA
测量美国儿童医院中发生严重支气管肺发育不良（BPD）的婴儿使用袢利尿剂的中心间差异，并比较低与高使用中心婴儿的死亡率和出院年龄。我们对胎龄<32周的早产儿进行了一项回顾性队列研究，这些早产儿发生了严重的BPD。主要结局是累积袢利尿剂使用，定义为入院和出院之间暴露天数的比例。在多变量模型中纳入了与P <0.10时使用袢利尿剂相关的婴儿特征，以调整病例组合的中心差异。医院在调整后的使用中从最低到最高进行排名，并分为低或高使用中心。然后，我们通过多变量分析比较了两组的死亡率和出院时的经后年龄。我们确定了来自43个中心的3252名受试者。尽管对婴儿特征进行了调整，但各中心之间仍存在显著差异，使用的调整平均范围为7.3%至49.4%，p < 0.0001。低剂量组和高剂量组的死亡率（校正比值比0.98 [95%CI 0.62，1.53]，p = 0.92）和出院时的经后年龄（边缘均值[95%CI]：47.3 [46.8，47.9] vs 47.4 [46.9，47.9]周，p = 0.96）分别相似。在美国儿童医院之间，患严重BPD的婴儿使用袢利尿剂的情况存在显著差异，但在死亡率或出院年龄方面没有观察到差异。需要进行研究，为这种常见的暴露提供循证指导。
To measure between-center variation in loop diuretic use for infants developing severe bronchopulmonary dysplasia (BPD) in United States children’s hospitals, and to compare mortality and age at discharge among infants from low versus high use centers. We performed a retrospective cohort study of preterm infants <32 weeks gestational age developing severe BPD. The primary outcome was cumulative loop diuretic use, defined as the proportion of days with exposure between admission and discharge. Infant characteristics associated with loop diuretic use at P < .10 were included in multivariable models to adjust for center differences in case-mix. Hospitals were ranked from lowest to highest in adjusted use, and dichotomized into low or high use centers. We then compared mortality and postmenstrual age at discharge between groups through multivariable analyses. We identified 3252 subjects from 43 centers. Significant variation between centers remained despite adjustment for infant characteristics, with use present in an adjusted mean range of 7.3% to 49.4% of days, p < 0.0001. Mortality (adjusted odds ratio 0.98 [95% CI 0.62, 1.53], p = 0.92) and postmenstrual age at discharge (marginal mean [95% CI]: 47.3 [46.8, 47.9] versus 47.4 [46.9, 47.9] weeks, p = 0.96) were similar in low and high use groups, respectively. Marked variation in loop diuretic use for infants developing severe BPD exists between US children’s hospital, without an observed difference on mortality or discharge age. Research to provide evidence-based guidance for this common exposure is needed.
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