Association between short-term systemic use of glucocorticoids and prognosis of cardiogenic shock: a retrospective analysis.
Objective: To investigate the prescription rate of short-term systemic use of glucocorticoids during hospitalization in patients with cardiogenic shock (CS), and outcomes related with glucocorticoid use. Methods: We extracted patients' information from the Medical Information Mart for Intensive Care...
| Publicado en: | BMC Anesthesiology Vol. 23; no. 1; pp. 1 - 17 |
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| Autores principales: | , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
BioMed Central
5/18/2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=163800324&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 163800324 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14712253 1CH3 jtl: BMC Anesthesiology issn: 14712253 maglogo: N pubinfo: dt: 5/18/2023 vid: 23 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 163800324 163800324 163800324 10.1186/s12871-023-02131-y 163800324 ppf: 1 ppct: 16 formats: tig: atl: Association between short-term systemic use of glucocorticoids and prognosis of cardiogenic shock: a retrospective analysis. aug: au: Fan, Hua-Ping Zhou, Yan Zhou, Yu Jin, Jun Hu, Tian-Yang affil: Department of Cardiology, 63650 Military Hospital, 841700, Urumqi, Xinjiang, China sug: subj: Glucocorticoids Adverse Effects Shock, Cardiogenic Epidemiology Treatment Outcomes Retrospective Design Myocardial Infarction Diagnosis Human Male Female Confidence Intervals Descriptive Statistics Adult Middle Age Comparative Studies Logistic Regression Database Management Software Chi Square Test Prospective Studies Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: Objective: To investigate the prescription rate of short-term systemic use of glucocorticoids during hospitalization in patients with cardiogenic shock (CS), and outcomes related with glucocorticoid use. Methods: We extracted patients' information from the Medical Information Mart for Intensive Care IV version 2.0 (MIMIC-IV v2.0) database. The primary endpoint was 90-day all-cause mortality. Secondary safety endpoints were infection identified by bacterial culture and at least one episode of hyperglycemia after ICU admission. Propensity score matching (PSM) was used to balance baseline characteristics. The difference in cumulative mortality rate between these treated with and without glucocorticoids was assessed by Kaplan–Meier curve with log-rank test. Independent risk factors for endpoints were identified by Cox or Logistic regression analysis. Results: A total of 1528 patients were enrolled, and one-sixth of these patients received short-term systemic therapy of glucocorticoids during hospitalization. These conditions, including rapid heart rate, the presence of rheumatic disease, chronic pulmonary disease and septic shock, high lactate level, the requirements of mechanical ventilation and continuous renal replacement therapy, were associated with an increase in glucocorticoid administration (all P ≤ 0.024). During a follow-up of 90 days, the cumulative mortality rate in patients treated with glucocorticoids was significantly higher than that in these untreated with glucocorticoids (log-rank test, P < 0.001). Multivariable Cox regression analysis showed that glucocorticoid use (hazard ratio 1.48, 95% confidence interval [CI] 1.22–1.81; P < 0.001) was independently associated with an increased risk for 90-day all-cause mortality. This result was consistent irrespective of age, gender, the presence of myocardial infarction, acute decompensated heart failure and septic shock, and inotrope therapy, but was more evident in low-risk patients as assessed by ICU scoring systems. Additionally, multivariable Logistic regression analysis showed that glucocorticoid exposure was an independent predictor of hyperglycemia (odds ratio 2.14, 95% CI 1.48–3.10; P < 0.001), but not infection (odds ratio 1.23, 95% CI 0.88–1.73; P = 0.221). After PSM, glucocorticoid therapy was also significantly related with increased risks of 90-day mortality and hyperglycemia. Conclusions: Real-world data showed that short-term systemic use of glucocorticoids was common in CS patients. Importantly, these prescriptions were associated with increased risks of adverse events. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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