Association between short-term systemic use of glucocorticoids and prognosis of cardiogenic shock: a retrospective analysis

作者全名："Fan, Hua-Ping; Zhou, Yan; Zhou, Yu; Jin, Jun; Hu, Tian-Yang"

作者地址："[Fan, Hua-Ping; Zhou, Yu] 63650 Mil Hosp, Dept Cardiol, Urumqi 841700, Xinjiang, Peoples R China; [Zhou, Yan] First Peoples Hosp Ziyang, Dept Ophthalmol, Ziyang 641300, Sichuan, Peoples R China; [Jin, Jun] Army Med Univ, Xinqiao Hosp, Inst Cardiovasc Dis, Chongqing 400038, Peoples R China; [Hu, Tian-Yang] Chongqing Med Univ, Precis Med Ctr, Affiliated Hosp 2, 74 Linjiang Rd, Chongqing 400010, Peoples R China"

通信作者："Hu, TY (通讯作者)，Chongqing Med Univ, Precis Med Ctr, Affiliated Hosp 2, 74 Linjiang Rd, Chongqing 400010, Peoples R China."

来源：BMC ANESTHESIOLOGY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000990699400001

JCR分区：Q2

影响因子：2.3

年份：2023

卷号：23

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Cardiogenic shock; Glucocorticoids; Adverse effects; Epidemiology; MIMIC-IV database

摘要："ObjectiveTo 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.MethodsWe 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.ResultsA 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.ConclusionsReal-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."

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