基于MIMIC-Ⅳ数据库分析PPIs与AECOPD患者预后相关性的回顾性队列研究

Correlation analysis between PPIs and prognosis of AECOPD patientsbased on MIMIC-Ⅳdatabase:a retrospective cohort study

目的探讨质子泵抑制剂(PPIs)的使用与慢性阻塞性肺疾病急性加重期(AECOPD)患者短期、长期预后关系。方法回顾性收集MIMIC-Ⅳ数据库中2008年1月—2019年12月入住重症监护病房(ICU)的AECOPD患者临床资料。根据在ICU治疗期间是否使用PPIs,将患者分别纳入PPIs组和非PPIs组。比较2组患者一般情况,并使用Kaplan-Meier法绘制生存曲线,分别比较2组在28 d、90 d生存率的差异。采用Cox比例风险回归模型分析PPIs使用情况与患者28 d、90 d死亡风险的关联。结果共纳入447例患者,其中PPIs组358例,非PPIs组89例。PPIs组28 d死亡率、90 d死亡率分别为15.64%、23.46%,均低于非PPIs组的31.46%、40.45%(P<0.05)。Kaplan-Meier曲线分析结果显示,PPIs组28 d、90 d生存率均高于非PPIs组(P<0.001)。Cox比例风险回归模型分析结果表明,在校正所有纳入变量后,与非PPIs组比较,PPIs组28 d、90 d死亡风险比分别为0.58[95%CI(0.35,0.94),P=0.030]、0.63[95%CI(0.41,0.96),P=0.022]。结论AECOPD患者使用PPIs可能会降低其28 d、90 d死亡风险。

Objective To explore the relationship between the use of proton pump inhibitors(PPIs)and the short-term and long-term prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Clinical data of AECOPD patients admitted to the intensive care unit(ICU)from January 2008 to December 2019 were extracted from the MIMIC-Ⅳdatabase.Patients were divided into PPIs group and non PPIs group based on whether PPIs were used during ICU treatment.Compare the general conditions of two groups of patients and plot survival curves using Kaplan-Meier method to compare the differences in survival rates between the two groups at 28 d and 90 d,respectively.Cox proportional hazards regression was used to analyze the association between PPIs usage and 28 d and 90 d mortality risk in two groups of patients.Results A total of 447 patients were included,including 358 in the PPIs group and 89 in the non PPIs group.The 28 d mortality rate and 90 d mortality rate of the PPIs group were 15.64%and 23.46%,respectively,which were lower than those of the non PPIs group(31.46%and 40.45%,respectively)(P<0.05).The Kaplan-Meier curve analysis showed that the 28 d and 90 d survival rates of the PPIs group were higher than those in the non PPIs group(P<0.001).The Cox proportional hazards regression analysis showed that after adjusting for all included variables,the hazard ratio(HR)for 28 d and 90 d mortality in the PPIs group were 0.58(95%CI 0.35 to 0.94,P=0.030),0.63(95%CI 0.41 to 0.96,P=0.022),respectively,compared to the non PPIs group.Conclusion In AECOPD patients,the use of PPIs may be reduce the 28 d and 90 d mortality risks.