Acute kidney injury (AKI) is a frequent and prognostically relevant complication in infarct-related cardiogenic shock (CS). Although sex differences in cardiovascular outcomes are increasingly recognized, their role in AKI incidence and prognosis in CS remains unclear.
Objectives
To assess sex-specific differences in the incidence, severity, and prognostic impact of AKI in patients with infarct-related CS.
Methods
We retrospectively analyzed 369 consecutive patients with infarct-related CS enrolled in a prospective registry between 2015 and 2020. AKI was classified using KDIGO criteria. Baseline characteristics, treatment exposure, renal replacement therapy (RRT), and in-hospital mortality were compared between women and men. Multivariable logistic regression identified independent predictors of AKI and mortality.
Results
AKI occurred in 158 patients (42.8 %). Women had a higher crude incidence than men (48.4 % vs. 39.7 %, p = 0.045) and a trend toward more severe AKI (stage 3: 43.3 % vs. 30.6 %, p = 0.061). After adjustment, female sex was not an independent predictor of AKI (adjusted OR 1.36, 95 % CI 0.84–2.21; p = 0.217). Among patients with AKI, women showed higher in-hospital mortality (74.6 % vs. 55.3 %, p = 0.018), and female sex remained independently associated with mortality (adjusted OR 1.81, 95 % CI 1.01–3.28; p = 0.047). Rates of RRT did not differ by sex. Sensitivity analyses confirmed the robustness of these findings.
Conclusion
Women with infarct-related CS experienced a higher crude incidence and severity of AKI, although sex was not an independent predictor after adjustment. In contrast, female sex independently predicted mortality among patients with AKI. These results indicate sex-specific vulnerability of the cardiorenal axis and highlight the need for closer renal monitoring and tailored management strategies in women with CS.
背景：急性肾损伤（AKI）是梗死相关性心源性休克（CS）中一种常见且与预后相关的并发症。尽管越来越多的人认识到心血管结局的性别差异，但它们在CS中AKI发病率和预后中的作用仍不清楚。目的评估梗死相关性CS患者AKI发生率、严重程度和预后影响的性别差异。方法回顾性分析了2015年至2020年前瞻性登记的369例连续梗死相关CS患者。AKI采用KDIGO标准进行分类。基线特征、治疗暴露、肾脏替代治疗（RRT）和住院死亡率在女性和男性之间进行比较。多变量logistic回归确定了AKI和死亡率的独立预测因子。结果158例（42.8%）患者发生aki。女性的原始发生率高于男性（48.4%比39.7%,p = 0.045），并且有更严重AKI的趋势（3期：43.3%比30.6%,p = 0.061）。调整后，女性性别不是AKI的独立预测因子（调整后OR 1.36, 95% CI 0.84-2.21; p = 0.217）。在AKI患者中，女性显示出更高的住院死亡率（74.6%对55.3%,p = 0.018），女性仍然与死亡率独立相关（调整OR 1.81, 95% CI 1.01-3.28; p = 0.047）。RRT的比率没有性别差异。敏感性分析证实了这些发现的稳健性。结论：尽管性别不是调整后的独立预测因素，但梗死相关CS的女性AKI的粗发生率和严重程度更高。相反，女性性别独立预测AKI患者的死亡率。这些结果表明心肾轴的性别特异性易感性，并强调需要对CS女性进行更密切的肾脏监测和量身定制的管理策略。
{"title":"Cardiogenic shock complicated by acute kidney injury: Sex-specific differences and prognostic impact","authors":"Priyanka Boettger MD , Henriette Preusse-Sondermann MD , Jamschid Sedighi MD , Jannik Jobst MD , Hassan Hassan MD , Utku Bayram MD , Jakob Lorenz MD , Birgit Assmus MD , Bernhard Unsoeld MD , Matthias Janusch MD , Henning Lemm MD , Samuel Sossalla MD , Michael Buerke MD","doi":"10.1016/j.hrtlng.2025.102717","DOIUrl":"10.1016/j.hrtlng.2025.102717","url":null,"abstract":"<div><h3>Background</h3><div>Acute kidney injury (AKI) is a frequent and prognostically relevant complication in infarct-related cardiogenic shock (CS). Although sex differences in cardiovascular outcomes are increasingly recognized, their role in AKI incidence and prognosis in CS remains unclear.</div></div><div><h3>Objectives</h3><div>To assess sex-specific differences in the incidence, severity, and prognostic impact of AKI in patients with infarct-related CS.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 369 consecutive patients with infarct-related CS enrolled in a prospective registry between 2015 and 2020. AKI was classified using KDIGO criteria. Baseline characteristics, treatment exposure, renal replacement therapy (RRT), and in-hospital mortality were compared between women and men. Multivariable logistic regression identified independent predictors of AKI and mortality.</div></div><div><h3>Results</h3><div>AKI occurred in 158 patients (42.8 %). Women had a higher crude incidence than men (48.4 % vs. 39.7 %, <em>p</em> = 0.045) and a trend toward more severe AKI (stage 3: 43.3 % vs. 30.6 %, <em>p</em> = 0.061). After adjustment, female sex was not an independent predictor of AKI (adjusted OR 1.36, 95 % CI 0.84–2.21; <em>p</em> = 0.217). Among patients with AKI, women showed higher in-hospital mortality (74.6 % vs. 55.3 %, <em>p</em> = 0.018), and female sex remained independently associated with mortality (adjusted OR 1.81, 95 % CI 1.01–3.28; <em>p</em> = 0.047). Rates of RRT did not differ by sex. Sensitivity analyses confirmed the robustness of these findings.</div></div><div><h3>Conclusion</h3><div>Women with infarct-related CS experienced a higher crude incidence and severity of AKI, although sex was not an independent predictor after adjustment. In contrast, female sex independently predicted mortality among patients with AKI. These results indicate sex-specific vulnerability of the cardiorenal axis and highlight the need for closer renal monitoring and tailored management strategies in women with CS.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102717"},"PeriodicalIF":2.6,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1016/j.hrtlng.2025.102713
Fei Yu , Kunyi Wang , Shiqiang Wang
Background
Respiratory symptoms and diseases often co-occur and may increase mortality risk.
Objective
This study aims to identify patterns of respiratory multimorbidity and assess their links with mortality.
Methods
We conducted a prospective cohort study using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2011, linked to mortality records through 2019. Participants aged ≥40 years were classified using latent class analysis based on respiratory symptoms, diseases, and spirometry patterns. Cox models were used to estimate the relationship between respiratory clusters and all-cause and respiratory mortality.
Results
Five clusters were identified. Compared with the minimal-symptom group (Cluster 4), the severe obstructive cluster (Cluster 5) had the highest risk of all-cause mortality (HR=1.355, 95% CI: 1.040–1.767) and respiratory mortality (HR=12.956, 95% CI: 4.870–34.465). The chronic cough-phlegm cluster (Cluster 1) also showed elevated risks for all-cause (HR=1.297, 95% CI: 1.001–1.680) and respiratory mortality (HR=4.605, 95% CI: 1.468–14.441). The restrictive lung cluster (Cluster 3) was associated with higher all-cause mortality (HR=1.295, 95% CI: 1.055–1.589), especially among participants with cardiovascular disease (HR=2.013, 95% CI: 1.346–3.010). No significant associations were found for the asthma-wheezing cluster (Cluster 2) after full adjustment.
Conclusion
Individuals with severe airflow obstruction or chronic cough and phlegm have the highest risk of death. Restrictive lung patterns also predict higher mortality, particularly when combined with cardiovascular disease. Early identification and integrated care are crucial for respiratory multimorbidity.
{"title":"Comorbidity patterns of respiratory symptoms and diseases and their impact on all-cause and respiratory mortality: Prospective cohort study","authors":"Fei Yu , Kunyi Wang , Shiqiang Wang","doi":"10.1016/j.hrtlng.2025.102713","DOIUrl":"10.1016/j.hrtlng.2025.102713","url":null,"abstract":"<div><h3>Background</h3><div>Respiratory symptoms and diseases often co-occur and may increase mortality risk.</div></div><div><h3>Objective</h3><div>This study aims to identify patterns of respiratory multimorbidity and assess their links with mortality.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2011, linked to mortality records through 2019. Participants aged ≥40 years were classified using latent class analysis based on respiratory symptoms, diseases, and spirometry patterns. Cox models were used to estimate the relationship between respiratory clusters and all-cause and respiratory mortality.</div></div><div><h3>Results</h3><div>Five clusters were identified. Compared with the minimal-symptom group (Cluster 4), the severe obstructive cluster (Cluster 5) had the highest risk of all-cause mortality (HR=1.355, 95% CI: 1.040–1.767) and respiratory mortality (HR=12.956, 95% CI: 4.870–34.465). The chronic cough-phlegm cluster (Cluster 1) also showed elevated risks for all-cause (HR=1.297, 95% CI: 1.001–1.680) and respiratory mortality (HR=4.605, 95% CI: 1.468–14.441). The restrictive lung cluster (Cluster 3) was associated with higher all-cause mortality (HR=1.295, 95% CI: 1.055–1.589), especially among participants with cardiovascular disease (HR=2.013, 95% CI: 1.346–3.010). No significant associations were found for the asthma-wheezing cluster (Cluster 2) after full adjustment.</div></div><div><h3>Conclusion</h3><div>Individuals with severe airflow obstruction or chronic cough and phlegm have the highest risk of death. Restrictive lung patterns also predict higher mortality, particularly when combined with cardiovascular disease. Early identification and integrated care are crucial for respiratory multimorbidity.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102713"},"PeriodicalIF":2.6,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Supplemental oxygen therapy has been traditionally used in acute myocardial infarction (AMI) management, but recent trials have questioned its routine use in people with normal oxygen saturation. However, critically ill patients were typically excluded, leaving an evidence gap for high-risk populations.
Objectives
To evaluate the association between early supplemental oxygen therapy and long-term mortality in ICU patients with AMI and normal oxygen saturation.
Methods
This retrospective cohort study analyzed data from the MIMIC-IV database (Boston, USA; 2008–2022). Adults with AMI and initial oxygen saturation of 92 % - 96 % within 6 h of ICU admission were included. The exposure was early supplemental oxygen therapy (FiO2 > 0.21) within 6 h post-admission. The primary outcome was 365-day all-cause mortality. Propensity score matching (1:1) and multivariable Cox regression adjusting for admission year were used to control for temporal confounders.
Results
Among 1912 eligible patients, 838 were matched (419 per group). Early supplemental oxygen therapy was independently associated with increased 365-day mortality (29.83 % vs 21.72 %; adjusted HR 1.477, 95 % CI 1.116 - 1.954; P = 0.006). Consistent harmful associations were observed for 28-day mortality, ICU mortality, and hospital mortality. People with chronic obstructive pulmonary disease were particularly vulnerable to hyperoxia.
Conclusions
Early supplemental oxygen therapy in ICU patients with AMI and normal oxygen saturation was independently associated with increased mortality. These findings support a shift from routine use toward individualized oxygen therapy reserved for patients with documented hypoxemia.
辅助氧治疗传统上用于急性心肌梗死（AMI）的治疗，但最近的试验对其在血氧饱和度正常人群中的常规应用提出了质疑。然而，危重病人通常被排除在外，给高危人群留下了证据空白。目的探讨血氧饱和度正常的急性心肌梗死ICU患者早期补氧治疗与长期死亡率的关系。方法本回顾性队列研究分析来自MIMIC-IV数据库（Boston， USA; 2008-2022）的数据。纳入AMI患者，入院后6小时内初始血氧饱和度为92% - 96%。暴露于入院后6小时内早期补充氧治疗（FiO2 > 0.21）。主要终点为365天全因死亡率。采用倾向评分匹配（1:1）和多变量Cox回归校正入院年份来控制时间混杂因素。结果1912例符合条件的患者中，匹配838例（每组419例）。早期补充氧治疗与365天死亡率增加独立相关（29.83% vs 21.72%；调整后HR 1.477, 95% CI 1.116 - 1.954; P = 0.006）。在28天死亡率、ICU死亡率和住院死亡率中观察到一致的有害关联。患有慢性阻塞性肺病的人特别容易受到高氧的影响。结论血氧饱和度正常的急性心肌梗死ICU患者早期补氧治疗与死亡率升高独立相关。这些发现支持从常规使用向个体化氧治疗的转变，为记录在案的低氧血症患者保留。
{"title":"Association of early supplemental oxygen therapy and long-term mortality after ICU admission in normoxic patients following myocardial infarction: A propensity matched cohort study","authors":"Yucheng Zhou , Yimeng Li , Dongxia Xu , Gangjun Zong","doi":"10.1016/j.hrtlng.2025.102718","DOIUrl":"10.1016/j.hrtlng.2025.102718","url":null,"abstract":"<div><h3>Background</h3><div>Supplemental oxygen therapy has been traditionally used in acute myocardial infarction (AMI) management, but recent trials have questioned its routine use in people with normal oxygen saturation. However, critically ill patients were typically excluded, leaving an evidence gap for high-risk populations.</div></div><div><h3>Objectives</h3><div>To evaluate the association between early supplemental oxygen therapy and long-term mortality in ICU patients with AMI and normal oxygen saturation.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed data from the MIMIC-IV database (Boston, USA; 2008–2022). Adults with AMI and initial oxygen saturation of 92 % - 96 % within 6 h of ICU admission were included. The exposure was early supplemental oxygen therapy (FiO<sub>2</sub> > 0.21) within 6 h post-admission. The primary outcome was 365-day all-cause mortality. Propensity score matching (1:1) and multivariable Cox regression adjusting for admission year were used to control for temporal confounders.</div></div><div><h3>Results</h3><div>Among 1912 eligible patients, 838 were matched (419 per group). Early supplemental oxygen therapy was independently associated with increased 365-day mortality (29.83 % vs 21.72 %; adjusted HR 1.477, 95 % CI 1.116 - 1.954; <em>P</em> = 0.006). Consistent harmful associations were observed for 28-day mortality, ICU mortality, and hospital mortality. People with chronic obstructive pulmonary disease were particularly vulnerable to hyperoxia.</div></div><div><h3>Conclusions</h3><div>Early supplemental oxygen therapy in ICU patients with AMI and normal oxygen saturation was independently associated with increased mortality. These findings support a shift from routine use toward individualized oxygen therapy reserved for patients with documented hypoxemia.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102718"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-31DOI: 10.1016/j.hrtlng.2025.102699
Najim Z. Alshahrani , Ahmed Khaled Shukri , Mohannad A. Alzain , Yusuff Adebayo Adebisi
<div><h3>Background</h3><div>Adults with cardiometabolic conditions are at high risk of smoking-related morbidity and mortality. However, little is known about patterns and predictors of e-cigarette use in this population.</div></div><div><h3>Objectives</h3><div>The study therefore aims to examine the prevalence and predictors of current e-cigarette use among adults with cardiometabolic conditions.</div></div><div><h3>Methods</h3><div>We analysed data from 6633 adults with cardiometabolic conditions who participated in the 2017, 2018, 2019, and 2021 waves of the Scottish Health Survey. For this study, cardiometabolic conditions were defined broadly to include diabetes, high blood pressure, angina, heart attack, and stroke, as well as other physician-diagnosed cardiovascular conditions (irregular heart rhythm, heart murmur, and other heart conditions). Current e-cigarette use was defined as self-reported present use of an e-cigarette or vaping device. Firth penalised multivariable logistic regression was used to examine sociodemographic, behavioural, and health related predictors of e-cigarette use, reporting adjusted odds ratios (AORs), 95 % confidence intervals (CIs), and p values.</div></div><div><h3>Results</h3><div>Overall, 5.2 % (95 % CI: 4.6–5.8) of adults with cardiometabolic conditions were current e-cigarette users, with prevalence ranging from 4.6 % (95 % CI: 4.0–5.2) among those with high blood pressure to 8.0 % (95 % CI: 6.1–10.5) among stroke survivors. E-cigarette use was more common in younger adults. Compared with those aged 16–24 years, adults aged 25–34 years (AOR 0.39, 95 % CI: 0.18–0.87, <em>p</em> = 0.021) and those aged 75+ years (AOR 0.05, 95 % CI: 0.02–0.12, <em>p</em> < 0.001) had lower odds of current e-cigarette use. Compared with never smokers, odds were substantially higher among current smokers (AOR 31.27, 95 % CI: 13.19–74.14, <em>p</em> < 0.001) and ex-smokers (AOR 39.65, 95 % CI: 18.06–87.06, <em>p</em> < 0.001). Reporting a desire to quit smoking was associated with higher odds of e-cigarette use compared with not wanting to quit or not smoking (AOR 2.12, 95 % CI: 1.38–3.25, <em>p</em> = 0.001). Higher odds were also observed among individuals with no educational qualifications (AOR 1.75, 95 % CI: 1.18–2.59, <em>p</em> = 0.005) and those reporting poor general health (AOR 1.36, 95 % CI: 1.04–1.77, <em>p</em> = 0.023). Sex, ethnicity, deprivation, psychological distress, and alcohol consumption were not significantly associated with use in the adjusted model.</div></div><div><h3>Conclusions</h3><div>Among adults with cardiometabolic conditions, e-cigarette use was more common among younger adults, current smokers, ex-smokers, those who wanted to quit smoking, individuals with lower educational attainment, and those reporting poorer health. These findings suggest the need for clinicians managing patients with cardiometabolic conditions to address e-cigarette use in the context of smoking cessation and seco
背景：患有心脏代谢疾病的成年人与吸烟相关的发病率和死亡率较高。然而，人们对这一人群使用电子烟的模式和预测因素知之甚少。因此，该研究旨在研究患有心脏代谢疾病的成年人中当前电子烟使用的患病率和预测因素。方法：我们分析了6633名患有心脏代谢疾病的成年人的数据，他们参加了2017年、2018年、2019年和2021年的苏格兰健康调查。在这项研究中，心脏代谢疾病被广泛地定义为包括糖尿病、高血压、心绞痛、心脏病发作和中风，以及其他医生诊断的心血管疾病（心律不规则、心脏杂音和其他心脏疾病）。当前电子烟使用被定义为自我报告当前使用电子烟或电子烟设备。Firth惩罚多变量逻辑回归用于检查电子烟使用的社会人口学、行为和健康相关预测因素，报告调整优势比（AORs）、95%置信区间（ci）和p值。总体而言，5.2% （95% CI: 4.6 - 5.8）患有心脏代谢疾病的成年人目前使用电子烟，高血压患者的患病率为4.6% (95% CI: 4.0-5.2)，中风幸存者的患病率为8.0% （95% CI: 6.1-10.5）。电子烟的使用在年轻人中更为常见。与16-24岁的成年人相比，25-34岁的成年人（AOR 0.39, 95% CI: 0.18-0.87, p = 0.021）和75岁以上的成年人（AOR 0.05, 95% CI: 0.02-0.12, p < 0.001）目前使用电子烟的几率较低。与从不吸烟者相比，当前吸烟者（AOR 31.27, 95% CI: 13.19-74.14, p < 0.001）和戒烟者（AOR 39.65, 95% CI: 18.06-87.06, p < 0.001）的患病几率明显更高。与不想戒烟或不吸烟的人相比，报告希望戒烟的人使用电子烟的几率更高（AOR 2.12, 95% CI: 1.38-3.25, p = 0.001）。在没有学历的个体（AOR 1.75, 95% CI: 1.18-2.59, p = 0.005）和总体健康状况较差的个体（AOR 1.36, 95% CI: 1.04-1.77, p = 0.023）中也观察到较高的几率。在调整后的模型中，性别、种族、贫困、心理困扰和饮酒与使用没有显著相关。结论：在患有心脏代谢疾病的成年人中，电子烟的使用在年轻人、当前吸烟者、戒烟者、想戒烟者、受教育程度较低的人以及健康状况较差的人中更为常见。这些研究结果表明，临床医生需要管理患有心脏代谢疾病的患者，以解决戒烟和二级预防背景下的电子烟使用问题。
{"title":"E-cigarette use among adults with cardiometabolic conditions","authors":"Najim Z. Alshahrani , Ahmed Khaled Shukri , Mohannad A. Alzain , Yusuff Adebayo Adebisi","doi":"10.1016/j.hrtlng.2025.102699","DOIUrl":"10.1016/j.hrtlng.2025.102699","url":null,"abstract":"<div><h3>Background</h3><div>Adults with cardiometabolic conditions are at high risk of smoking-related morbidity and mortality. However, little is known about patterns and predictors of e-cigarette use in this population.</div></div><div><h3>Objectives</h3><div>The study therefore aims to examine the prevalence and predictors of current e-cigarette use among adults with cardiometabolic conditions.</div></div><div><h3>Methods</h3><div>We analysed data from 6633 adults with cardiometabolic conditions who participated in the 2017, 2018, 2019, and 2021 waves of the Scottish Health Survey. For this study, cardiometabolic conditions were defined broadly to include diabetes, high blood pressure, angina, heart attack, and stroke, as well as other physician-diagnosed cardiovascular conditions (irregular heart rhythm, heart murmur, and other heart conditions). Current e-cigarette use was defined as self-reported present use of an e-cigarette or vaping device. Firth penalised multivariable logistic regression was used to examine sociodemographic, behavioural, and health related predictors of e-cigarette use, reporting adjusted odds ratios (AORs), 95 % confidence intervals (CIs), and p values.</div></div><div><h3>Results</h3><div>Overall, 5.2 % (95 % CI: 4.6–5.8) of adults with cardiometabolic conditions were current e-cigarette users, with prevalence ranging from 4.6 % (95 % CI: 4.0–5.2) among those with high blood pressure to 8.0 % (95 % CI: 6.1–10.5) among stroke survivors. E-cigarette use was more common in younger adults. Compared with those aged 16–24 years, adults aged 25–34 years (AOR 0.39, 95 % CI: 0.18–0.87, <em>p</em> = 0.021) and those aged 75+ years (AOR 0.05, 95 % CI: 0.02–0.12, <em>p</em> < 0.001) had lower odds of current e-cigarette use. Compared with never smokers, odds were substantially higher among current smokers (AOR 31.27, 95 % CI: 13.19–74.14, <em>p</em> < 0.001) and ex-smokers (AOR 39.65, 95 % CI: 18.06–87.06, <em>p</em> < 0.001). Reporting a desire to quit smoking was associated with higher odds of e-cigarette use compared with not wanting to quit or not smoking (AOR 2.12, 95 % CI: 1.38–3.25, <em>p</em> = 0.001). Higher odds were also observed among individuals with no educational qualifications (AOR 1.75, 95 % CI: 1.18–2.59, <em>p</em> = 0.005) and those reporting poor general health (AOR 1.36, 95 % CI: 1.04–1.77, <em>p</em> = 0.023). Sex, ethnicity, deprivation, psychological distress, and alcohol consumption were not significantly associated with use in the adjusted model.</div></div><div><h3>Conclusions</h3><div>Among adults with cardiometabolic conditions, e-cigarette use was more common among younger adults, current smokers, ex-smokers, those who wanted to quit smoking, individuals with lower educational attainment, and those reporting poorer health. These findings suggest the need for clinicians managing patients with cardiometabolic conditions to address e-cigarette use in the context of smoking cessation and seco","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102699"},"PeriodicalIF":2.6,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-31DOI: 10.1016/j.hrtlng.2025.102698
Kangjoon Kim, Daegeun Lee, Eunhye Bae, Jin-Young Huh, So-Young Park, Jae Chol Choi
Background
Dexmedetomidine (DEX) is widely used for sedation in critically ill adults, but its association with mortality remains unclear. Prior trial data suggest that this association may differ by age.
Methods
We conducted a retrospective cohort study of mechanically ventilated adults admitted to the intensive care units (ICUs) of a university-affiliated hospital in South Korea between March 2022 and September 2023. Patients were grouped by DEX use during ICU stay. To reduce confounding, inverse probability of treatment weighting was applied using a propensity score model. The primary outcome was 28-day mortality; the secondary outcome was ICU length of stay among survivors. Outcomes were analyzed using weighted logistic regression. Subgroup analyses were stratified by age (<65 vs ≥65 years), and interaction terms were tested.
Results
Among 245 patients, 124 received DEX. In patients aged <65 years, DEX use was associated with lower 28-day mortality (odds ratio [OR], 0.27; 95% CI, 0.12–0.54; p < 0.001). No significant association was observed in those aged ≥65 years (OR, 0.72; 95% CI, 0.44–1.17; p = 0.182). An interaction between age group (<65 vs ≥65 years) and DEX use was significant (OR, 2.71; 95% CI, 1.13–6.72; p = 0.028). Among survivors aged ≥65 years, DEX use was associated with longer ICU stay (+5.36 days; 95% CI, 1.04–9.68; p = 0.017).
Conclusions
In this observational cohort, DEX use was associated with lower 28-day mortality among younger critically ill adults but not among older patients. These findings require confirmation in larger multicenter studies.
右美托咪定（DEX）被广泛用于危重成人的镇静，但其与死亡率的关系尚不清楚。先前的试验数据表明，这种关联可能因年龄而异。方法对2022年3月至2023年9月在韩国某大学附属医院重症监护病房（icu）入住的机械通气成人进行回顾性队列研究。根据患者在ICU期间使用DEX进行分组。为了减少混淆，使用倾向评分模型应用处理加权的逆概率。主要终点为28天死亡率；次要结局是幸存者在ICU的住院时间。结果分析采用加权逻辑回归。亚组分析按年龄（65岁vs≥65岁）分层，并检验相互作用项。结果245例患者中，124例接受了DEX治疗。在65岁的患者中，使用DEX与较低的28天死亡率相关（优势比[OR]， 0.27; 95% CI, 0.12-0.54; p < 0.001）。≥65岁患者无显著相关性（OR, 0.72; 95% CI, 0.44-1.17; p = 0.182）。年龄组（65岁vs≥65岁）和DEX使用之间的相互作用是显著的（OR, 2.71; 95% CI, 1.13-6.72; p = 0.028）。在年龄≥65岁的幸存者中，使用DEX与ICU住院时间延长相关（+5.36天；95% CI, 1.04-9.68; p = 0.017）。结论：在这个观察性队列中，在年轻危重患者中使用DEX与较低的28天死亡率相关，但与老年患者无关。这些发现需要在更大规模的多中心研究中得到证实。
{"title":"Age modifies the effect of dexmedetomidine on 28-day mortality in mechanically ventilated critically ill adults: A propensity score–weighted cohort study","authors":"Kangjoon Kim, Daegeun Lee, Eunhye Bae, Jin-Young Huh, So-Young Park, Jae Chol Choi","doi":"10.1016/j.hrtlng.2025.102698","DOIUrl":"10.1016/j.hrtlng.2025.102698","url":null,"abstract":"<div><h3>Background</h3><div>Dexmedetomidine (DEX) is widely used for sedation in critically ill adults, but its association with mortality remains unclear. Prior trial data suggest that this association may differ by age.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of mechanically ventilated adults admitted to the intensive care units (ICUs) of a university-affiliated hospital in South Korea between March 2022 and September 2023. Patients were grouped by DEX use during ICU stay. To reduce confounding, inverse probability of treatment weighting was applied using a propensity score model. The primary outcome was 28-day mortality; the secondary outcome was ICU length of stay among survivors. Outcomes were analyzed using weighted logistic regression. Subgroup analyses were stratified by age (<65 vs ≥65 years), and interaction terms were tested.</div></div><div><h3>Results</h3><div>Among 245 patients, 124 received DEX. In patients aged <65 years, DEX use was associated with lower 28-day mortality (odds ratio [OR], 0.27; 95% CI, 0.12–0.54; <em>p</em> < 0.001). No significant association was observed in those aged ≥65 years (OR, 0.72; 95% CI, 0.44–1.17; <em>p</em> = 0.182). An interaction between age group (<65 vs ≥65 years) and DEX use was significant (OR, 2.71; 95% CI, 1.13–6.72; <em>p</em> = 0.028). Among survivors aged ≥65 years, DEX use was associated with longer ICU stay (+5.36 days; 95% CI, 1.04–9.68; <em>p</em> = 0.017).</div></div><div><h3>Conclusions</h3><div>In this observational cohort, DEX use was associated with lower 28-day mortality among younger critically ill adults but not among older patients. These findings require confirmation in larger multicenter studies.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102698"},"PeriodicalIF":2.6,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-31DOI: 10.1016/j.hrtlng.2025.102707
Necibe Dagcan Sahin PhD, RN , Burcu Nal PhD, RN , Mehmet Ali Astarcioglu MD
Background
Pain and anxiety are common issues experienced by patients after coronary angiography, often negatively impacting recovery and causing changes in vital signs.
Objective
This study aimed to compare the effects of reflexology and classical hand massage on pain, anxiety, and vital signs in patients after coronary angiography.
Methods
It was designed as a single-blind randomized controlled trial with 70 patients who underwent coronary angiography in a hospital. Patients were randomly assigned into two groups via block randomization: reflexology hand massage (n = 35) and classical hand massage (n = 35). Data were collected using the Patient Information Form, State Anxiety Inventory, Visual Analog Scale, and Vital Signs Form. Both massages were applied to both hands for 20 min after angiography. Measurements were taken before the intervention and at 30, 60, and 120 min afterward.
Results
In the reflexology group, a significantly greater reduction was found in pain (effect size=0.926) and anxiety (effect size=0.680) compared to the classical massage group (p < .05). Systolic blood pressure decreased significantly in both groups (reflexology: 0.971; classical: 0.986), while diastolic pressure dropped significantly only in the reflexology group (effect size = -1.019). A significant reduction in pulse rate was also noted only in the reflexology group (effect size=0.985). No significant change was observed in respiratory rate; however, oxygen saturation increased significantly in the reflexology group (effect size=0.998).
Conclusions
Reflexology was more effective than classical hand massage in reducing pain, anxiety, and certain vital signs after coronary angiography.
{"title":"Comparison of the effects of reflexology and classical hand massage on pain, anxiety, and vital signs in patients after coronary angiography: A randomized controlled trial","authors":"Necibe Dagcan Sahin PhD, RN , Burcu Nal PhD, RN , Mehmet Ali Astarcioglu MD","doi":"10.1016/j.hrtlng.2025.102707","DOIUrl":"10.1016/j.hrtlng.2025.102707","url":null,"abstract":"<div><h3>Background</h3><div>Pain and anxiety are common issues experienced by patients after coronary angiography, often negatively impacting recovery and causing changes in vital signs.</div></div><div><h3>Objective</h3><div>This study aimed to compare the effects of reflexology and classical hand massage on pain, anxiety, and vital signs in patients after coronary angiography.</div></div><div><h3>Methods</h3><div>It was designed as a single-blind randomized controlled trial with 70 patients who underwent coronary angiography in a hospital. Patients were randomly assigned into two groups via block randomization: reflexology hand massage (<em>n</em> = 35) and classical hand massage (<em>n</em> = 35). Data were collected using the Patient Information Form, State Anxiety Inventory, Visual Analog Scale, and Vital Signs Form. Both massages were applied to both hands for 20 min after angiography. Measurements were taken before the intervention and at 30, 60, and 120 min afterward.</div></div><div><h3>Results</h3><div>In the reflexology group, a significantly greater reduction was found in pain (effect size=0.926) and anxiety (effect size=0.680) compared to the classical massage group (<em>p</em> < .05). Systolic blood pressure decreased significantly in both groups (reflexology: 0.971; classical: 0.986), while diastolic pressure dropped significantly only in the reflexology group (effect size = -1.019). A significant reduction in pulse rate was also noted only in the reflexology group (effect size=0.985). No significant change was observed in respiratory rate; however, oxygen saturation increased significantly in the reflexology group (effect size=0.998).</div></div><div><h3>Conclusions</h3><div>Reflexology was more effective than classical hand massage in reducing pain, anxiety, and certain vital signs after coronary angiography.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102707"},"PeriodicalIF":2.6,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-31DOI: 10.1016/j.hrtlng.2025.102705
Xin-yi Zhou MS, RN , Yan-feng Wang MS, RN , Yue-xin Huang BS, RN, Xiao-ge Liu BS, RN, Jia-hui Liu BS, RN, Zi-han Li BS, RN, Qiao-hong Yang PhD, RN
Background
Acute Myocardial Infarction (AMI) patients are experiencing an increasing incidence rate annually, coupled with substantial psychosocial adjustment challenges.
Objectives
The aim of this study was to analyze the longitudinal sequential mediating role of psychological flexibility and perceived stress between Type D personality and psychosocial adjustment in patients.
Methods
This study is a half-longitudinal panel design with a three-wave tracking survey. 212 young and middle-aged patients with first-time AMI from a Guangzhou hospital were conveniently sampled and followed at three time points: hospitalization (T1), 3 months (T2), and 6 months post-discharge (T3). Participants completed measures on Type D personality (DS-14), psychological flexibility (AAQ-II), perceived stress (PSS), and psychosocial adjustment (PAIS-SR). The data were used to construct a cross-lagged panel and a half-longitudinal sequential mediation model.
Results
30.66% of young and middle-aged patients with AMI exhibited Type D personality. These patients had clinically meaningfully poorer psychosocial adjustment at 6 months post-discharge (28.82±14.53) than non-Type D patients (22.76±11.73). At T1, Type D personality affected psychosocial adjustment at T3 through two serial mediation pathways: one through T2 psychological flexibility to T3 perceived stress (effect size = 0.051, accounting for 8.97% of the total effect) and another through T2 perceived stress to T3 psychological flexibility (effect size = 0.034, accounting for 5.27% of the total effect). Interventions targeting psychological flexibility and stress management may be of crucial importance for this group.
Conclusion
Among young and middle-aged AMI patients, the proportion of Type D personality is relatively high, and their psychosocial adjustment level is poorer.
{"title":"Association between Type D personality and psychosocial adjustment in AMI patients: Mediating role of psychological flexibility and perceived stress","authors":"Xin-yi Zhou MS, RN , Yan-feng Wang MS, RN , Yue-xin Huang BS, RN, Xiao-ge Liu BS, RN, Jia-hui Liu BS, RN, Zi-han Li BS, RN, Qiao-hong Yang PhD, RN","doi":"10.1016/j.hrtlng.2025.102705","DOIUrl":"10.1016/j.hrtlng.2025.102705","url":null,"abstract":"<div><h3>Background</h3><div>Acute Myocardial Infarction (AMI) patients are experiencing an increasing incidence rate annually, coupled with substantial psychosocial adjustment challenges.</div></div><div><h3>Objectives</h3><div>The aim of this study was to analyze the longitudinal sequential mediating role of psychological flexibility and perceived stress between Type D personality and psychosocial adjustment in patients.</div></div><div><h3>Methods</h3><div>This study is a half-longitudinal panel design with a three-wave tracking survey. 212 young and middle-aged patients with first-time AMI from a Guangzhou hospital were conveniently sampled and followed at three time points: hospitalization (T1), 3 months (T2), and 6 months post-discharge (T3). Participants completed measures on Type D personality (DS-14), psychological flexibility (AAQ-II), perceived stress (PSS), and psychosocial adjustment (PAIS-SR). The data were used to construct a cross-lagged panel and a half-longitudinal sequential mediation model.</div></div><div><h3>Results</h3><div>30.66% of young and middle-aged patients with AMI exhibited Type D personality. These patients had clinically meaningfully poorer psychosocial adjustment at 6 months post-discharge (28.82±14.53) than non-Type D patients (22.76±11.73). At T1, Type D personality affected psychosocial adjustment at T3 through two serial mediation pathways: one through T2 psychological flexibility to T3 perceived stress (effect size = 0.051, accounting for 8.97% of the total effect) and another through T2 perceived stress to T3 psychological flexibility (effect size = 0.034, accounting for 5.27% of the total effect). Interventions targeting psychological flexibility and stress management may be of crucial importance for this group.</div></div><div><h3>Conclusion</h3><div>Among young and middle-aged AMI patients, the proportion of Type D personality is relatively high, and their psychosocial adjustment level is poorer.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102705"},"PeriodicalIF":2.6,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-30DOI: 10.1016/j.hrtlng.2025.102694
Abdullah Al-Murad , Ibtesam Hilmi
Background
Infants recovering from congenital heart surgery risk complications such as low cardiac output syndrome (LCOS) and acute kidney injury (AKI). Although clinicians use the vasoactive–inotropic score (VIS) to assess cardiovascular support, relying only on the peak value (VIS-max) may overlook meaningful changes in vasoactive requirements during early recovery.
Objective
This study evaluated whether early VIS kinetics—captured through the area under the curve (VIS-AUC₀–₁₂h) and the rate of change (VIS-slope₀–₁₂h)—offer better prediction of LCOS and AKI compared with VIS-max.
Methods
We retrospectively reviewed 320 infants under 24 months undergoing congenital heart surgery with cardiopulmonary bypass. Vasoactive doses from the first 12 postoperative hours were used to calculate VIS-max, VIS-AUC, and VIS-slope. LCOS and AKI were defined using standardized criteria. Predictive performance was evaluated with multivariable logistic regression and cross-validated AUCs.
Results
Among 320 infants, 31.6% developed LCOS and 10.3% developed AKI. Infants with LCOS showed higher VIS-max, greater VIS-AUC₀–₁₂h, and steeper VIS-slope trajectories than those without LCOS. VIS kinetics provided modest but consistent improvement in LCOS prediction over VIS-max (AUC 0.760 vs 0.746), and decision-curve analysis indicated additional net clinical benefit. In contrast, VIS metrics showed limited discrimination for AKI.
Conclusions
Monitoring VIS trends during early postoperative hours offers a broader assessment of circulatory stress than relying solely on VIS-max. Early VIS kinetics may help identify infants at higher risk of LCOS and support closer hemodynamic surveillance, while their limited value for AKI suggests a need for additional renal risk markers.
{"title":"Early vasoactive–inotropic score kinetics predict low cardiac output syndrome and acute kidney injury after infant cardiac surgery: a retrospective cohort study","authors":"Abdullah Al-Murad , Ibtesam Hilmi","doi":"10.1016/j.hrtlng.2025.102694","DOIUrl":"10.1016/j.hrtlng.2025.102694","url":null,"abstract":"<div><h3>Background</h3><div>Infants recovering from congenital heart surgery risk complications such as low cardiac output syndrome (LCOS) and acute kidney injury (AKI). Although clinicians use the vasoactive–inotropic score (VIS) to assess cardiovascular support, relying only on the peak value (VIS-max) may overlook meaningful changes in vasoactive requirements during early recovery.</div></div><div><h3>Objective</h3><div>This study evaluated whether early VIS kinetics—captured through the area under the curve (VIS-AUC₀–₁₂h) and the rate of change (VIS-slope₀–₁₂h)—offer better prediction of LCOS and AKI compared with VIS-max.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 320 infants under 24 months undergoing congenital heart surgery with cardiopulmonary bypass. Vasoactive doses from the first 12 postoperative hours were used to calculate VIS-max, VIS-AUC, and VIS-slope. LCOS and AKI were defined using standardized criteria. Predictive performance was evaluated with multivariable logistic regression and cross-validated AUCs.</div></div><div><h3>Results</h3><div>Among 320 infants, 31.6% developed LCOS and 10.3% developed AKI. Infants with LCOS showed higher VIS-max, greater VIS-AUC₀–₁₂h, and steeper VIS-slope trajectories than those without LCOS. VIS kinetics provided modest but consistent improvement in LCOS prediction over VIS-max (AUC 0.760 vs 0.746), and decision-curve analysis indicated additional net clinical benefit. In contrast, VIS metrics showed limited discrimination for AKI.</div></div><div><h3>Conclusions</h3><div>Monitoring VIS trends during early postoperative hours offers a broader assessment of circulatory stress than relying solely on VIS-max. Early VIS kinetics may help identify infants at higher risk of LCOS and support closer hemodynamic surveillance, while their limited value for AKI suggests a need for additional renal risk markers.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102694"},"PeriodicalIF":2.6,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-30DOI: 10.1016/j.hrtlng.2025.102697
Hong-Jae Choi , Hyeryn Park , Dongjoon Lee , Changhee Lee , Hack-Lyoung Kim
Background
Prognosis prediction for high-risk patients undergoing invasive coronary angiography (ICA) is crucial for clinical decision-making. Despite machine learning (ML) advancements, time-to-event survival prediction remains limited.
Objectives
This study developed an ensemble ML model based on survival analysis to predict long-term outcomes in ICA patients.
Methods
A total of 9517 ICA patients (2008–2020) were retrospectively analyzed. The primary outcome was all-cause mortality, with follow-up until December 31, 2021. Using 8 ML algorithms, we developed a model comprising 80 variables. Model performance was assessed using time-dependent C-index and Brier score, with variable importance analyzed using permutation-based and partial dependent plots.
Results
Survival Quilts model achieved the highest time-dependent C-index (0.920 at 30 days, 0.897 at 365 days), outperforming other ML algorithms. Time-dependent Brier scores generally increased, which remained stable. ICA-related characteristics had the greatest impact on mortality, while laboratory results, comorbidities, and patient characteristics gained influence over time. By day 365, patient characteristics and laboratory results became more prominent predictors. Among the domains, key variables included catheterization status, C-reactive protein, smoking, and chronic kidney disease.
Conclusion
Survival analysis-based ensemble ML models, such as Survival Quilts, improve survival prediction by capturing time-varying influences of key predictors, offering a foundation for more precise cardiovascular care.
{"title":"Development of a long-term survival prediction model for patients undergoing invasive coronary angiography using ensemble-based machine learning in time-to-event analysis","authors":"Hong-Jae Choi , Hyeryn Park , Dongjoon Lee , Changhee Lee , Hack-Lyoung Kim","doi":"10.1016/j.hrtlng.2025.102697","DOIUrl":"10.1016/j.hrtlng.2025.102697","url":null,"abstract":"<div><h3>Background</h3><div>Prognosis prediction for high-risk patients undergoing invasive coronary angiography (ICA) is crucial for clinical decision-making. Despite machine learning (ML) advancements, time-to-event survival prediction remains limited.</div></div><div><h3>Objectives</h3><div>This study developed an ensemble ML model based on survival analysis to predict long-term outcomes in ICA patients.</div></div><div><h3>Methods</h3><div>A total of 9517 ICA patients (2008–2020) were retrospectively analyzed. The primary outcome was all-cause mortality, with follow-up until December 31, 2021. Using 8 ML algorithms, we developed a model comprising 80 variables. Model performance was assessed using time-dependent C-index and Brier score, with variable importance analyzed using permutation-based and partial dependent plots.</div></div><div><h3>Results</h3><div>Survival Quilts model achieved the highest time-dependent C-index (0.920 at 30 days, 0.897 at 365 days), outperforming other ML algorithms. Time-dependent Brier scores generally increased, which remained stable. ICA-related characteristics had the greatest impact on mortality, while laboratory results, comorbidities, and patient characteristics gained influence over time. By day 365, patient characteristics and laboratory results became more prominent predictors. Among the domains, key variables included catheterization status, C-reactive protein, smoking, and chronic kidney disease.</div></div><div><h3>Conclusion</h3><div>Survival analysis-based ensemble ML models, such as Survival Quilts, improve survival prediction by capturing time-varying influences of key predictors, offering a foundation for more precise cardiovascular care.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102697"},"PeriodicalIF":2.6,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-30DOI: 10.1016/j.hrtlng.2025.102696
Jennifer Cortes , Kayla Cann , Gabriel Patarroyo - Aponte , Brandy McKelvy , Sophie Samuel
Background
Norepinephrine is the first-line vasopressor in septic shock, with vasopressin commonly added as a second-line agent. However, the optimal norepinephrine dose threshold for initiating vasopressin remains uncertain.
Objectives
To evaluate whether initiating vasopressin at lower norepinephrine doses (<20 µg/min) is associated with improved clinical outcomes compared with initiation at higher doses (≥20 µg/min) in adults with septic shock.
Methods
This retrospective observational cohort study included adult patients with septic shock who received norepinephrine followed by vasopressin at a tertiary academic center between 2017 and 2022. Patients were stratified by norepinephrine dose at vasopressin initiation: <20 µg/min (Low-dose) versus ≥20 µg/min (High-dose). The primary outcome was in-hospital mortality. Inverse probability of treatment weighting and Cox proportional hazards modeling were used for adjustment.
Results
Of 570 included patients, 343 received vasopressin at Low-dose norepinephrine and 227 at High-dose. Crude mortality was higher in the High-Dose group (64.3% vs 54.2%), with a relative risk of 0.84 (95% CI, 0.74–0.97; p = 0.017). After adjustment, vasopressin initiation at higher norepinephrine doses remained independently associated with increased mortality (HR 1.54; 95% CI, 1.23–1.93; p = 0.0002). Kaplan–Meier and Aalen–Johansen competing-risk analyses also demonstrated lower survival and higher cumulative incidence of in-hospital death in the High-dose group.
Conclusions
Initiating vasopressin at higher norepinephrine dose thresholds was associated with increased mortality, suggesting potential benefit from earlier vasopressin use. Residual confounding due to greater illness severity cannot be excluded.
背景：去甲肾上腺素是脓毒性休克的一线抗利尿激素，抗利尿激素通常作为二线药物。然而，启动抗利尿激素的最佳去甲肾上腺素剂量阈值仍然不确定。目的：评估在较低的去甲肾上腺素剂量下是否启动抗利尿激素(方法：这项回顾性观察队列研究纳入了2017年至2022年在三级学术中心接受去甲肾上腺素和抗利尿激素治疗的感染性休克成年患者。结果：在570例纳入的患者中，343例接受低剂量去甲肾上腺素治疗，227例接受高剂量去甲肾上腺素治疗。高剂量组粗死亡率更高（64.3% vs 54.2%），相对危险度为0.84 （95% CI, 0.74-0.97; p = 0.017）。调整后，高去甲肾上腺素剂量的抗利尿激素起始与死亡率增加独立相关（HR 1.54; 95% CI, 1.23-1.93; p = 0.0002）。Kaplan-Meier和aallen - johansen竞争风险分析也表明，高剂量组的生存率较低，住院死亡的累积发生率较高。结论：在更高的去甲肾上腺素剂量阈值下启动抗利尿激素与死亡率增加相关，提示早期使用抗利尿激素可能有益。不能排除由于更严重的疾病引起的残留混杂。
{"title":"Impact of vasopressin initiation at norepinephrine dose thresholds in septic shock patients with high SOFA scores: A retrospective observational cohort study","authors":"Jennifer Cortes , Kayla Cann , Gabriel Patarroyo - Aponte , Brandy McKelvy , Sophie Samuel","doi":"10.1016/j.hrtlng.2025.102696","DOIUrl":"10.1016/j.hrtlng.2025.102696","url":null,"abstract":"<div><h3>Background</h3><div>Norepinephrine is the first-line vasopressor in septic shock, with vasopressin commonly added as a second-line agent. However, the optimal norepinephrine dose threshold for initiating vasopressin remains uncertain.</div></div><div><h3>Objectives</h3><div>To evaluate whether initiating vasopressin at lower norepinephrine doses (<20 µg/min) is associated with improved clinical outcomes compared with initiation at higher doses (≥20 µg/min) in adults with septic shock.</div></div><div><h3>Methods</h3><div>This retrospective observational cohort study included adult patients with septic shock who received norepinephrine followed by vasopressin at a tertiary academic center between 2017 and 2022. Patients were stratified by norepinephrine dose at vasopressin initiation: <20 µg/min (Low-dose) versus ≥20 µg/min (High-dose). The primary outcome was in-hospital mortality. Inverse probability of treatment weighting and Cox proportional hazards modeling were used for adjustment.</div></div><div><h3>Results</h3><div>Of 570 included patients, 343 received vasopressin at Low-dose norepinephrine and 227 at High-dose. Crude mortality was higher in the High-Dose group (64.3% vs 54.2%), with a relative risk of 0.84 (95% CI, 0.74–0.97; <em>p</em> = 0.017). After adjustment, vasopressin initiation at higher norepinephrine doses remained independently associated with increased mortality (HR 1.54; 95% CI, 1.23–1.93; <em>p</em> = 0.0002). Kaplan–Meier and Aalen–Johansen competing-risk analyses also demonstrated lower survival and higher cumulative incidence of in-hospital death in the High-dose group.</div></div><div><h3>Conclusions</h3><div>Initiating vasopressin at higher norepinephrine dose thresholds was associated with increased mortality, suggesting potential benefit from earlier vasopressin use. Residual confounding due to greater illness severity cannot be excluded.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102696"},"PeriodicalIF":2.6,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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