{"title":"ICU脓毒症患者第一周最佳PaO2为130-160 mmHg：基于MIMIC-IV数据库的回顾性队列研究。","authors":"Haoran Chen, Xinyi Tang, Xiaomin Li, Yongpeng Xie","doi":"10.1097/SHK.0000000000002528","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The relationship between the partial pressure of oxygen in arterial blood (PaO2) and the prognosis of sepsis patients, and its potential variation over time, remains unclear. The optimal PaO2 range for sepsis patients has always been a contentious issue, with no consensus. We aimed to explore the association between different levels of PaO2 exposure over time and the 28-day mortality of sepsis patients, and to identify the optimal PaO2 range for sepsis patients within a specific time frame.</p><p><strong>Methods: </strong>We retrieved data on adult patients diagnosed with sepsis within 24 hours before or after ICU admission from the Medical Information Mart for Intensive Care IV (MIMIC-IV; version 2.2) database. We excluded patients who were not admitted to the ICU for the first time, those with ICU stay <24 hours, and those without PaO2 results during their ICU stay. We calculated the time-weighted average (TWA) of PaO2 and used piece-wise exponential additive mixed models (PAMMs) to estimate the time-dependent changes in the association between TWA-PaO2 and patient prognosis.</p><p><strong>Results: </strong>A total of 16,880 sepsis patients were included in the MIMIC cohort. Results indicated that patients' TWA-PaO2 correlates with increased 28-day mortality after intensive care unit (ICU) admission in sepsis patients, and this association was mainly manifested in the early course of the disease. With a time window of the first 1-7 days after ICU admission, the optimal TWA-PaO2 range for sepsis patients was ≥130 mmHg and ≤ 160 mmHg. Increased exposure time, proportion of exposure time, and exposure dose of high-risk PaO2 outside the range were all associated with an increased risk of 28-day mortality.</p><p><strong>Conclusion: </strong>PaO2 in sepsis patients should be closely monitored. During the first 1-7 days of ICU admission, PaO2 should be maintained within the range of ≥130 mmHg and ≤ 160 mmHg. A dose-dependent relationship exists between high-risk PaO2 outside the range and patient outcome.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Optimal PaO2 is 130-160 mmHg in the first week for sepsis patients in ICU: a retrospective cohort study based on MIMIC-IV database.\",\"authors\":\"Haoran Chen, Xinyi Tang, Xiaomin Li, Yongpeng Xie\",\"doi\":\"10.1097/SHK.0000000000002528\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The relationship between the partial pressure of oxygen in arterial blood (PaO2) and the prognosis of sepsis patients, and its potential variation over time, remains unclear. The optimal PaO2 range for sepsis patients has always been a contentious issue, with no consensus. We aimed to explore the association between different levels of PaO2 exposure over time and the 28-day mortality of sepsis patients, and to identify the optimal PaO2 range for sepsis patients within a specific time frame.</p><p><strong>Methods: </strong>We retrieved data on adult patients diagnosed with sepsis within 24 hours before or after ICU admission from the Medical Information Mart for Intensive Care IV (MIMIC-IV; version 2.2) database. We excluded patients who were not admitted to the ICU for the first time, those with ICU stay <24 hours, and those without PaO2 results during their ICU stay. We calculated the time-weighted average (TWA) of PaO2 and used piece-wise exponential additive mixed models (PAMMs) to estimate the time-dependent changes in the association between TWA-PaO2 and patient prognosis.</p><p><strong>Results: </strong>A total of 16,880 sepsis patients were included in the MIMIC cohort. Results indicated that patients' TWA-PaO2 correlates with increased 28-day mortality after intensive care unit (ICU) admission in sepsis patients, and this association was mainly manifested in the early course of the disease. With a time window of the first 1-7 days after ICU admission, the optimal TWA-PaO2 range for sepsis patients was ≥130 mmHg and ≤ 160 mmHg. Increased exposure time, proportion of exposure time, and exposure dose of high-risk PaO2 outside the range were all associated with an increased risk of 28-day mortality.</p><p><strong>Conclusion: </strong>PaO2 in sepsis patients should be closely monitored. During the first 1-7 days of ICU admission, PaO2 should be maintained within the range of ≥130 mmHg and ≤ 160 mmHg. A dose-dependent relationship exists between high-risk PaO2 outside the range and patient outcome.</p>\",\"PeriodicalId\":21667,\"journal\":{\"name\":\"SHOCK\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-12-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"SHOCK\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/SHK.0000000000002528\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"SHOCK","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SHK.0000000000002528","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Optimal PaO2 is 130-160 mmHg in the first week for sepsis patients in ICU: a retrospective cohort study based on MIMIC-IV database.
Background: The relationship between the partial pressure of oxygen in arterial blood (PaO2) and the prognosis of sepsis patients, and its potential variation over time, remains unclear. The optimal PaO2 range for sepsis patients has always been a contentious issue, with no consensus. We aimed to explore the association between different levels of PaO2 exposure over time and the 28-day mortality of sepsis patients, and to identify the optimal PaO2 range for sepsis patients within a specific time frame.
Methods: We retrieved data on adult patients diagnosed with sepsis within 24 hours before or after ICU admission from the Medical Information Mart for Intensive Care IV (MIMIC-IV; version 2.2) database. We excluded patients who were not admitted to the ICU for the first time, those with ICU stay <24 hours, and those without PaO2 results during their ICU stay. We calculated the time-weighted average (TWA) of PaO2 and used piece-wise exponential additive mixed models (PAMMs) to estimate the time-dependent changes in the association between TWA-PaO2 and patient prognosis.
Results: A total of 16,880 sepsis patients were included in the MIMIC cohort. Results indicated that patients' TWA-PaO2 correlates with increased 28-day mortality after intensive care unit (ICU) admission in sepsis patients, and this association was mainly manifested in the early course of the disease. With a time window of the first 1-7 days after ICU admission, the optimal TWA-PaO2 range for sepsis patients was ≥130 mmHg and ≤ 160 mmHg. Increased exposure time, proportion of exposure time, and exposure dose of high-risk PaO2 outside the range were all associated with an increased risk of 28-day mortality.
Conclusion: PaO2 in sepsis patients should be closely monitored. During the first 1-7 days of ICU admission, PaO2 should be maintained within the range of ≥130 mmHg and ≤ 160 mmHg. A dose-dependent relationship exists between high-risk PaO2 outside the range and patient outcome.
期刊介绍：
SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.
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