对乙酰氨基酚的使用与脓毒症相关急性肾损伤患者死亡率和肾功能恢复的关系。

Association of acetaminophen use with mortality and renal recovery in patients with sepsis-associated acute kidney injury.

机构信息

Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, 613 Huangpu Avenue West, Guangzhou, 510630, China.

Intensive Care Unit, Centro Hospitalar Conde de São Januário, Macau, China.

出版信息

BMC Anesthesiol. 2024 Nov 28;24(1):440. doi: 10.1186/s12871-024-02756-7.

DOI:10.1186/s12871-024-02756-7

PMID:39604841

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11603937/

Abstract

BACKGROUND

Sepsis-associated acute kidney injury (SA-AKI) is common and associated with poor outcomes in critically ill patients. Acetaminophen is often used as an antipyretic and analgesic drug, but the association of acetaminophen use with mortality and recovery of renal function in SA-AKI patients remain unclear. We aimed to investigate the association between acetaminophen use and outcomes in SA-AKI patients.

METHODS

This is a retrospective cohort study based on the MIMIC-IV database. Adult patients with SA-AKI were included in the analysis. The exposure was acetaminophen use within 7 days after the onset of SA-AKI. The primary outcome was 28-day mortality. Secondary outcomes included ICU mortality, in-hospital mortality, 90-day mortality, 1-year mortality, and renal recovery. Cox proportional hazards regression models were used to estimate the hazard ratio (HR) with 95% confidence interval (CI) for mortality. Logistic regression models were used to estimate the odd ratio (OR) with 95% CI for renal recovery.

RESULTS

6752 patients with SA-AKI were included, and 3892 (57.6%) patients received acetaminophen. Acetaminophen use was associated with decreased 28-day mortality (HR 0.69, 95% CI 0.63-0.75), ICU mortality (HR 0.56, 95% CI 0.50-0.63), in-hospital mortality (HR 0.62, 95% CI 0.57-0.69), 90-day mortality (HR 0.73, 95% CI 0.68-0.79), and 1-year mortality (HR 0.62, 95% CI 0.57-0.69). Acetaminophen use also was associated with improved renal recovery (OR 1.15, 95% CI 1.04-1.28).

CONCLUSIONS

Acetaminophen use is associated with decreased mortality and improved renal recovery in SA-AKI patients.

摘要

背景

脓毒症相关性急性肾损伤（SA-AKI）在危重症患者中较为常见，与不良预后相关。对乙酰氨基酚常被用作解热镇痛药，但在 SA-AKI 患者中，使用对乙酰氨基酚与死亡率和肾功能恢复之间的关系尚不清楚。本研究旨在探讨 SA-AKI 患者使用对乙酰氨基酚与结局之间的关系。

方法

这是一项基于 MIMIC-IV 数据库的回顾性队列研究。纳入分析的对象为 SA-AKI 成人患者。暴露因素为 SA-AKI 发病后 7 天内使用对乙酰氨基酚。主要结局为 28 天死亡率。次要结局包括 ICU 死亡率、住院死亡率、90 天死亡率、1 年死亡率和肾功能恢复。采用 Cox 比例风险回归模型估计死亡率的风险比（HR）及其 95%置信区间（CI）。采用 logistic 回归模型估计肾功能恢复的比值比（OR）及其 95%CI。

结果

共纳入 6752 例 SA-AKI 患者，其中 3892 例（57.6%）患者使用了对乙酰氨基酚。使用对乙酰氨基酚与降低 28 天死亡率（HR 0.69，95%CI 0.63-0.75）、ICU 死亡率（HR 0.56，95%CI 0.50-0.63）、住院死亡率（HR 0.62，95%CI 0.57-0.69）、90 天死亡率（HR 0.73，95%CI 0.68-0.79）和 1 年死亡率（HR 0.62，95%CI 0.57-0.69）相关。使用对乙酰氨基酚与改善肾功能恢复（OR 1.15，95%CI 1.04-1.28）相关。