Prior Use of Calcium Channel Blockers Is Associated With Decreased Mortality in Critically Ill Patients With Sepsis: A Prospective Observational Study

        Objectives

        Experimental studies suggest that calcium channel blockers can improve sepsis outcome. The aim of this study was to determine the association between prior use of calcium channel blockers and the outcome of patients admitted to the ICU with sepsis.

        目的: 实验研究表明,钙通道阻滞剂能改善脓毒症的结果。本研究的目的是确定优先使用钙通道阻滞剂和因脓毒症收入ICU的患者的结果之间的关系。

        Design

        A prospective observational study.

        设计：一项前瞻性观察研究

        Setting

        The ICUs of two tertiary care hospitals in the Netherlands.

        设置：荷兰两家三级医院的ICU。

        Patients

        In total, 1,060 consecutive patients admitted with sepsis were analyzed, 18.6% of whom used calcium channel blockers.

        患者：一共有1060名连续的因脓毒症入院的患者，其中18.6%使用了钙通道阻滞剂。

        Interventions

        None.

        干预措施：无。

        Measurements and Main Results

        Considering large baseline differences between calcium channel blocker users and nonusers, a propensity score matched cohort was constructed to account for differential likelihoods of receiving calcium channel blockers. Fifteen plasma biomarkers providing insight in key host responses implicated in sepsis pathogenesis were measured during the first 4 days after admission. Severity of illness over the first 24 hours, sites of infection and causative pathogens were similar in both groups. Prior use of calcium channel blockers was associated with improved 30-day survival in the propensity-matched cohort (20.2% vs 32.9% in non-calcium channel blockers users; p = 0.009) and in multivariate analysis (odds ratio, 0.48; 95% CI, 0.31–0.74; p = 0.0007). Prior calcium channel blocker use was not associated with changes in the plasma levels of host biomarkers indicative of activation of the cytokine network, the vascular endothelium and the coagulation system, with the exception of antithrombin levels, which were less decreased in calcium channel blocker users.

        测量及主要结果:考虑钙通道阻滞剂使用者和非使用者之间的基线差异很大,构建倾向得分匹配队列来说明接受钙通道阻滞剂的可能性差别。在入院后的前4天内测量15项血浆生物标志物，这些生物标志物能通过关键宿主反应来探索脓毒症发病机制。在前24小时内疾病的严重程度,感染部位和病原体两组是相似的。优先使用钙通道阻滞剂与在倾向匹配队列 (20.2% vs 32.9% 在非通道阻滞剂使用者;p = 0.009)，和在多变量分析(优势比,0.48;95%置信区间,0.48 - 0.31;p = 0.0007) 中能改善30天生存率。优先使用钙通道阻滞剂与血浆中指示细胞因子网络、血管内皮和凝血系统激活的宿主生物标志物的水平无关。而抗凝血酶水平,它在钙通道阻滞剂使用者中下降较少。

        Conclusions

        Prior calcium channel blocker use is associated with reduced mortality in patients following ICU admission with sepsis.

        结论:优先使用钙通道阻滞剂与减少患者入住ICU后脓毒症的死亡率相关。