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: 實驗研究表明,鈣通道阻滯劑能改善膿毒症的結果。本研究的目的是確定優先使用鈣通道阻滯劑和因膿毒症收入ICU的患者的結果之間的關係。

        Design

        A prospective observational study.

        設計：一項前瞻性觀察研究

        Setting

        The ICUs of two tertiary care hospitals in the Netherlands.

        設置：荷蘭兩家三級醫院的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名連續的因膿毒症入院的患者，其中18.6%使用了鈣通道阻滯劑。

        Interventions

        None.

        幹預措施：無。

        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.

        測量及主要結果:考慮鈣通道阻滯劑使用者和非使用者之間的基線差異很大,構建傾向得分匹配隊列來說明接受鈣通道阻滯劑的可能性差別。在入院後的前4天內測量15項血漿生物標誌物，這些生物標誌物能通過關鍵宿主反應來探索膿毒症發病機製。在前24小時內疾病的嚴重程度,感染部位和病原體兩組是相似的。優先使用鈣通道阻滯劑與在傾向匹配隊列 (20.2% vs 32.9% 在非通道阻滯劑使用者;p = 0.009)，和在多變量分析(優勢比,0.48;95%置信區間,0.48 - 0.31;p = 0.0007) 中能改善30天生存率。優先使用鈣通道阻滯劑與血漿中指示細胞因子網絡、血管內皮和凝血係統激活的宿主生物標誌物的水平無關。而抗凝血酶水平,它在鈣通道阻滯劑使用者中下降較少。

        Conclusions

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

        結論:優先使用鈣通道阻滯劑與減少患者入住ICU後膿毒症的死亡率相關。