ICU患者体温昼夜变异对患者预后的影响  

Effects of circadian body temperature variation on the prognosis in intensive care unit patients

作　　者：赵苗 李若寒 任佳佳 金旭婷 李佳媚[1] 张静静[1] 高雅[1] 王岗[1] Zhao Miao;Li Ruohan;Ren Jiajia;Jin Xuting;Li Jiamei;Zhang Jingjing;Gao Ya;Wang Gang(Department of Critical Care Medicine,the Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710004,China)

机构地区：[1]西安交通大学第二附属医院重症医学科,陕西西安710004

出　　处：《中国急救医学》2023年第10期800-805,共6页Chinese Journal of Critical Care Medicine

基　　金：陕西省“高层次人才特殊支持计划”项目;西安交通大学医学“基础-临床”融合创新项目(YXJLRH2022060)。

摘　　要：目的探讨重症监护室(ICU)成年患者体温昼夜变异对医院病死率的影响。方法采用回顾性队列研究方法,收集多参数重症监护数据库(MIMIC-ⅡV2.6)中首次收住ICU、住院时间>1 d且入ICU后24 h内有完整体温监测记录的成年患者。提取患者的年龄、性别、种族、首次序贯器官衰竭评分(sequential organ failure assessment,SOFA)、药物使用情况、基础患病情况、机械通气情况、28天病死率、90天病死率及体温监测数据等。根据昼夜体温变异(昼夜体温变异=夜间体温平均值/白天体温平均值)将研究对象分为两组:比值≤1组和比值>1组。采用多因素COX比例风险模型研究体温昼夜变异与ICU患者28天病死率和90天病死率之间的关系。之后根据SOFA评分将总体人群分为两组(SOFA≤9分和SOFA>9分)进行亚组分析。结果本研究共纳入患者3534例,比值≤1组患者653例(18.5%),比值>1组患者2881例(81.5%)。比值≤1组患者的28天病死率(13.2%vs.3.3%,P<0.001)和90天病死率(17.3%vs.5.6%,P<0.001)均高于比值>1组。多因素COX回归显示,比值≤1组患者具有较高的28天死亡风险(HR=1.949,95%CI 1.422~2.670)和90天死亡风险(HR=1.531,95%CI 1.178~1.989)。亚组分析结果表明,在SOFA≤9分的亚组中,昼夜体温变异与28天病死率(HR=2.566,95%CI 1.368~4.812)和90天病死率(HR=2.666,95%CI 1.622~4.382)的相关性仍具有统计学意义;在SOFA>9分的亚组中,比值≤1组患者28天死亡风险仍高于比值>1组(HR=1.595,95%CI 1.101~2.311),但在该亚组中未显示出昼夜体温变异与90天病死率的相关性(HR=1.206,95%CI 0.883~1.646)。结论夜间体温低于白天体温的ICU患者28天病死率及90天病死率较高,提示夜间体温降低可能是危重症患者的死亡风险因素。Objective To explore the effect of circadian body temperature variation on the prognosis in intensive care unit(ICU)patients.Methods Adult patients enrolled from the Medical Information Mart for Intensive Care-ⅡV2.6(MIMIC-ⅡV2.6)database with complete records of body temperature monitoring during the first 24 hours of initial ICU stay and a length of stay in ICU>1 day were included.The information about age,sex,race,the first sequential organ failure assessment(SOFA)scores,drug usage,underlying diseases,mechanical ventilation,28-day mortality,90-day mortality,and body temperature were extracted.And then,the participants were divided into two groups based on circadian body temperature variation(mean nighttime body temperature/mean daytime body temperature):ratio≤1 and ratio>1.COX proportional hazards models were utilized to investigate the relationship of circadian body temperature variations with 28-day mortality and 90-day mortality in ICU patients.Subgroup analysis was conducted for the patients with SOFA scores≤9 or SOFA scores>9.Results A total of 3534 patients were analyzed.Patients with ratio≤1(n=653,18.5%)had higher 28-day mortality(13.2%vs.3.3%,P<0.001)and 90-day mortality(17.3%vs.5.6%,P<0.001)than those with ratio>1(n=2881,81.5%).Multivariate COX regression showed that circadian body temperature variation≤1 was related with increased 28-day mortality(HR=1.949,95%CI 1.422-2.670)and 90-day mortality(HR=1.531,95%CI 1.178-1.989)in ICU patients.Subgroup analysis showed the correlation of circadian body temperature variation with 28-day mortality(HR=2.566,95%CI 1.368-4.812)and 90-day mortality(HR=2.666,95%CI 1.622-4.382)in SOFA scores≤9 subgroup remained statistically significant.In SOFA scores>9 subgroup,the patients with ratio≤1 was also associated with elevated 28-day mortality(HR=1.595,95%CI 1.101-2.311),but the relationship of circadian body temperature variation with 90-day mortality had no statistical significance(HR=1.206,95%CI 0.883-1.646).Conclusions Patients who have the lower nightti

关 键 词：昼夜节律 重症监护室 体温变异 病死率 

分 类 号：R459.7[医药卫生—急诊医学]