Early, Goal-Directed Therapy for Septic Shock— A Patient-Level Meta-Analysis脓毒症休克的早期靶向治疗 -患者水平荟萃分析

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1、ThenewenglandjournalofmedicineOriginalArticleEarly,Goal-DirectedTherapyforSepticShock—APatient-LevelMeta-AnalysisThePRISMInvestigators*ABSTRACTBACKGROUNDAfterasingle-centertrialandobservationalstudiessuggestingthatearly,goal-Themembersofthewritingcommitteedirectedtherapy(EGDT)reducedmor

2、talityfromsepticshock,threemulticenter(KathrynM.Rowan,Ph.D.,DerekC.An-gus,M.D.,M.P.H.,MichaelBailey,Ph.D.,trials(ProCESS,ARISE,andProMISe)showednobenefit.Thismeta-analysisofAmberE.Barnato,M.D.,RinaldoBellomo,individualpatientdatafromthethreerecenttrialswasdesignedprospectivelytoM.D.,Rut

3、hR.Canter,M.Sc.,TimothyJ.improvestatisticalpowerandexploreheterogeneityoftreatmenteffectofEGDT.Coats,M.D.,AnthonyDelaney,M.D.,Ph.D.,ElizabethGimbel,R.N.,B.S.,Rich-ardD.Grieve,Ph.D.,DavidA.Harrison,METHODSPh.D.,AlisaM.Higgins,M.P.H.,BelindaWeharmonizedentrycriteria,interventionprotocols,

4、outcomes,resource-useHowe,M.P.H.,DavidT.Huang,M.D.,measures,anddatacollectionacrossthetrialsandspecifiedallanalysesbeforeM.P.H.,JohnA.Kellum,M.D.,PaulR.Mouncey,M.Sc.,EdvinMusic,M.S.I.S.,unblinding.Aftercompletionofthetrials,wepooleddata,excludingtheprotocol-SandraL.Peake,M.D.,Ph.D.,Fran

5、cisbasedstandard-therapygroupfromtheProCESStrial,andresolvedresidualdiffer-Pike,Ph.D.,MichaelC.Reade,M.B.,B.S.,ences.Theprimaryoutcomewas90-daymortality.SecondaryoutcomesincludedD.Phil.,M.ZiaSadique,Ph.D.,MervynSinger,M.D.,andDonaldM.Yealy,M.D.)1-yearsurvival,organsupport,andhospitaliza

6、tioncosts.Wetestedfortreatment-assumeresponsibilityfortheoverallcon-by-subgroupinteractionsfor16patientcharacteristicsand6care-deliverycharac-tentandintegrityofthisarticle.Theaffili-ationsofthewritingcommitteemem-teristics.bersarelistedintheAppendix.AddressreprintrequeststoDr.Rowanatthe

7、In-RESULTStensiveCareNationalAuditandResearchWestudied3723patientsat138hospitalsinsevencountries.Mortalityat90daysCentre,NapierHouse,24HighHolborn,LondonWC1V6AZ,UnitedKingdom,orwassimilarforEGDT(462of1852patients[24.9%])andusualcare(475of1871atkathy.rowan@icnarc.org.patients[25