敗血症関連急性呼吸不全の重症患者におけるチアミン使用と死亡率の関連：MIMIC-IVデータベースの後ろ向き解析

The association between thiamine use and mortality in critically ill patients with sepsis-associated acute respiratory failure: A retrospective analysis of the MIMIC-IV database.

Yin Ming, Suo Xingxing, Li Min, He Qian ほか — Respiratory medicine

Abstract（原文）

BACKGROUND: Thiamine (vitamin B1) is a crucial cofactor in energy metabolism and antioxidant defense, yet its specific impact on patients with sepsis-associated acute respiratory failure remains unclear. METHODS: We conducted a retrospective cohort study of 6248 sepsis-associated acute respiratory failure patients in the MIMIC-IV database (2008-2019). Patients were categorized based on thiamine supplementation. The primary endpoints were in-hospital and ICU mortality, analyzed using Kaplan-Meier curves, multivariable Cox regression, propensity score matching (PSM), and subgroup analyses. RESULTS: The thiamine group comprised 1576 patients and the no-thiamine group 4672. After adjustment, the no thiamine group had a higher risk of hospital mortality (HR = 1.24, 95%CI 1.10-1.39) and ICU mortality (HR = 1.31, 95%CI 1.14-1.51). This protective association was confirmed in the PSM-matched cohort (n = 2784). Subgroup analysis indicated the benefit was most pronounced in patients aged ≥65 years, with no significant association observed in younger patients. CONCLUSION: Thiamine supplementation was independently associated with reduced in-hospital and ICU mortality in critically ill patients with sepsis-associated acute respiratory failure, particularly in the elderly.These findings support the need for randomized controlled trials to validate its potential as an adjunctive therapy.

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