Hyperbaric oxygen treatment in the management of necrotising soft-tissue infections: results from a Danish nationwide registry study
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Hyperbaric oxygen treatment in the management of necrotising soft-tissue infections : results from a Danish nationwide registry study. / Hedetoft, Morten; Madsen, Martin Bruun; Hyldegaard, Ole.
I: BMJ Open, Bind 13, Nr. 2, e066117, 2023.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Hyperbaric oxygen treatment in the management of necrotising soft-tissue infections
T2 - results from a Danish nationwide registry study
AU - Hedetoft, Morten
AU - Madsen, Martin Bruun
AU - Hyldegaard, Ole
N1 - Publisher Copyright: © 2023 BMJ Publishing Group. All rights reserved.
PY - 2023
Y1 - 2023
N2 - Objectives Application of hyperbaric oxygen (HBO 2) treatment in the multidisciplinary setting of necrotising soft-tissue infection (NSTI) is debated as a considerable number of studies are of low quality with marked prognostication bias due to inadequately addressing disease severity. The objective of this study was to associate HBO 2 treatment with mortality in patients with NSTI including disease severity as a prognostic variable. Design Nationwide population-based register study. Setting Denmark. Participants Danish residents with NSTI patients between January 2011 and June 2016. Primary and secondary outcome measures Thirty-day mortality was compared between patients receiving and patients not receiving HBO 2 treatment using inverse probability of treatment weighting and propensity-score matching with predetermined variables (age, sex and weighted Charlson comorbidity score, presence of septic shock and Simplified Acute Physiology Score II (SAPS II)). Results A total of 671 NSTI patients were included with a median age of 63 (52-71), 61% male sex, 30% had septic shock and a median SAPS II of 46 (34-58). Patients who received HBO 2 treatment (n=266) were younger and had lower SAPS II, but a larger fraction had septic shock compared with patients not receiving HBO 2 treatment. Overall, all-cause 30-day mortality was 19% (95% CI 17% to 23%). The statistical models were in general acceptably balanced with covariates reaching <0.1 absolute standardised mean differences and patients receiving HBO 2 treatment were associated with lower 30-day mortality (OR 0.40, 95% CI 0.30 to 0.53, p<0.001). Conclusions In analyses using inverse probability of treatment weighting and propensity score analysis, patients treated with HBO 2 treatment were associated with improved 30-day survival.
AB - Objectives Application of hyperbaric oxygen (HBO 2) treatment in the multidisciplinary setting of necrotising soft-tissue infection (NSTI) is debated as a considerable number of studies are of low quality with marked prognostication bias due to inadequately addressing disease severity. The objective of this study was to associate HBO 2 treatment with mortality in patients with NSTI including disease severity as a prognostic variable. Design Nationwide population-based register study. Setting Denmark. Participants Danish residents with NSTI patients between January 2011 and June 2016. Primary and secondary outcome measures Thirty-day mortality was compared between patients receiving and patients not receiving HBO 2 treatment using inverse probability of treatment weighting and propensity-score matching with predetermined variables (age, sex and weighted Charlson comorbidity score, presence of septic shock and Simplified Acute Physiology Score II (SAPS II)). Results A total of 671 NSTI patients were included with a median age of 63 (52-71), 61% male sex, 30% had septic shock and a median SAPS II of 46 (34-58). Patients who received HBO 2 treatment (n=266) were younger and had lower SAPS II, but a larger fraction had septic shock compared with patients not receiving HBO 2 treatment. Overall, all-cause 30-day mortality was 19% (95% CI 17% to 23%). The statistical models were in general acceptably balanced with covariates reaching <0.1 absolute standardised mean differences and patients receiving HBO 2 treatment were associated with lower 30-day mortality (OR 0.40, 95% CI 0.30 to 0.53, p<0.001). Conclusions In analyses using inverse probability of treatment weighting and propensity score analysis, patients treated with HBO 2 treatment were associated with improved 30-day survival.
KW - adult intensive & critical care
KW - infection control
KW - infectious diseases
U2 - 10.1136/bmjopen-2022-066117
DO - 10.1136/bmjopen-2022-066117
M3 - Journal article
C2 - 36813488
AN - SCOPUS:85148548647
VL - 13
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 2
M1 - e066117
ER -
ID: 341347380