Skip to main content

Advertisement

SpringerLink
Log in

Effects of Tanreqing Injection on ICU Mortality among ICU Patients Receiving Mechanical Ventilation: Time-Dependent Cox Regression Analysis of A Large Registry

  • Original Article
  • Published:
Chinese Journal of Integrative Medicine Aims and scope Submit manuscript

Abstract

Objective

To assess whether the use of Tanreqing (TRQ) Injection could show improvements in time to extubation, intensive care unit (ICU) mortality, ventilator-associated events (VAEs) and infection-related ventilator associated complication (IVAC) among patients receiving mechanical ventilation (MV).

Methods

A time-dependent cox-regression analysis was conducted using data from a well-established registry of healthcare-associated infections at ICUs in China. Patients receiving continuous MV for 3 days or more were included. A time-varying exposure definition was used for TRQ Injection, which were recorded on daily basis. The outcomes included time to extubation, ICU mortality, VAEs and IVAC. Time-dependent Cox models were used to compare the clinical outcomes between TRQ Injection and non-use, after controlling for the influence of comorbidities/conditions and other medications with both fixed and time-varying covariates. For the analyses of time to extubation and ICU mortality, Fine-Gray competing risk models were also used to measure competing risks and outcomes of interest.

Results

Overall, 7,685 patients were included for the analyses of MV duration, and 7,273 patients for the analysis of ICU mortality. Compared to non-use, patients with TRQ Injection had a lower risk of ICU mortality (Hazards ratios (HR) 0.761, 95% CI, 0.581–0.997), and was associated with a higher hazard for time to extubation (HR 1.105, 95% CI, 1.005–1.216), suggesting a beneficial effect on shortened time to extubation. No significant differences were observed between TRQ Injection and non-use regarding VAEs (HR 1.057, 95% CI, 0.912–1.225) and IVAC (HR 1.177, 95% CI, 0.929–1.491). The effect estimates were robust when using alternative statistic models, applying alternative inclusion and exclusion criteria, and handling missing data by alternative approaches.

Conclusion

Our findings suggested that the use of TRQ Injection might lower mortality and improve time to extubation among patients receiving MV, even after controlling for the factor that the use of TRQ changed over time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. He Q, Wang W, Zhu S, Wang M, Kang Y, Zhang R, et al. The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study. Crit Care 2021;25:44.

    PubMed  PubMed Central  Google Scholar 

  2. Ye Y, Zhu B, Jiang L, Jiang Q, Wang M, Hua L, et al. A contemporary assessment of acute mechanical ventilation in Beijing: description, costs, and outcomes. Crit Care Med 2017;45:1160–1167.

    PubMed  PubMed Central  Google Scholar 

  3. Klompas M. Potential strategies to prevent ventilator-associated events. Am J Respir Crit Care Med 2015;192:1420–1430.

    PubMed  Google Scholar 

  4. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med 2013;369:2126–2136.

    CAS  PubMed  Google Scholar 

  5. Zhu S, Wang W, Kang Y, He Q, Zhang H, Deng Y, et al. Clinical outcomes and risk factors for mortality from ventilator-associated events: a registry-based cohort study among 30,830 intensive care unit patients. Infect Control Hosp Epidemiol 2021:1–8.

  6. Zhang X, Wang M, Wang W, Li L, Sun X. Utilization of traditional Chinese medicine in the intensive care unit. Chin Med 2021;16:84.

    PubMed  PubMed Central  Google Scholar 

  7. Qu CC, Zhao GZ, Wang XP, Xu XL, Li B, Guo YH, et al. Tanreqing Injection for patients with influenza: a systematic review and meta-analysis of randomized controlled trials. Chin J Integr Med 2020;26:936–942.

    PubMed  Google Scholar 

  8. Huang X, Duan X, Zhu Y, Wang K, Wu J, Tian X. Comparative efficacy of Chinese herbal injections for the treatment of community-acquired pneumonia: a bayesian network meta-analysis of randomized controlled trials. Phytomedicine 2019;63:153009.

    PubMed  Google Scholar 

  9. Zhu H, Chen M, Shi X, Shi C, Huang C. Material basis studies of anti-Influenza A active ingredients in Tanreqing Injection. Biomed Chromatogr 2018;32:https://doi.org/10.1002/bmc.4097.

  10. Jin L, Chen P, Xu Y. Effects of four types of Chinese medicines as concomitant drugs with azithromycin for the treatment of mycoplasma pneumonia in children in China: a network meta-analysis. Rev Assoc Med Bras (1992) 2021;67:395–399.

    PubMed  Google Scholar 

  11. Li X, Wei S, Ma X, Li H, Jing M, Liu H, et al. Efficacy and safety of Tanreqing Injection combined with antibiotics against Streptococcus pneumoniae pneumonia: a systematic review and meta-analysis. J Clin Pharm Ther 2022;47:1159–1172.

    CAS  PubMed  Google Scholar 

  12. Yuan Y, Zheng Q, Si Z, Liu J, Li Z, Xiong L, et al. Efficacy of Chinese herbal injections for elderly patients with pneumonia-a bayesian network meta-analysis of randomized control trials. Front Pharmacol 2021;12:610745.

    PubMed  PubMed Central  Google Scholar 

  13. Wang P, Liao X, Xie YM, Chai Y, Li LH. Tanreqing Injection for acute bronchitis disease: a systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2016;25:143–158.

    PubMed  Google Scholar 

  14. Wang Y, Wang T, Hu J, Ren C, Lei H, Hou Y, et al. Anti-biofilm activity of Tanreqing, a traditional Chinese medicine used for the treatment of acute pneumonia. J Ethnopharmacol 2011;134:165–170.

    PubMed  Google Scholar 

  15. Lu J, Zhao Z, Wang F, Ding Y, Ye X, Ma D, et al. Preventive effect of irrigating endotracheal tube with Tanreqing Injection on ventilator associated pneumonia. Chin J Crit Care Med (Chin) 2013;5:279–283.

    Google Scholar 

  16. Klompas M, Li L, Kleinman K, Szumita PM, Massaro AF. Associations between ventilator bundle components and outcomes. JAMA Intern Med 2016;176:1277–1283.

    PubMed  Google Scholar 

  17. Pazzagli L, Linder M, Zhang M, Vago E, Stang P, Myers D, et al. Methods for time-varying exposure related problems in pharmacoepidemiology: an overview. Pharmacoepidemiol Drug Saf 2018;27:148–160.

    PubMed  Google Scholar 

  18. Wang W, Zhu S, He Q, Zhang R, Kang Y, Wang M, et al. Developing a registry of healthcare-associated infections at intensive care units in West China: study rationale and patient characteristics. Clin Epidemiol 2019;11:1035–1045.

    PubMed  PubMed Central  Google Scholar 

  19. Wang W, Zhu S, He Q, Wang M, Kang Y, Zhang R, et al. Fluid balance and ventilator-associated events among patients admitted to ICUs in China: a nested case-control study. Crit Care Med 2022;50:307–316.

    CAS  PubMed  Google Scholar 

  20. Wang W, He Q, Zhu S, Wang M, Kang Y, Zhang R, et al. Association between blood transfusion and ventilator-associated events: a nested case-control study. Infect Control Hosp Epidemiol 2022;43:597–602.

    PubMed  Google Scholar 

  21. Zhu S, Kang Y, Wang W, Cai L, Sun X, Zong Z. The clinical impacts and risk factors for non-central line-associated bloodstream infection in 5,046 intensive care unit patients: an observational study based on electronic medical records. Crit Care 2019;23:52.

    PubMed  PubMed Central  Google Scholar 

  22. Wang W, Liu Y, Yu C, Tan J, Xiong W, Dong D, et al. Cefoperazone-sulbactam and risk of coagulation disorders or bleeding: a retrospective cohort study. Expert Opin Drug Saf 2020;19:339–347.

    CAS  PubMed  Google Scholar 

  23. Centers for Disease Control and Prevention. Surveillance for ventilator-associated events. Available on http://www.cdc.gov/nhsn/acute-care-hospital/vae/index.html. Published 2014. Accessed March 25,2014.

  24. Mohammad KA, Fatima-Tuz-Zahura M, Bari W. Fine and Gray competing risk regression model to study the cause-specific under-five child mortality in Bangladesh. BMC Int Health Hum Rights 2017;17:3.

    PubMed  PubMed Central  Google Scholar 

  25. Zhou D, Xie L, Shi X, Liu F, Wu S, Zhang S, et al. A meta-analysis of the clinical efficacy of Tanreqing injection combined with antibiotics vs. antibiotics alone for treating pulmonary infection secondary to intracerebral hemorrhage. Medicine (Baltimore) 2021;100:e24905.

    CAS  PubMed  Google Scholar 

  26. Liu C, Li Y, Wang X, Lu T, Wang X. Adjuvant therapy efficacy of Chinese drugs pharmaceutics for COPD patients with respiratory failure: a meta-analysis. Biosci Rep 2019;39:BSR20182279.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Li W, Yu X, Gao Z, Nie W, Wang L. Tanreqing Injection in treatment of severe pneumonia with the syndrome of phlegm-heat obstructing the lung: a clinical observation. J Aanhui Univ Chin Med (Chin) 2021;40:19–24.

    Google Scholar 

  28. Xiong L, Chen L, Wang C, Yue J, Li Y, Zhou W, et al. Clinical efficacy and safety of Tanreqing Injection for pulmonary infection in patients with tuberculosis: a meta-analysis. J Altern Complement Med 2018;24:1051–1062.

    PubMed  Google Scholar 

  29. Liu W, Zhang X, Mao B, Jiang H. Systems pharmacology-based study of Tanreqing Injection in airway mucus hypersecretion. J Ethnopharmacol 2020;249:112425.

    CAS  PubMed  Google Scholar 

  30. Xiang Y, Zheng F, Zhang Q, Zhang R, Pan H, Pang Z, et al. Tanreqing Injection regulates cell function of hypoxia-induced human pulmonary artery smooth muscle cells (HPASMCs) through TRPC1/CX3CL1 signaling pathway. Oxid Med Cell Longev 2022;2022:3235102.

    PubMed  PubMed Central  Google Scholar 

  31. Liu W, Jiang HL, Cai LL, Yan M, Dong SJ, Mao B. Tanreqing Injection attenuates lipopolysaccharide-induced airway inflammation through MAPK/NF-κB signaling pathways in rats model. Evid Based Complement Alternat Med 2016;2016:5292346.

    PubMed  PubMed Central  Google Scholar 

  32. He YQ, Zhou CC, Deng JL, Wang L, Chen WS. Tanreqing inhibits LPS-induced acute lung injury in vivo and in vitro through downregulating STING signaling pathway. Front Pharmacol 2021;12:746964.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China

    Wen Wang, Qiao He, Ming-qi Wang, Jia-yue Xu, Kang Zou &  Xin Sun

  2. NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China

    Wen Wang, Qiao He, Ming-qi Wang, Jia-yue Xu, Kang Zou &  Xin Sun

  3. Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041, China

    Wen Wang, Qiao He, Ming-qi Wang, Jia-yue Xu, Kang Zou &  Xin Sun

  4. Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, 610041, China

    Peng Ji

  5. Information Center, West China Hospital, Sichuan University, Chengdu, 610041, China

    Rui Zhang

Authors
  1. Wen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qiao He
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ming-qi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jia-yue Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peng Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rui Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kang Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xin Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Sun X conceived and designed the research and assistant in revision of manuscript; Wang W designed the research, wrote the initial paper, and interpret research results; He Q, Wang MQ, and Xu JY cleared, analysed and interpret research data. Ji P collected the research data and assistant in interpretation of research results; Zhang R assistant in acquisition and clean data; Zou K assistant in interpretation research results. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xin Sun.

Ethics declarations

The authors declare no conflicts of interest.

Additional information

Supported by the National Natural Science Foundation of China (No. 72104155), Postdoctoral Research Project, West China Hospital, Sichuan University (No. 2020HXBH148), and the 1•3•5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (No. ZYYC08003)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, W., He, Q., Wang, Mq. et al. Effects of Tanreqing Injection on ICU Mortality among ICU Patients Receiving Mechanical Ventilation: Time-Dependent Cox Regression Analysis of A Large Registry. Chin. J. Integr. Med. 29, 782–790 (2023). https://doi.org/10.1007/s11655-023-3634-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11655-023-3634-z

Keywords

Search

Navigation