重症患者应用依拉环素后凝血功能的变化及新发出血事件的影响因素

Tab 1 General data of included patients

关键词:  依拉环素  重症患者  凝血功能  出血

Key words:  eravacycline  intensive care unit patients  coagulation function  bleeding

摘要:

目的:评估重症患者应用依拉环素后凝血功能的变化及影响新发出血事件的可能因素。方法:回顾性收集重症监护病房中应用依拉环素抗感染治疗的患者,分析依拉环素用药前后凝血指标的变化,采用Logistic回归分析影响新发出血事件的独立危险因素。结果:最终纳入49例患者,依拉环素用药前存在基线凝血指标异常的情况包括纤维蛋白原偏低(10.20%)、凝血酶原时间延长(59.18%)、血小板计数偏低(22.45%)；20.41%的患者在依拉环素用药前1周至开始用药后3天内已发生出血事件。依拉环素用药前后的凝血指标对比结果显示,与基线值相比,依拉环素停药后患者的纤维蛋白原水平显著下降(P＜0.05),凝血酶原时间明显延长(P＜0.05),血小板计数无明显变化。对于依拉环素用药后出现新发出血事件进行Logistic回归分析,结果显示依拉环素用药后血小板计数下降是新发出血事件的独立危险因素(P=0.014,OR 18.40,95%CI 1.79~189.43),依拉环素总疗程超过2周是新发出血风险增加的可能影响因素(P=0.052,OR 10.72,95%CI 0.98~117.88)。结论:重症患者应用依拉环素治疗后可出现凝血指标异常,如纤维蛋白原下降、凝血酶原时间延长,此外依拉环素用药后若出现血小板计数明显下降或用药疗程超过2周,需警惕新发出血事件的风险增加。

Abstract:

ABSTRACT: OBJECTIVE To evaluate the changes of coagulation function and the influencing factors of new bleeding events in critically ill patients after application of eravacycline. METHODS Retrospective collection of patients in intensive care unit who received anti-infection therapy with eravacycline, and analysis of the changes of coagulation indexes before and after treatment with eravacycline. Logistic regression was used to analyze the independent risk factors of new bleeding events. Results Finally, 49 patients were included. At the end of intravenous therapy with eravacycline, 26.53% patients had decreased fibrinogen, 12.24% patients had prolonged prothrombin time, 20.41% patients had decreased platelet count and 14.28% patients had new bleeding events. The results of comparison of coagulation indexes before and after medication showed that the fibrinogen of patients was lower than the baseline value, and the prothrombin time level was longer than the baseline value, with statistical significance (P < 0.05). Logistic regression analysis showed that the obvious decrease of platelet count was an independent risk factor for new bleeding events after taking eravacycline (P=0.014, OR 18.40, 95%CI 1.79~189.43), and the total course of treatment of eravacycline for more than 2 weeks was a possible influencing factor for the increased risk of new bleeding (P=0.052, OR 10.72, 95% CI 0.98). Conclusion Severe patients may have abnormal coagulation indexes after the treatment with eravacycline, such as decreased fibrinogen and prolonged prothrombin time. In addition, the platelet count decreased significantly during the treatment with eravacycline or the treatment course with eravacycline exceeded 2 weeks, so it is necessary to be alert to the increased risk of new bleeding events.