Brophy Gretchen M, Sheehan Valerie, Shapiro Marc J, Lottenberg Lawrence, Scarlata Debra, Audhya Paul
Departments of Pharmacy and Neurosurgery, Virginia Commonwealth University, Richmond, Virginia 23298-0533, USA.
Clin Ther. 2008 Dec;30(12):2324-34. doi: 10.1016/j.clinthera.2008.12.024.
Anemia is a common comorbid condition among patients admitted to the intensive care unit (ICU). Darbepoietin alfa and epoetin alfa are erythropoiesis-stimulating agents (ESAs) used to manage anemia in the ICU, although neither drug has an indication in critically ill patients.
This study describes ESA practice patterns in anemic, critically ill patients admitted to the ICU.
A total of 19 hospitals participated in this US multicenter, retrospective, observational study of adult patients not receiving chronic hemodialysis who were admitted to the ICU for >or=24 hours between February 2005 and September 2005 and who received >or=1 dose of darbepoietin alfa or epoetin alfa. Data on ESA doses, dosing frequencies, hemoglobin levels, and red blood cell (RBC) transfusions were abstracted from electronic medical records.
A total of 438 patients were included in the analysis, of whom 201 (46%) were treated with darbepoietin alfa and 237 (54%) were treated with epoetin alfa. In the respective groups, similar proportions were male (121/201 [60%] and 126/237 [53%]) and white (146/195 [75%] and 140/184 [76%]); age was also similar (mean [SD], 62 [19] and 60 [18] years). The mean (SD) dose during the first week of ICU stay was 96.5 (40.5) microg with darbepoietin alfa and 33,439 (23,508) U with epoetin alfa. The most commonly prescribed dosing frequency with darbepoietin alfa was once weekly (88.1% of all prescribed doses), with a mean (SD) number of injections of 1.8 (1.75). With epoetin alfa, the most common dosing frequencies were 3 times weekly (35.9%), 1-time dosing (28.5%), and once weekly (24.0%), with a mean (SD) number of injections of 2.9 (4.2). In both groups, the duration of therapy was <or=1 week in ~50% of patients, and the mean change in hemoglobin concentration was 0.8 g/dL. Overall, 47% (darbepoietin alfa) and 44% (epoetin alfa) of patients were RBC transfusion independent (ie, did not require a transfusion during their ICU or hospital stay) after receiving the first ESA dose.
Based on these results, it is apparent that the practice patterns associated with ESA treatment of critically ill patients admitted to the ICU between February 2005 and September 2005 were highly variable.
贫血是重症监护病房（ICU）患者中常见的合并症。达贝泊汀α和促红细胞生成素α是用于治疗ICU患者贫血的促红细胞生成剂（ESA），尽管这两种药物均未被批准用于危重症患者。
本研究描述了入住ICU的贫血危重症患者使用ESA的实际情况。
共有19家医院参与了这项美国多中心、回顾性、观察性研究，研究对象为未接受慢性血液透析的成年患者，这些患者于2005年2月至2005年9月期间入住ICU≥24小时，并接受了≥1剂达贝泊汀α或促红细胞生成素α。从电子病历中提取了关于ESA剂量、给药频率、血红蛋白水平和红细胞（RBC）输注的数据。
共有438例患者纳入分析，其中201例（46%）接受达贝泊汀α治疗，237例（54%）接受促红细胞生成素α治疗。在各自的组中，男性比例相似（分别为121/201[60%]和126/237[53%]），白人比例也相似（分别为146/195[75%]和140/184[76%]）；年龄也相似（平均[标准差]，分别为62[19]岁和60[18]岁）。入住ICU第一周的平均（标准差）剂量，达贝泊汀α为96.5（40.5）μg，促红细胞生成素α为33439（23508）U。达贝泊汀α最常用的给药频率是每周一次（占所有规定剂量的88.1%），平均（标准差）注射次数为1.8（1.75）次。促红细胞生成素α最常见的给药频率是每周3次（35.9%）、单次给药（28.5%）和每周一次（24.0%），平均（标准差）注射次数为2.9（4.2）次。在两组中，约50%的患者治疗持续时间≤1周，血红蛋白浓度的平均变化为0.8g/dL。总体而言，47%（达贝泊汀α）和44%（促红细胞生成素α）的患者在接受第一剂ESA后无需输注红细胞（即，在ICU或住院期间不需要输血）。
基于这些结果，显然2005年2月至2005年9月期间入住ICU的危重症患者使用ESA治疗的实际情况差异很大。
