1 Department of Pharmaceutical Services, University of California San Francisco Medical Center, San Francisco, CA, USA.
2 Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
J Intensive Care Med. 2017 Oct;32(9):547-553. doi: 10.1177/0885066616657004. Epub 2016 Jul 19.
This study evaluated thiocyanate concentrations and factors associated with thiocyanate accumulation in intensive care unit patients receiving nitroprusside with and without sodium thiosulfate coadministration.
This retrospective study evaluated critically ill adults who received nitroprusside infusions and had at least one thiocyanate concentration. Patients with thiocyanate accumulation (concentrations ≥30 µg/mL) were compared to patients without accumulation. Factors associated with accumulation were determined by Spearman correlation and multivariate regression.
Thiocyanate concentrations (n = 192) were obtained from 87 patients. Fourteen of the 87 (16%) patients experienced thiocyanate accumulation with a mean (SD) thiocyanate concentration of 44 ± 11 µg/mL. Patients with accumulation had received greater cumulative nitroprusside doses (28 vs 8.2 mg/kg, P < .01), greater cumulative sodium thiosulfate doses (16.8 vs 10.1 mg/kg, P < .01), and longer infusion durations (10.9 vs 6.0 days, P < .01), compared to patients without accumulation. Sodium thiosulfate coadministration resulted in greater thiocyanate concentrations (22.8 ± 16.7 vs 16.8 ± 14.9 μg/mL, P = .01), despite utilization of lower cumulative nitroprusside doses (10.2 vs 14.6 mg/kg, P = .03). Cumulative nitroprusside dose ( r .44, P < .001) and cumulative sodium thiosulfate dose ( r .32, P < .001) demonstrated a significant correlation with measured thiocyanate concentrations. Thiocyanate accumulation was independently associated with cumulative nitroprusside dose in mg/kg (regression coefficient 0.75, 95% CI 0.63-0.89; P < .01). No clinically significant adverse effects of cyanide or thiocyanate toxicity were observed.
Cumulative nitroprusside dose was independently associated with thiocyanate accumulation. Despite elevated thiocyanate levels in 16% of patients, there was no clinical evidence of cyanide or thiocyanate toxicity. Routine monitoring of thiocyanate concentrations appears most warranted in patients receiving higher cumulative doses of nitroprusside.
本研究评估了接受硝普钠与（或）硫代硫酸钠联合治疗的重症监护病房患者的硫氰酸盐浓度及其与硫氰酸盐蓄积的相关性。
本回顾性研究纳入了接受硝普钠输注且至少有一次硫氰酸盐浓度检测结果的重症成年患者。比较了硫氰酸盐蓄积（浓度≥30μg/mL）患者与无蓄积患者。采用 Spearman 相关分析和多变量回归确定与蓄积相关的因素。
从 87 例患者中获得了 192 个硫氰酸盐浓度值。87 例患者中有 14 例（16%）出现硫氰酸盐蓄积，其平均（标准差）硫氰酸盐浓度为 44±11μg/mL。与无蓄积患者相比，硫氰酸盐蓄积患者接受的累积硝普钠剂量更大（28 比 8.2mg/kg，P＜0.01），累积硫代硫酸钠剂量更大（16.8 比 10.1mg/kg，P＜0.01），输注时间更长（10.9 比 6.0 天，P＜0.01）。与无蓄积患者相比，尽管使用的累积硝普钠剂量较低（10.2 比 14.6mg/kg，P=0.03），但硫代硫酸钠联合应用可导致更高的硫氰酸盐浓度（22.8±16.7 比 16.8±14.9μg/mL，P=0.01）。累积硝普钠剂量（r=0.44，P＜0.001）和累积硫代硫酸钠剂量（r=0.32，P＜0.001）与测量的硫氰酸盐浓度呈显著相关。硫氰酸盐蓄积与以 mg/kg 为单位的累积硝普钠剂量独立相关（回归系数 0.75，95%置信区间 0.63-0.89；P＜0.01）。未观察到氰化物或硫氰酸盐毒性的临床相关不良事件。
累积硝普钠剂量与硫氰酸盐蓄积独立相关。尽管 16%的患者硫氰酸盐水平升高，但无氰化物或硫氰酸盐毒性的临床证据。在接受较高累积硝普钠剂量的患者中，似乎最需要常规监测硫氰酸盐浓度。
