Moss Jeffrey D, Wu May, Axelrod David M, Kwiatkowski David M
Department of Pharmacy, Lucile Packard Children's Hospital Stanford, Palo Alto, USA.
Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, USA.
Cardiol Young. 2019 Sep;29(9):1160-1164. doi: 10.1017/S1047951119001653.
Limited data exist for management of hyperuricemia in non-oncologic patients, particularly in paediatric cardiac patients. Hyperuricemia is a risk factor for acute kidney injury and may prompt treatment in critically ill patients. The primary objective was to determine if rasburicase use was associated with greater probability normalisation of serum uric acid compared to allopurinol. Secondary outcomes included percent reduction in uric acid, changes in serum creatinine, and cost of therapy.
A single-centre retrospective chart review.
A 20-bed quaternary cardiovascular ICU in a university-based paediatric hospital in California.
Patients admitted to cardiovascular ICU who received rasburicase or intravenous allopurinol between 2015 and 2016.
None.
Data from a cohort of 14 patients receiving rasburicase were compared to 7 patients receiving IV allopurinol. Patients who were administered rasburicase for hyperuricemia were more likely to have a post-treatment uric acid level less than 8 mg/dl as compared to IV allopurinol (100 versus 43%; p = 0.0058). Patients who received rasburicase had a greater absolute reduction in post-treatment day 1 uric acid (-9 mg/dl versus -1.9 mg/dl; p = 0.002). There were no differences in post-treatment day 3 or day 7 serum creatinine or time to normalisation of serum creatinine. The cost of therapy normalised to a 20 kg patient was greater in the allopurinol group ($18,720 versus $1928; p = 0.001).
In a limited paediatric cardiac cohort, the use of rasburicase was associated with a greater reduction in uric acid levels and associated with a lower cost compared to IV allopurinol.
关于非肿瘤患者高尿酸血症管理的数据有限，尤其是儿科心脏病患者。高尿酸血症是急性肾损伤的危险因素，可能促使对危重症患者进行治疗。主要目的是确定与别嘌醇相比，使用拉布立酶是否更有可能使血清尿酸正常化。次要结局包括尿酸降低百分比、血清肌酐变化和治疗费用。
单中心回顾性病历审查。
加利福尼亚州一家大学附属医院的拥有20张床位的四级心血管重症监护病房。
2015年至2016年间入住心血管重症监护病房并接受拉布立酶或静脉注射别嘌醇的患者。
无。
将14例接受拉布立酶治疗的患者队列数据与7例接受静脉注射别嘌醇治疗的患者数据进行比较。与静脉注射别嘌醇相比，因高尿酸血症接受拉布立酶治疗的患者治疗后尿酸水平低于8mg/dl的可能性更高（100%对43%；p = 0.0058）。接受拉布立酶治疗的患者在治疗后第1天尿酸的绝对降低幅度更大（-9mg/dl对-1.9mg/dl；p = 0.002）。治疗后第3天或第7天的血清肌酐或血清肌酐恢复正常的时间没有差异。以体重20kg患者为标准计算，别嘌醇组的治疗费用更高（18720美元对1928美元；p = 0.001）。
在一个有限的儿科心脏病队列中，与静脉注射别嘌醇相比，使用拉布立酶可使尿酸水平降低幅度更大且成本更低。
