Department of Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Japan.
Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashi-ku, Japan.
J Clin Pharm Ther. 2022 Jul;47(7):1070-1078. doi: 10.1111/jcpt.13646. Epub 2022 Mar 21.
Nafamostat mesylate (NM) is used clinically in combination with antiviral drugs to treat coronavirus disease (COVID-19). One of the adverse events of NM is hyperkalaemia due to inhibition of the amiloride-sensitive sodium channels (ENaC). The incidence and risk factors for hyperkalaemia due to NM have been studied in patients with pancreatitis but not in COVID-19. COVID-19 can be associated with hypokalaemia or hyperkalaemia, and SARS-CoV-2 is thought to inhibit ENaC. Therefore, frequency and risk factors for hyperkalaemia due to NM may differ between COVID-19 and pancreatitis. Hyperkalaemia may worsen the respiratory condition of patients. The objective of this study was to determine the incidence and risk factors for hyperkalaemia in COVID-19 patients treated with favipiravir, dexamethasone and NM.
This retrospective study reviewed the records of hospitalized COVID-19 patients treated with favipiravir and dexamethasone, with or without NM, between March 2020 and January 2021. Multivariable logistic regression analysis was performed to identify the risk factors for hyperkalaemia.
Of 45 patients who received favipiravir and dexamethasone with NM for the treatment of COVID-19, 21 (47%) experienced hyperkalaemia. The duration of NM administration was a significant predictor of hyperkalaemia (odds ratio: 1.55, 95% confidence interval: 1.04-2.31, p = 0.031). The receiver-operating characteristic curve analysis determined that the cut-off value for predicting the number of days until the onset of hyperkalaemia was 6 days and the area under the curve was 0.707.
This study revealed that the incidence of hyperkalaemia is high in patients treated for COVID-19 with NM, and that the duration of NM administration is a key risk factor. When NM is administered for the treatment of COVID-19, it should be discontinued within 6 days to minimize the risk of hyperkalaemia.
甲磺酸萘莫司他（NM）在临床上与抗病毒药物联合用于治疗冠状病毒病（COVID-19）。NM 的不良反应之一是由于抑制阿米洛利敏感的钠离子通道（ENaC）而导致的高钾血症。在胰腺炎患者中已经研究了 NM 引起高钾血症的发生率和危险因素，但在 COVID-19 中尚未研究。COVID-19 可伴有低钾血症或高钾血症，并且认为 SARS-CoV-2 抑制 ENaC。因此，NM 引起的高钾血症在 COVID-19 和胰腺炎中的频率和危险因素可能不同。高钾血症可能使患者的呼吸状况恶化。本研究的目的是确定用奈玛特韦/利托那韦、地塞米松和 NM 治疗 COVID-19 患者发生高钾血症的发生率和危险因素。
本回顾性研究回顾了 2020 年 3 月至 2021 年 1 月期间接受奈玛特韦/利托那韦和地塞米松联合或不联合 NM 治疗的住院 COVID-19 患者的记录。进行多变量逻辑回归分析以确定高钾血症的危险因素。
在 45 名接受 NM 治疗 COVID-19 的患者中，有 21 名（47%）出现高钾血症。NM 给药时间是高钾血症的显著预测因子（优势比：1.55，95%置信区间：1.04-2.31，p=0.031）。受试者工作特征曲线分析确定预测高钾血症发作天数的截止值为 6 天，曲线下面积为 0.707。
本研究表明，NM 治疗 COVID-19 患者的高钾血症发生率较高，NM 给药时间是关键的危险因素。当 NM 用于治疗 COVID-19 时，应在 6 天内停药，以最大程度降低高钾血症的风险。
