Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School; Center for Individualized Infection Medicine (CiiM), Hannover; German Center for Infection Research (DZIF), German Liver Foundation, HepNet, Hannover; Twincore, Center for Experimental and Clinical Infection Research, Hannover; German Center for Infection Research (DZIF), Hannover-Braunschweig; Institute for Clinical Pharmacology, Hannover Medical School.
Dtsch Arztebl Int. 2022 Oct 14;119(41):687-693. doi: 10.3238/arztebl.m2022.0280.
Because of the increased risk of acute renal failure (ARF), the use of cyclooxygenase (COX) inhibitors is not recommended in patients with decompensated hepatic cirrhosis. Metamizole is not a classic COX inhibitor, but there are insufficient data to support its safe use. In this study, we investigate the effect of metamizole on the risk of ARF in these patients.
Metamizole use, ARF incidence, and patient mortality were examined in a large, retrospective, exploratory cohort and validated with data from a prospective registry.
523 patients were evaluated in the exploratory cohort. Metamizole use at baseline was documented in 110 cases (21%) and was independently associated with the development of ARF, severe (grade 3) ARF, and lower survival without liver transplantation at follow-up on day 28 (HR: 2.2, p < 0.001; HR: 2.8, p < 0.001; and HR: 2.6, p < 0.001, respectively). Interestingly, the risk of ARF depended on the dose of metamizole administered (HR: 1.038, p < 0.001). Compared to patients who were treated with opioids, the rate of ARF was higher in the metamizole group (49% vs. 79%, p = 0.014). An increased risk of ARF with metamizole use was also demonstrated in the independent validation cohort (p < 0.001).
Metamizole therapy, especially at high doses, should only be used with a high level of caution in patients with decompensated cirrhosis.
由于急性肾衰竭（ARF）风险增加，不建议失代偿性肝硬化患者使用环氧化酶（COX）抑制剂。美洛昔康不是经典的 COX 抑制剂，但缺乏安全使用的数据支持。在这项研究中，我们研究了美洛昔康对这些患者发生 ARF 的影响。
在一个大型回顾性探索性队列中检查了美洛昔康的使用、ARF 发生率和患者死亡率，并使用前瞻性登记的数据进行了验证。
在探索性队列中评估了 523 例患者。基线时记录了 110 例（21%）患者使用美洛昔康，且与 ARF、严重（3 级）ARF 和无肝移植随访 28 天生存率降低独立相关（HR：2.2，p < 0.001；HR：2.8，p < 0.001；HR：2.6，p < 0.001）。有趣的是，ARF 的风险取决于美洛昔康的给药剂量（HR：1.038，p < 0.001）。与接受阿片类药物治疗的患者相比，美洛昔康组的 ARF 发生率更高（49%比 79%，p = 0.014）。在独立验证队列中也证明了美洛昔康使用与 ARF 风险增加相关（p < 0.001）。
美洛昔康治疗，特别是高剂量，应仅在失代偿性肝硬化患者中谨慎使用。
