Wen Wen, Krinsky Scott, Kroshinsky Daniela, Durant Olivia, He Jeffrey, Seethapathy Rituvanthikaa, Hillien Shelsea Annette St, Mengesha Beza, Malhotra Rajeev, Chitalia Vipul, Nazarian Rosalynn M, Goverman Jeremy, Lyons Karen S, Nigwekar Sagar U
Division of Nephrology, Massachusetts General Hospital, Boston, MA.
Department of Dermatology, Massachusetts General Hospital, Boston, MA.
Mayo Clin Proc Innov Qual Outcomes. 2023 Jan 24;7(1):81-92. doi: 10.1016/j.mayocpiqo.2022.12.006. eCollection 2023 Feb.
To describe the pain intensity among hospitalized patients with calciphylaxis, elucidate the factors associated with pain improvement, and examine the link between pain improvement and clinical outcomes.
Patients were identified from the Partners Research Patient Data Registry and the Partners Calciphylaxis Registry and Biorepository (Clinicaltrials.gov ID: NCT03032835). Those with calciphylaxis requiring hospitalization for at least 14 consecutive days during the study period from May 2016 through December 2021 were included. Pain intensity was assessed using patient-reported pain scores on numerical rating scales from 0 to 10. Associations between pain improvement and clinical outcomes, including lesion improvement, amputation, and mortality, were examined using univariate and multivariate regression models.
Our analysis included 111 patients (age, 58±14 years; men, 40%; on maintenance dialysis, 79%). No significant improvement of pain intensity was observed over the 14 days of hospitalization (mean difference, -0.71; =.08). However, among 49 (44.1%) patients who showed at least 1-point improvement in the pain score, there was an association with surgical debridement during hospitalization (odds ratio, 3.37; 95% CI, 1.17-9.67; =.02). Hyperbaric oxygen therapy was associated with pain improvement (odds ratio, 5.38; 95% CI, 1.14-25.50; =.03) in patients on maintenance dialysis. Pain improvement was associated with lower rates of subsequent amputation at 6 months of follow up (6% vs 13%; <.05) but did not predict lesion improvement or survival.
Pain control remains a challenge among hospitalized patients with calciphylaxis. Surgical debridement and hyperbaric oxygen therapy may improve pain intensity. Pain improvement predicted a lower risk of future amputation.
描述钙化防御住院患者的疼痛强度，阐明与疼痛改善相关的因素，并研究疼痛改善与临床结局之间的联系。
从合作伙伴研究患者数据登记处以及合作伙伴钙化防御登记处和生物样本库（Clinicaltrials.gov标识符：NCT03032835）中识别患者。纳入在2016年5月至2021年12月研究期间因钙化防御需要连续住院至少14天的患者。使用患者报告的0至10数字评分量表上的疼痛评分评估疼痛强度。使用单变量和多变量回归模型研究疼痛改善与临床结局之间的关联，包括病变改善、截肢和死亡率。
我们的分析纳入了111例患者（年龄58±14岁；男性40%；接受维持性透析的患者占79%）。在住院的14天内未观察到疼痛强度有显著改善（平均差异为-0.71；P = 0.08）。然而，在49例（44.1%）疼痛评分至少改善1分的患者中，疼痛改善与住院期间的手术清创有关（比值比为3.37；95%置信区间为1.17 - 9.67；P = 0.02）。高压氧治疗与维持性透析患者的疼痛改善有关（比值比为5.38；95%置信区间为1.14 - 25.50；P = 0.03）。疼痛改善与随访6个月时后续截肢率较低相关（6%对13%；P < 0.05），但不能预测病变改善或生存情况。
对于钙化防御住院患者，疼痛控制仍然是一项挑战。手术清创和高压氧治疗可能会改善疼痛强度。疼痛改善预示着未来截肢风险较低。
