Li Zhaolin, Zeng Qiaojun, Xu Shuwan, Li Yuewei, Tang Tiantian, Shi Jianting, Song Xueming, He Wenman, Chen Liang, Liu Guirong, Gao Boying, Zheng Jianming, Huang Linjie, Chen Ming, Jiang Shanping
Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
Department of Cardiology, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, People's Republic of China.
Infect Drug Resist. 2023 Jan 24;16:423-434. doi: 10.2147/IDR.S388438. eCollection 2023.
Although tigecycline is an effective drug against drug-resistant bacteria, it demonstrated a higher all-cause mortality than comparator antibiotics and a high incidence of coagulation disorders which can be accompanied by severe bleeding. At present, a predictive model for tigecycline-related coagulopathy is not readily available, and the prognostic value of coagulopathy in tigecycline-administered patients has not been elucidated. In this paper, we investigate the association between tigecycline-related coagulopathy and in-hospital mortality to develop a nomogram for the prediction of tigecycline-related coagulopathy.
This retrospective cohort study includes 311 adults prescribed with tigecycline from 2018 to 2020. The primary cohort and validation cohort were constructed by dividing the participants in a ratio of 7:3. The endpoint is tigecycline-related coagulopathy, defined as a condition with no abnormality in coagulation prior to tigecycline application but developed the following symptoms upon prescription: activated partial thromboplastin time (APTT) extended by >10 s than the upper limit of normal (ULN), prothrombin time (PT) prolonged for >3 s than the ULN or reduced serum level of fibrinogen to <2.0 g/L. A predictive nomogram based on logistic regression was subsequently constructed.
Tigecycline intake for over 7 days, combined other antibiotics, initial PT, initial fibrinogen and estimated glomerular filtration rate (eGFR), are independent prognostic factors of tigecycline-related coagulopathy. The primary and validation cohort each has an area under the receiver operating characteristic curve (AUC) of 0.792 (0.732-0.851) and 0.730 (0.629-0.832) for nomogram, respectively. Furthermore, the fitted calibration curve illustrated adequate fit of the model, while the decision curve analysis demonstrated good clinical value. Survival curves showed a high mortality rate among patients with tigecycline-related coagulopathy.
This nomogram exhibited helpful clinical value in predicting tigecycline-related coagulopathy that could reduce the high mortality rate of patients prescribed with tigecycline.
尽管替加环素是一种对抗耐药菌有效的药物，但它显示出比对照抗生素更高的全因死亡率以及高发生率的凝血障碍，且可能伴有严重出血。目前，尚无现成的替加环素相关凝血病预测模型，替加环素治疗患者中凝血病的预后价值也尚未阐明。在本文中，我们研究替加环素相关凝血病与院内死亡率之间的关联，以建立一个预测替加环素相关凝血病的列线图。
这项回顾性队列研究纳入了2018年至2020年期间311例接受替加环素治疗的成年人。按照7:3的比例将参与者分为初级队列和验证队列。终点是替加环素相关凝血病，定义为在应用替加环素前凝血无异常，但用药后出现以下症状：活化部分凝血活酶时间（APTT）延长超过正常上限（ULN）10秒以上、凝血酶原时间（PT）延长超过ULN 3秒以上或纤维蛋白原血清水平降至<2.0 g/L。随后基于逻辑回归构建了一个预测列线图。
替加环素使用超过7天、联合使用其他抗生素、初始PT、初始纤维蛋白原和估计肾小球滤过率（eGFR）是替加环素相关凝血病的独立预后因素。列线图在初级队列和验证队列中的受试者工作特征曲线（AUC）下面积分别为0.792（0.732 - 0.851）和0.730（0.629 - 0.832）。此外，拟合校准曲线表明模型拟合良好，而决策曲线分析显示出良好的临床价值。生存曲线显示替加环素相关凝血病患者的死亡率很高。
该列线图在预测替加环素相关凝血病方面具有有益的临床价值，可降低接受替加环素治疗患者的高死亡率。
