Peng Danyang, Zhang Fan, Li Zhaozhen, Lyu Pin, Guo Ziqi, Chen Yinyin, Zhao Jingge, Niu Jingjing, Guo Bo, Jia Wenqing, Jiang Xiaofeng, Li Xiaozhao, Qi Shaoyan, Qin Bingyu, Shao Huanzhang
Department of Critical Care Medicine, People's Hospital of Henan University, Zhengzhou 450003, Henan, China.
Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, Henan, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Jan;35(1):88-92. doi: 10.3760/cma.j.cn121430-20220906-00819.
To investigate the effects of continuous renal replacement therapy (CRRT) on plasma concentration, clinical efficacy and safety of colistin sulfate.
Clinical data of patients received with colistin sulfate were retrospectively analyzed from our group's previous clinical registration study, which was a prospective, multicenter observation study on the efficacy and pharmacokinetic characteristics of colistin sulfate in patients with severe infection in intensive care unit (ICU). According to whether patients received blood purification treatment, they were divided into CRRT group and non-CRRT group. Baseline data (gender, age, whether complicated with diabetes, chronic nervous system disease, etc), general data (infection of pathogens and sites, steady-state trough concentration, steady-state peak concentration, clinical efficacy, 28-day all-cause mortality, etc) and adverse event (renal injury, nervous system, skin pigmentation, etc) were collected from the two groups.
A total of 90 patients were enrolled, including 22 patients in the CRRT group and 68 patients in the non-CRRT group. (1) There was no significant difference in gender, age, basic diseases, liver function, infection of pathogens and sites, colistin sulfate dose between the two groups. Compared with the non-CRRT group, the acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) were higher in the CRRT group [APACHE II: 21.77±8.26 vs. 18.01±6.34, P < 0.05; SOFA: 8.5 (7.8, 11.0) vs. 6.0 (4.0, 9.0), P < 0.01], serum creatinine level was higher [μmol/L: 162.0 (119.5, 210.5) vs. 72.0 (52.0, 117.0), P < 0.01]. (2) Plasma concentration: there was no significant difference in steady-state trough concentration between CRRT group and non-CRRT group (mg/L: 0.58±0.30 vs. 0.64±0.25, P = 0.328), nor was there significant difference in steady-state peak concentration (mg/L: 1.02±0.37 vs. 1.18±0.45, P = 0.133). (3) Clinical efficacy: there was no significant difference in clinical response rate between CRRT group and non-CRRT group [68.2% (15/22) vs. 80.9% (55/68), P = 0.213]. (4) Safety: acute kidney injury occurred in 2 patients (2.9%) in the non-CRRT group. No obvious neurological symptoms and skin pigmentation were found in the two groups.
CRRT had little effect on the elimination of colistin sulfate. Routine blood concentration monitoring (TDM) is warranted in patients received with CRRT.
探讨持续肾脏替代治疗（CRRT）对硫酸黏菌素血浆浓度、临床疗效及安全性的影响。
回顾性分析本团队既往临床注册研究中接受硫酸黏菌素治疗患者的临床资料，该研究是一项关于硫酸黏菌素在重症监护病房（ICU）重症感染患者中的疗效及药代动力学特征的前瞻性、多中心观察研究。根据患者是否接受血液净化治疗，将其分为CRRT组和非CRRT组。收集两组的基线资料（性别、年龄、是否合并糖尿病、慢性神经系统疾病等）、一般资料（病原体及感染部位、稳态谷浓度、稳态峰浓度、临床疗效、28天全因死亡率等）及不良事件（肾损伤、神经系统、皮肤色素沉着等）。
共纳入90例患者，其中CRRT组22例，非CRRT组68例。（1）两组在性别、年龄、基础疾病、肝功能、病原体及感染部位、硫酸黏菌素剂量方面无显著差异。与非CRRT组相比，CRRT组的急性生理与慢性健康状况评分系统II（APACHE II）和序贯器官衰竭评估（SOFA）更高[APACHE II：21.77±8.26 vs. 18.01±6.34，P<0.05；SOFA：8.5（7.8，11.0）vs. 6.0（4.0，9.0），P<0.01]，血清肌酐水平更高[μmol/L：162.0（119.5，210.5）vs. 72.0（52.0，117.0），P<0.01]。（2）血浆浓度：CRRT组与非CRRT组的稳态谷浓度无显著差异（mg/L：0.58±0.30 vs. 0.64±0.25，P = 0.328），稳态峰浓度也无显著差异（mg/L：1.02±0.37 vs. 1.18±0.45，P = 0.133）。（3）临床疗效：CRRT组与非CRRT组的临床有效率无显著差异[68.2%（15/22）vs. 80.9%（55/68），P = 0.213]。（4）安全性：非CRRT组有例患者发生急性肾损伤（2.9%）。两组均未发现明显的神经症状和皮肤色素沉着。
CRRT对硫酸黏菌素的清除作用较小。接受CRRT治疗的患者有必要进行常规血药浓度监测（TDM）。
