Zhang Xingcheng, Li Zhuangli, Lei Xiqun, Wang Huaxue, Shan Nanbing, Sun Yun
The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
Department of Critical Care Medicine, Fuyang Second People's Hospital, Fuyang, Anhui, China.
Front Med (Lausanne). 2025 Aug 6;10:1618914. doi: 10.3389/fmed.2025.1618914. eCollection 2025.
To evaluate the efficacy of sivelestat sodium in reducing ventilator-associated pneumonia (VAP) in patients with sepsis and acute respiratory distress syndrome (ARDS).
A retrospective analysis was performed on the clinical data of 187 adult patients with sepsis combined with ARDS admitted to the intensive care unit (ICU) of Fuyang Second People's Hospital from 1 January 2022 to 1 December 2024. Among these patients, 60 received sivelestat sodium as part of their treatment, while 127 did not. The treatment efficacy indices were oxygenation index (PaO/FiO), procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6) levels (all measured before and within 7 days of treatment), and VAP, bacteremia, time to first mechanical ventilation, CRRT, length of stay in ICU, length of stay, and 28 days mortality.
There were no significant differences in age, sex, comorbidities, use of hormones, use of vasoactive drugs, APACHE II score, or SOFA score between the two groups before treatment. Compared with patients who did not receive sivelestat sodium, those treated with sivelestat sodium had significantly lower incidences of VAP (χ = 6.910, = 0.009) and bacteremia (χ = 5.372, = 0.023), as well as shorter times to first mechanical ventilation (t = -2.071, = 0.041) and ICU stays (t = -2.085, = 0.039). At 28 days, the fatality rate in the sivelestat group was 33.33%, and that in the control group was 34.65%, although this slight reduction was not significant (χ = 0.031, = 1.000). There was also no significant difference in the length of stay between the two groups (t = -0.609, = 0.054). Log-Rank test analysis revealed that the time without VAP in the sivelestat group was significantly longer than that in the control group (χ = 7.600, = 0.006). After adjusting for APACHE II score and age, COX proportional risk model analysis revealed that the 28 days survival risk for VAP with sivelestat sodium was 34.67% higher than that in the control group (Z = -2.537, = 0.011).
Sivelestat sodium therapy was associated with a reduced incidence of VAP and a shorter ICU stay in patients with ARDS. However, there was no significant benefit on 28 days survival or total hospital stay.
评估西维来司他钠在降低脓毒症和急性呼吸窘迫综合征（ARDS）患者呼吸机相关性肺炎（VAP）方面的疗效。
对2022年1月1日至2024年12月31日在阜阳市第二人民医院重症监护病房（ICU）收治的187例成年脓毒症合并ARDS患者的临床资料进行回顾性分析。其中，60例患者接受西维来司他钠治疗，127例未接受。治疗疗效指标包括氧合指数（PaO/FiO）、降钙素原（PCT）、C反应蛋白（CRP）和白细胞介素-6（IL-6）水平（均在治疗前及治疗7天内测量），以及VAP、菌血症、首次机械通气时间、连续性肾脏替代治疗（CRRT）、ICU住院时间、总住院时间和28天死亡率。
两组治疗前在年龄、性别、合并症、激素使用、血管活性药物使用、急性生理与慢性健康状况评分系统II（APACHE II）评分或序贯器官衰竭评估（SOFA）评分方面无显著差异。与未接受西维来司他钠治疗的患者相比，接受西维来司他钠治疗的患者VAP发生率（χ = 6.910，P = 0.009）和菌血症发生率（χ = 5.372，P = 0.023）显著更低，首次机械通气时间（t = -2.071，P = 0.041）和ICU住院时间（t = -2.085，P = 0.039）也更短。28天时，西维来司他钠组的死亡率为33.33%，对照组为34.65%，尽管这一轻微降低无统计学意义（χ = 0.031，P = 1.000）。两组总住院时间也无显著差异（t = -0.609，P = 0.054）。对数秩检验分析显示，西维来司他钠组无VAP的时间显著长于对照组（χ = 7.600，P = 0.006）。在调整APACHE II评分和年龄后，COX比例风险模型分析显示，使用西维来司他钠治疗VAP的28天生存风险比对照组高34.67%（Z = -2.537，P = 0.011）。
西维来司他钠治疗可降低ARDS患者的VAP发生率，并缩短ICU住院时间。然而，在28天生存率或总住院时间方面无显著益处。
