危重症患者替加环素相关低纤维蛋白原血症的临床特点及危险因素分析

Analysis of clinical characteristics and risk factors of tigecycline-associated hypofibrinogenemia in critically ill patients

目的 分析危重症患者替加环素相关低纤维蛋白原血症的临床特点及危险因素。方法 收集2019年1月1日至2021年12月31日在内蒙古自治区人民医院ICU接受替加环素治疗的重症感染患者资料,分为低纤维蛋白原血症组(纤维蛋白原<2.0 g/L)和正常纤维蛋白原组(纤维蛋白原≥2.0 g/L),比较两组患者的性别、年龄、基础疾病、治疗前纤维蛋白原水平、器官功能、感染指标以及替加环素用法用量、使用疗程、合并用药等差异。采用多因素logistic回归分析危重症患者替加环素相关低纤维蛋白原症的危险因素。结果 共纳入99例患者,低纤维蛋白原血症组37例,正常纤维蛋白原组62例。替加环素治疗后4.5(3.0~7.0)d出现低纤维蛋白原血症,停用替加环素3.5(3.0~5.0)d后纤维蛋白原水平恢复正常。多因素logistic回归分析发现,疗程(P=0.003)、高剂量(负荷剂量200 mg,维持剂量100 mg,每12 h 1次,P=0.010)、替加环素治疗前纤维蛋白原水平(P=0.001)是危重症患者导致低纤维蛋白原血症的独立危险因素。结论 低纤维蛋白原血症多发生于替加环素治疗后4.5(3.0~7.0)d,其与替加环素疗程、剂量、替加环素治疗前纤维蛋白原水平有关,临床应予以重视。

Objective To analyze the clinical characteristics and risk factors of tigecycline-associated hypofibrinogenemia in critically ill patients.Methods The data of patients with severe infections who were treated with tigecycline in the ICU of the Inner Mongolia People's Hospital from January 1,2019 to December 31,2021 were collected.They were divided into hypofibrinogenemia group(fibrinogen<2.0 g/L) and normal fibrinogen group(fibrinogen≥2.0 g/L).Differences in sex,age,underlying diseases,pre-treatment fibrinogen levels,organ function,infection index,tigecycline dosage and duration,and concomitant medication were compared between the two groups.Multivariate logistic regression was used to analyze the risk factors of tigecycline-related hypofibrinogenemia in critically ill patients.Results A total of 99 patients were enrolled,with 37 patients in the hypofibrinogenemia group and 62 in the normal fibrinogen group.The median time of onset of hypofibrinogenemia was 4.5(3.0 to 7.0) days after tigecycline initiation,and the median time of fibrinogen levels returned to normal was 3.5(3.0 to 5.0) days after discontinuation of tigecycline.In multivariate logistic regression analysis,duration of treatment(P=0.003),high dose(loading dose 200 mg,maintaining dose 100 mg,every 12 hours,P=0.010) and pre-treatment fibrinogen levels(P=0.001) were independent risk factors for hypofibrinogenemia.Conclusion Tigecycline-associated hypofibrinogenemia usually occurs 4.5(3.0 to 7.0) days after treatment,and is related to its duration and dosage,as well as pre-treatment fibrinogen levels.They should be given attention in clinical practice.