ICU重症患者替加环素相关性低纤维蛋白原血症的发生率及其危险因素分析

Incidence and risk factors of tigecycline associated hypofibrinogenemia in ICU patients

目的:探讨ICU重症患者应用替加环素(tigecycline,TGC)后TGC相关性低纤维蛋白原血症的发生率及危险因素,为临床安全合理使用TGC提供参考。方法:回顾性分析2018年9月至2021年6月南京医科大学第一附属医院各ICU 331例接受TGC治疗的成年重症患者的临床资料。按TGC使用剂量分为大剂量组和标准剂量组,根据用药后纤维蛋白原(fibrinogen,FIB)水平是否<2.0 g·L^(-1)分为低FIB组和正常FIB组。应用单因素和logistics回归分析TGC相关性低纤维蛋白原血症的危险因素,并分析低纤维蛋白原血症对患者预后的影响。结果:TGC相关性低纤维蛋白原血症的总发生率为59.9%,大剂量组与标准剂量组的发生率无显著差异(61.2%vs.58.3%,P>0.05)。单因素分析显示,疗程、合并肾损伤是TGC相关性低纤维蛋白原血症的危险因素,进一步多因素logistics分析显示疗程>9 d是独立危险因素(OR:3.100,95%CI:1.707~5.631,P<0.01),而高水平的基础FIB值则是保护因素(OR:0.621,95%CI:0.507~0.761,P<0.01)。低FIB组使用TGC后ICU住院时间显著长于正常FIB组[17(10,35)vs.12(6,22),P=0.01],而2组死亡率无显著差异(45.8%vs.35.8%,P=0.127)。结论:ICU重症患者使用TGC后易发生低纤维蛋白原血症,长疗程用药是其发生的独立危险因素。低纤维蛋白原血症能显著延长患者的ICU住院时间;TGC使用期间应定期监测,并及时治疗TGC相关性凝血功能障碍。

OBJECTIVE To investigate the incidence and risk factors of hypofibrinogenemia in ICU patients treated with tigecycline(TGC),so as to provide reference for safe and rational use of TGC in clinical practice.METHODS The clinical data of 331 adult patients in ICUs of The First Affiliated Hospital with Nanjing Medical University treated with TGC were retrospectively analyzed.According to the dose used,the patients were divided into high-dose group and standard dose group.According to whether the plasma fibrinogen(FIB)level was<2.0 g·L^(-1) after TGC treatment,the patients were divided into low-FIB group and normal-FIB group.The risk factors of TGC induced hypofibrinogenemia were determined via univariate and multivariate logistic regression analyses,and the impact of hypofibrinogenemia on the prognosis of patients was analyzed.RESULTS The overall incidence of hypofibrinogenemia after TGC treatment was 59.9%,and there was no significant difference in the incidence of hypofibrinogenemia between the high-dose group and the standard-dose group(61.2%vs.58.3%,P>0.05).Univariate analysis showed that the course of treatment and acute renal injury were risk factors for hypofibrinogenemia in ICU patients after TGC treatment.Further multivariate analysis showed that the course of treatment>9 days was an independent risk factor for TGC-related hypofibrinogenemia(OR:3.100,95%CI:1.707-5.631,P<0.01),and a high level of basal FIB was a protective factor(OR:0.621,95%CI:0.507-0.761,P<0.01).The duration of ICU stay after TGC use was significantly longer in the low-FIB group than that in the normal group[17(10,35)vs.12(6,22),P=0.01],but there was no significant difference in mortality between the two groups(45.8%vs.35.8%,P=0.127).CONCLUSION Severe ICU patients who use TGC are prone to developing hypofibrinogenemia,and long-term medication is an independent risk factor for its occurrence.Hypofibrinogenemia can significantly prolong the ICU hospitalization time of patients.Regular monitoring and timely treatment of TGC related coagulation dysfunction should be carried out during the use of TGC.