依拉环素致老年患者凝血功能异常的相关因素研究OA

Objective To investigate relative factors of coagulation abnormalities induced by eravacycline injection in elderly patients.Methods Elderly patients(age≥65 years)who received eravacycline for infection were enrolled.The patients were divided into the abnormal coagulation group and the normal coagulation group based on whether there was prolongation of prothrombin time(PT)by more than 3 seconds and/or a decrease in fibrinogen to ≤ 1.5 g·L-1.The clinical data,medication prescribed,sequential organ failure assessment(SOFA)score,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,and nutrition risk screening 2002(NRS2002)score before treatment were recorded.The incidence of coagulation abnormalities after eravacycline injection treatment was statistically analyzed.Comorbidities,baseline liver,kidney function,coagulation function,SOFA,APACHE Ⅱ and NRS2002 scores were compared between normal coagulation group and abnormal coagulation group.Logistic regression analyses were performed for further exploration.Results A total of 84 elderly patients were enrolled.At 1 week of eravacycline injection treatment,33 patients developed coagulation abnormalities,with an incidence rate of 39.29％(33 cases/84 cases).The proportion of chronic liver disease of normal coagulation group and abnormal coagulation group were 6.00％(3 cases/51 cases)and 24.24％(8 cases/33 cases),respectively;the proportion of combined antithrombotic drugs were 68.00％(34 cases/51 cases)and 45.45％(15 cases/33 cases),respectively;baseline levels of white blood cell count were 8.30(4.55,12.41)and 11.40(7.08,13.88)× 109·L-1,respectively;total bilirubin(TBIL)levels were 14.00(10.80,19.83)and 23.50(14.70,46.90)umol·L-1,respectively;direct bilirubin(DBIL)levels were 5.98(3.69,9.60)and 9.50(6.20,25.05)umol·L-1,respectively;C-reactive protein(CRP)levels were 57.91(22.43,97.33)and 69.20(33.87,86.54)mg·L-1,respectively;interleukin-6(IL-6)levels were 43.11(22.26,106.98)and 91.12(24.30,181.60)pg·mL-1,respectively;PT were 12.90(11.95,15.00)and 14.40(12.80,15.70)s,respectively;activated partial thromboplastin time(APTT)were 31.50(28.35,34.00)and 34.10(30.70,37.95)s,respectively;international normalized ratio(INR)were 1.13(1.05,1.29)and 1.27(1.13,1.36),respectively.The differences of above indicators between the two groups were all statistically significant(all P＜0.05).Regression analysis showed that TBIL was associated with eravacycline injection-induced coagulation abnormalities in elderly patients,with an odds ratio(OR)of 1.04(P＜0.05).Among the 62 patients who received eravacycline injection for more than 1 week,27 developed coagulation abnormalities by the end of treatment,with an incidence rate of 43.55％(27 cases/62 cases).The proportion of chronic kidney disease of normal coagulation group and abnormal coagulation group were 29.41％(10 cases/35 cases)and 59.26％(16 cases/27 cases),respectively;the proportion of combined antithrombotic drugs were 70.59％(24 cases/35 cases)and 40.74％(11 cases/27 cases),respectively;baseline APACHE Ⅱ scores were(14.82±6.62)and(19.68±6.38)point,respectively;NRS2002 scores were 4.00(3.00,4.00)and 5.00(3.50,7.00)point,respectively;CRP levels were 57.62(21.48,83.29)and 88.11(49.11,149.80)mg·L-1,respectively;IL-6 levels were 26.45(13.58,78.82)and 99.32(43.79,191.57)pg·mL-1,respectively;APTT were 30.30(28.10,33.15)and 33.90(28.90,36.40)s,respectively;platelet levels were 176.50(120.25,225.50)and 132.00(81.00,195.00)×109·L-1,respectively.The differences of above indicatiors between the two groups were all statistically significant(all P＜0.05).Regression analysis showed that the NRS2002 score was associated with eravacycline-induced coagulation abnormalities in elderly patients,with an OR of 2.04(P＜0.05).The incidence of coagulation abnormalities increases with the prolongation of eravacycline injection treatment.The dosage of eravacycline of normal coagulation group and abnormal coagulation group were(0.78±0.14)and(0.84±0.17)mg·kg-1,the difference between the two groups was not statistically significant(P＞0.05)Conclusion Coagulation abnormalities may occur in elderly patients treated with eravacycline injection.Total bilirubin level and NRS2002 score are risk factors for coagulation abnormalities.Coagulation indicators should be closely monitored during treatment.