Outcomes related to intravenous fluid administration in sickle cell patients during vaso-occlusive crisis
Outcomes related to intravenous fluid administration in sickle cell patients during vaso-occlusive crisis
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DOI：
10.1007/s00277-020-04050-1
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发表时间：
2020-05-04
影响因子：
3.5
通讯作者：
Quinn, Roswell
中科院分区：
文献类型：
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作者：
Gaut, Daria;Jones, Jennifer;Quinn, Roswell
虽然液体替代疗法是镰状细胞病血管闭塞性危象的主要治疗方式，但其安全性、有效性和变异性的数据有限。我们对2013年至2017年在我们机构因血管闭塞发作住院的49名镰状细胞患者的157例独特患者进行了回顾性分析。中位住院时间为4天（IQR 2-7）。住院期间静脉输液的平均总量为7.4 L（标准9.6）。平均液体摄入总量（包括静脉输液、输血和口服液）为14.2 L（标准18.2）。多变量分析显示，任何不良事件的发生（包括新的氧气需求、急性胸部综合征、吸入事件、其他医院获得性感染、急性肾损伤和重症监护室转移）和以下变量：前24小时静脉输液（p = 0.001，OR 1.899，95% CI 1.319-2.733），静脉输液总量（p = 0.005，OR 1.081，95% CI 1.023-1.141）和液体摄入总量，包括口服液体、输血和静脉输液（p = 0.009，OR 1.046，95% CI 1.011-1.081）。与任何不良事件显著相关的其他因素包括入院前透析依赖（p < 0.001，OR 12.984，95% CI 3.660-46.056）和入院时住院服务与急诊室或观察单位（p = 0.008，OR 3.201，95% CI 1.346-7.612）。虽然理论上给予液体可以减缓镰状化过程，但该数据表明，在血管闭塞发作期间给予液体，特别是在前24小时给予的总体积，也可能导致不良事件。
While fluid replacement therapy is a primary treatment modality used in vaso-occlusive crises for sickle cell disease, data is limited on its safety, efficacy, and variability. We performed a retrospective analysis on 157 unique patient encounters from 49 sickle cell patients hospitalized with a vaso-occlusive episode at our institution from 2013 to 2017. The median length of hospital stay was 4 days (IQR 2-7). The mean total amount of intravenous fluid administered during the hospitalization was 7.4 L (Std 9.6). The mean total amount of fluid intake including intravenous fluids, blood transfusions, and oral fluids was 14.2 L (Std 18.2). Multivariate analyses revealed significant associations between the development of any adverse event (including a new oxygen requirement, acute chest syndrome, aspiration event, other hospital-acquired infection, acute kidney injury, and intensive care unit transfer) and the following variables: intravenous fluid administered in the first 24 h (p = 0.001, OR 1.899, 95% CI 1.319-2.733), total amount of intravenous fluid administered (p = 0.005, OR 1.081, 95% CI 1.023-1.141), and total amount of fluid intake including oral fluids, blood transfusions, and intravenous fluids (p = 0.009, OR 1.046, 95% CI 1.011-1.081). Other factors found to be significantly associated with any adverse event were dialysis dependence prior to admission (p < 0.001, OR 12.984, 95% CI 3.660-46.056) and admission to an inpatient service versus an emergency room or observation unit (p = 0.008, OR 3.201, 95% CI 1.346-7.612). While fluid administration may theoretically slow the sickling process, this data suggests that fluid administration during a vaso-occlusive episode, and especially total volume given in the first 24 h, may also lead to adverse events.