Epsilon aminocaproic acid is associated with acute kidney injury after life-threatening hemorrhage in children.
Epsilon aminocaproic acid is associated with acute kidney injury after life-threatening hemorrhage in children.
复制标题
ε-氨基己酸与儿童危及生命的出血后的急性肾损伤有关。
DOI：
10.1111/trf.17373
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发表时间：
2023
期刊：
影响因子：
2.9
通讯作者：
Spinella,PhilipC
中科院分区：
文献类型：
--
作者：
Kolodziej,JuliaH;Leeper,ChristineM;Leonard,JulieC;Josephson,CassandraD;Zenati,MazenS;Spinella,PhilipC
研究设计和方法我们对儿童大量输血（阿基）进行了二次分析，MATIC是一个前瞻性收集的危及生命的出血（LTH）儿童的数据库，并评估了抗纤维蛋白溶解治疗，氨基己酸（EACA）或氨甲环酸（TXA）。主要结果是阿基和次要结果是急性呼吸窘迫综合征（ARDS）和sepsis.ResultsOf 448名儿童包括，中位数（四分位数范围）年龄为7（2-15）岁，55%是男性，和LTH病因是46%创伤，34%手术，和20%的医疗。393例患者未接受抗纤溶药物（88%）; 37例（8%）接受TXA，18例（4%）接受EACA。无抗纤溶组中67例（17.1%）患者发生阿基，TXA组中6例（16.2%）患者，EACA组中9例（50%）患者（p= 0.002）。在调整心胸手术、紫绀性心脏病、既存肾脏疾病、LTH前最低血红蛋白和LTH期间体重调整后的总输血量后，与无抗纤溶药物组相比，EACA组的阿基风险增加（调整后比值比3.3 [95% CI：1.0-10.3]）。TXA与阿基无关。抗纤溶治疗与ARDS或败血症均无关。结论LTH期间给予EACA可能会增加阿基的风险。需要进行更多的研究来比较EACA和TXA在儿科患者中发生阿基的风险。
BackgroundAntifibrinolytic medications have been associated with reduced mortality in pediatric hemorrhage but may contribute to adverse events such as acute kidney injury (AKI).Study Design and MethodsWe conducted a secondary analysis of the MAssive Transfusion in Children (MATIC), a prospectively collected database of children with life‐threatening hemorrhage (LTH), and evaluated for risk of adverse events with either antifibrinolytic treatment, epsilon aminocaproic acid (EACA) or tranexamic acid (TXA). The primary outcome was AKI and secondary outcomes were acute respiratory distress syndrome (ARDS) and sepsis.ResultsOf 448 children included, median (interquartile range) age was 7 (2–15) years, 55% were male, and LTH etiology was 46% trauma, 34% operative, and 20% medical. Three hundred and ninety‐three patients did not receive an antifibrinolytic (88%); 37 (8%) received TXA and 18 (4%) received EACA. Sixty‐seven (17.1%) patients in the no antifibrinolytic group developed AKI, 6 (16.2%) patients in the TXA group, and 9 (50%) patients in the EACA group (p= .002). After adjusting for cardiothoracic surgery, cyanotic heart disease, preexisting renal disease, lowest hemoglobin pre‐LTH, and total weight‐adjusted transfusion volume during the LTH, the EACA group had increased risk of AKI (adjusted odds ratio 3.3 [95% CI: 1.0–10.3]) compared to no antifibrinolytic. TXA was not associated with AKI. Neither antifibrinolytic treatment was associated with ARDS or sepsis.ConclusionAdministration of EACA during LTH may increase the risk of AKI. Additional studies are needed to compare the risk of AKI between EACA and TXA in pediatric patients.