Fluid overload due to intravenous fluid therapy for vaso-occlusive crisis in sickle cell disease: incidence and risk factors.
Fluid overload due to intravenous fluid therapy for vaso-occlusive crisis in sickle cell disease: incidence and risk factors.
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DOI：
10.1111/bjh.17696
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发表时间：
2021-09
影响因子：
6.5
通讯作者：
Nur E
中科院分区：
文献类型：
--
作者：
Gaartman AE;Sayedi AK;Gerritsma JJ;de Back TR;van Tuijn CF;Tang MW;Heijboer H;de Heer K;Biemond BJ;Nur E
静脉液体疗法(IV-FT)通常用于血管闭塞危象(VOCs)的治疗，因为脱水可能促进和维持红细胞的病态。镰状细胞病(SCD)患者由于静脉注射FT而有发生舒张期功能障碍和液体超负荷的风险。然而，关于IV-FT对VOC的不利影响的数据很少。我们的目的是评估SCD患者静脉注射FT所致液体超负荷的发生率和危险因素。回顾分析2016年9月至2018年9月期间接受IV-FT治疗的VOC患者的连续住院情况。中位数(四分位数范围)年龄为25.0岁(18.3-33.8岁)，65%的人有严重的HbSS/Hbsβ0-THAL基因。在100名患者中，21%的患者发生了液体超载。液体超负荷的患者住院天数较长(6.0天比4.0天，P=0.037)。液体超负荷史(P=0.017)、乳酸脱氢酶水平(P=0.011)、入院时补液(P=0.005)是液体超负荷发生的独立危险因素。尽管既往有液体超负荷的病史，但86%的患者的IV-FT没有减少。在对VOC进行IV-FT时，经常会遇到液体超载的情况。尽管有体液超负荷的阳性病史或需要补充输液，但IV-FT经常不会调整，强调需要更多地意识到这种并发症和个性化的方法。
Intravenous fluid therapy (IV‐FT) is routinely used in the treatment of vaso‐occlusive crises (VOCs), as dehydration possibly promotes and sustains erythrocyte sickling. Patients with sickle cell disease (SCD) are at risk of developing diastolic dysfunction and fluid overload due to IV‐FT. However, data on the adverse effects of IV‐FT for VOC is sparse. We aimed to evaluate the incidence and risk factors of fluid overload due to IV‐FT in patients with SCD. Consecutive hospitalisations for VOC treated with IV‐FT between September 2016 and September 2018 were retrospectively analysed. The median (interquartile range) age was 25·0 (18·3–33·8) years and 65% had a severe genotype (HbSS/HbSβ0‐thal). Fluid overload occurred in 21% of 100 patients. Hospital stay was longer in patients with fluid overload (6·0 vs. 4·0 days, P = 0·037). A positive history of fluid overload (P = 0·017), lactate dehydrogenase level (P = 0·011), and top‐up transfusion during admission (P = 0·005) were independently associated with fluid overload occurrence. IV‐FT was not reduced in 86% of patients despite a previous history of fluid overload. Fluid overload is frequently encountered during IV‐FT for VOC. IV‐FT is often not adjusted despite a positive history of fluid overload or when top‐up transfusion is indicated, emphasising the need for more awareness of this complication and a personalised approach.
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