Procedural adverse events in pediatric patients with sickle cell disease undergoing chronic automated red cell exchange.
Procedural adverse events in pediatric patients with sickle cell disease undergoing chronic automated red cell exchange.
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DOI：
10.1111/trf.16807
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发表时间：
2022-03
期刊：
影响因子：
2.9
通讯作者：
Fasano RM
中科院分区：
文献类型：
--
作者：
Wade J;Yee MEM;Easley KA;Pahz S;Butler H;Zerra PE;Josephson CD;Fasano RM
慢性自动红细胞交换（RCE）越来越多地用于镰状细胞病（SCD）。关于RCE不良事件（AE）的发生率以及AE的潜在患者和手术风险因素的数据很少。对接受长期RCE超过3年的儿童SCD患者进行了回顾性审查，以确定AE的频率并确定手术和患者AE风险因素。根据各种手术和患者特征，通过单变量（UV）和多变量（MV）分析计算AE发生率、AE发生率、发生率比（IRR）和相对风险（RR）。在接受760例手术的38例患者中，发生了150例（19.7%）AE，其中36例（4.7%）为症状性AE。AE发生率为20.2/100人月[95% CI 17.2，23.6]。症状性AE的发生率为4.8/100人月[95% CI 3.49，6.70]。AE发生率为：低钙血症（117; 15.4%）、头晕（22; 3.0%）、低血压（15; 2.0%）和恶心（14; 1.8%）。基线Hct ≥30%的患者发生的总AE和症状性AE更多。术前初始收缩压<第50百分位数和患有重度CNS血管病变和非SCA表型（即HbSC或Sβ+地中海贫血）的患者与总AE增加相关。IHD耗竭与AE或症状性AE的发生率增加无关。Hct ≥ 30%、收缩压<第50百分位数、重度CNS血管病变和可能非SCA基因型的SCD患者发生RCE相关AE的风险可能更高。IHD对AE风险的影响可能很小。应在所有接受慢性自动RCE的SCD患者中进行个体化AE风险评估。
Chronic automated red cell exchange (RCE) is increasingly employed for sickle cell disease (SCD). There is a paucity of data on the incidence of RCE adverse events (AEs) and potential patient and procedural risk factors for AEs. A retrospective review of pediatric SCD patients receiving chronic RCE over 3 years was performed to determine the frequency of AEs and identify procedural and patient AE risk factors. AE incidence, AE rate, incidence rate ratios (IRRs), and relative risks (RR) were calculated based on various procedural and patient characteristics by univariable (UV) and multivariable (MV) analyses. In 38 patients receiving 760 procedures, there were 150 (19.7%) AEs, of which 36 (4.7%) were symptomatic AEs. The rate of AEs was 20.2 per 100 person-months [95% CI 17.2, 23.6]. and the rate of symptomatic AEs was 4.8 per 100 person-months [95% CI 3.49, 6.70]. AE incidences were: hypocalcemia (117; 15.4%), dizziness (22; 3.0%), hypotension (15; 2.0%), and nausea (14; 1.8%). Patients with a baseline Hct ≥30% experienced more total AEs and symptomatic AEs. Pre-procedure initial systolic BP < 50th percentile and patients with severe CNS vasculopathy and non SCA phenotype (i.e. HbSC or Sβ+ thalassemia) were associated with an increase in total AEs. IHD depletion was not associated with an increased incidence of AEs or symptomatic AEs. SCD patients with Hct ≥30%, systolic BP <50th percentile, severe CNS vasculopathy and possibly non-SCA genotype may be at higher risk for RCE-related AEs. The effect of IHD on AE risk is likely minimal. Individualized AE risk assessment should be performed in all SCD patients undergoing chronic automated RCE.
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