RESUMO
Objective:To investigate characteristics of fever and drug-induced liver injury (DILI) in inpatients with severe drug eruptions.Methods:A retrospective analysis was carried out on clinical data collected from 63 inpatients with severe drug eruptions from June 2007 to June 2020, and their characteristics of fever and DILI were investigated. Two-independent-sample t test or Kruskal-Wallis H test was used for intergroup comparison of measurement data, and intergroup comparison of enumeration data was performed using chi-square test or Fisher′s exact test. Results:Among the 63 patients with severe drug eruptions, 54 developed fever; low, moderate and high/ultra-high fever all occurred in about one third of the patients; of 17 patients with high/ultra-high fever, 16 sufferred from Stevens-Johnson syndrome (SJS) , toxic epidermal necrolysis (TEN) or drug hypersensitivity syndrome (DHS) ; 45 had irregular fever; fever duration ranged from 1 to 14 days in 51 patients; there were no significant differences in the fever grade or duration among the patients with different clinical types of drug eruptions ( P = 0.303, 0.719, respectively) ; rashes occurred earlier than or at the same time as fever in 92.59% of the patients. DILI occurred in 11 patients, 8 of whom had hepatocellular injury at admission, including 5 with DHS, 2 with SJS and 1 with TEN; 6 patients were accompanied by low, moderate or high fever, with the fever duration being 7.33 ± 4.97 days, and they all had grade 1 liver injury; liver function retesting at discharge showed complete recovery in 5 patients, improvement in 1, as well as conversion from hepatocellular injury to mixed liver injury in 1, and 1 patient did not undergo the liver function retesting due to against-medical-advice discharge. The other 3 patients had cholestatic liver injury, all of whom were diagnosed with DHS and accompanied by high or ultra-high fever, wtih the fever duration being 8.33 ± 3.51 days, and 1 patient had grade 4 liver injury (acute liver failure) ; liver function was improved in all the 3 patients at discharge. Conclusions:Patients with severe drug eruptions are prone to be accompanied by various types of fever, irregular fever is more common, fever usually lasts 2 weeks, and rashes often occur earlier than or at the same time as fever. DILI can occur in patients with severe drug eruptions, and is usually accompanied by fever; hepatocellular injury is more common, and prone to be improved rapidly; cholestatic liver injury is characterized by severe clinical symptoms and a long disease course, and most frequently occurs in patients with DHS.
RESUMO
Objective To investigate the clinical effect and safety of the application of contitunous renal replacement therapy (CRRT) in non-kidney severe patients in MICU.Methods Twenty-nine cases who underwent the CRRT in MICU were included in the study.Vessel pathway were all through inserting double channel catheter in femoral vein or internal carotid vein.According to the patient's condition,patients were treated by slow continuous ultrafiltration( CVVH )or continuous veno-venous hemodialysis (CVVHDF).The duration was 4-12 hours or continuation if necessary.The volume of blood flow was 100-180 ml/h.The displacement liquid was 30-50 ml/time.The volume of dehydration was 0-4 kg according to the patient's condition.The clinical symptoms,hemodynamics,blood biochemistry,PaO2/FiO2,pH,tumor necrosis factor and acute physiology and chronic health evaluation (APACHE) Ⅱ were observed before and after therapy.The complications were monitored.Results The vital signs of the patients became stable shortly after CRRT therapy,before CRRT temperature ( 37.6 ± 0.88 ) ℃,respiratory rate ( 110.3 ± 19.54)time/min,the oxygention index (262.6 ± 10.6),WBC ( 11.33 ± 2.27) × 109/L,NE (85.62 ± 7.83 ) %,AST ( 74.58 ± 19.34 ) U/L,APPACHE Ⅱ score ( 24.37 ± 9.23 ),after CRRT temperature ＞( 36.84 ± 0.58 ) ℃.respiratory rate ( 102.0 ± 16.2 ) times/min,the oxygention index ( 373.2 ± 11.2),WBC (9.62 ±3.26) × 109/L,NE (71.58 ± 10.54) %,AST(38.34 ± 13.96) U/L,APACHE Ⅱ score ( 14.65 ± 6.54).There were significantly difference between the indices at before and after treatment ( P ＜ 0.05 ).Serious ions and acid base abnormality were rectified during CRRT therapy without any severe complications.Conclusions CRRT therapy could decline the level of infections reaction and improve organs' function,adjust the balance of internal environment,stable hemodynamics without any severe complication after treatment.CRRT is safe and effective.In conclusion,CRRT is a primary treatment and an important supportive therapy.