Efficacy and safety of sivelestat sodium in patients with sepsis / 中华危重病急救医学

ABSTRACT

Objective:To investigate the efficacy and safety of sivelestat sodium in patients with sepsis.Methods:The clinical data of 141 adult patients with sepsis admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Zhengzhou University from January 1, 2019 to January 1, 2022 were retrospectively analyzed. The patients were divided into the sivelestat sodium group ( n = 70) and the control group ( n = 71) according to whether they received sivelestat sodium or not. The efficacy indexes included oxygenation index, procalcitonin (PCT), C-reactive protein (CRP), white blood count (WBC), sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) before and after 7 days of treatment, as well as ventilator supporting time, the length of ICU stay, the length of hospital stay and ICU mortality. The safety indicators included platelet count (PLT) and liver and kidney function. Results:There were no significant differences in age, gender, underlying diseases, infection site, basic drugs, etiology, oxygenation index, biochemical indexes, SOFA and APACHE Ⅱ scores between the two groups. Compared with the control group, the oxygenation index in 7 days was significantly increased [mmHg (1 mmHg ≈ 0.133 kPa) 233.5 (181.0, 278.0) vs. 202.0 (153.0, 243.0), P < 0.01], the levels of PCT, CRP, alanine aminotransferase (ALT) and APACHE Ⅱ score were significantly decreased in the sivelestat sodium group [PCT (μg/L) 0.87 (0.41, 1.61) vs. 1.53 (0.56, 5.33), CRP (mg/L) 64.12 (19.61, 150.86) vs. 107.20 (50.30, 173.00), ALT (U/L) 25.0 (15.0, 43.0) vs. 31.0 (20.0, 65.0), APACHE Ⅱ 14 (11, 18) vs. 16 (13, 21), all P < 0.05]. However, there were no significant differences in SOFA, WBC, serum creatinine (SCr), PLT, total bilirubin (TBil), aspartate aminotransferase (AST) in 7 days between the sivelestat sodium group and the control group [SOFA 6.5 (5.0, 10.0) vs. 7.0 (5.0, 10.0), WBC (×10 9/L) 10.5 (8.2, 14.7) vs. 10.5 (7.2, 15.2), SCr (μmol/L) 76.0 (50.0, 124.1) vs. 84.0 (59.0, 129.0), PLT (×10 9/L) 127.5 (59.8, 212.3) vs. 121.0 (55.0, 211.0), TBil (μmol/L) 16.8 (10.0, 32.1) vs. 16.6 (8.4, 26.9), AST (U/L) 31.5 (22.0, 62.3) vs. 37.0 (24.0, 63.0), all P > 0.05]. The ventilator supporting time and the length of ICU stay in the sivelestat sodium group were significantly shorter than those in control group [ventilator supporting time (hours) 147.50 (86.83, 220.00) vs. 182.00 (100.00, 360.00), the length of ICU stay (days) 12.5 (9.0, 18.3) vs. 16.0 (11.0, 23.0), both P < 0.05]. However, there were no significant differences in the length of hospital stay and ICU mortality between the sivelestat sodium group and the control group [the length of hospital stay (days) 20.0 (11.0, 27.3) vs. 13.0 (11.0, 21.0), ICU mortality 17.1% (12/70) vs. 14.1% (10/71), both P > 0.05]. Conclusions:Sivelestat sodium is safe and effective in patients with sepsis. It can improve the oxygenation index and APACHE Ⅱ score, reduce the levels of PCT and CRP, shorten ventilator supporting time and the length of ICU stay. No adverse reactions such as liver and kidney function injury and platelet abnormality are observed.