在移植患者的败血症中进行免疫抑制疗法的管理:一项前性多中心研究
Valentin Rivet1, Adrien Joseph2, Romain Arrestier3
1Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. valentin.rivet@aphp.fr.
Annals of intensive care
|August 10, 2025
概括
在接受脏移植并入住ICU的接受者中,在败血症期间停止服用mycophenolic acid (MPA) 与更糟糕的结果有关. 卡尔西纽林抑制剂的使用对死亡率或移植功能没有显著影响.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 临界护理医学 临界护理医学
- 免疫学 免疫学 免疫学
背景情况:
- 败血症是接受脏移植患者 (KTRs) 进入ICU的主要原因.
- 对于在ICU中患有败血症的KTR患者的最佳免疫抑制疗法 (IST) 管理仍未确定.
- 这项研究评估了IST对KTR死亡率和败血症后移植功能的影响.
研究的目的:
- 评估免疫抑制疗法 (IST) 管理与严重脏不良事件 (MAKE 180) 在患有败血症的重症脏移植接受者 (KTRs) 之间的关联.
- 调查菌酸 (MPA) 和氨酸抑制剂 (CNI) 管理对KTR结果的影响.
主要方法:
- 一项多中心,前性,观察性研究涉及124名因败血症入院到法国11个重症监护室的KTR.
- 在ICU入院前7天内或在ICU停留期间收集的关于IST变化的数据.
- 主要结局:MAKE 180 (死亡率,移植功能障碍或在180天后进行透析).
主要成果:
- 停用MPA显著与MAKE 180的风险增加有关 (调整后OR=1.45,p=0.018).
- 停止使用CNI并没有与MAKE 180显著相关 (调整后OR=1.05,p=0.6).
- 停药和ICU获得的感染之间没有发现显著的关联.
结论:
- 停用MPA可能与患有败血症的重症KTR患者的不良结果有关.
- 由于潜在的混因素,包括SARS-CoV-2治疗方法,研究结果需要谨慎解释.
- 需要进行进一步的干预试验,以确定在败血症期间针对KTR的最佳IST策略.
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