Risk factors of anaphylaxis caused by sodium dimercaptopropane injection in patients with hepatolenticular degeneration and an analysis of its predictive value
10.3760/cma.j.cn114015-20221017-00951
- VernacularTitle:二巯丙磺钠注射液致肝豆状核变性患者过敏反应危险因素及其预测价值分析
- Author:
Kang CAO
1
;
Huan LUO
;
Xiang LI
;
Yanquan HAN
;
Hao CHEN
;
Ying LI
Author Information
1. 安徽中医药大学第一附属医院药学部，合肥 230031
- Publication Type:Journal Article
- Keywords:
Hepatolenticular degeneration;
Anaphylaxis;
Risk assessment;
Sodium dimercaptopropanesulfonate
- From:
Adverse Drug Reactions Journal
2023;25(7):398-404
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the risk factors of anaphylaxis caused by sodium dimercaptopropane sulfonate (DMPS) in patients with hepatolenticular degeneration (HLD) and its predictive value.Methods:The electronic medical records of patients who were hospitalized for the first time in the First Affiliated Hospital of Anhui University of Chinese Medicine due to HLD from January 2019 to December 2021 and received DMPS treatment were collected. The basic information, relevant laboratory test results before the application of DMPS, daily dose of DMPS, and occurrence, treatment and outcome of allergic reactions in patients were recorded. The patients were divided into allergy group and control group based on whether DMPS-related anaphylaxis occurred. The clinical characteristics in patients in the 2 groups were compared. The risk factors of DMPS-induced anaphylaxis were analyzed using binary logistic regression, and the odds ratio ( OR) and its 95% confidence interval ( CI) were calculated. All independent risk factors were merged into joint predictor and the predictive value of individual risk factors and joint predictor for risk of anaphylaxis were analyzed using receiver operating characteristic (ROC) curve. Results:A total of 477 patients were enrolled in the study, including 124 patients in the allergy group and 353 patients in the control group. Among the 124 patients in the allergy group, 80 were male and 44 were female, aged 1-51 years, with 55 patients <18 years of age. Among the 353 patients in the control group, 237 were male and 116 were female, aged 2-66 years, with 106 patients <18 years of age. A total of 191 times of allergic reactions occurred in patients in the allergy group, the main manifestations were pruritus (67 times, 35.1%) and drug-induced dermatitis (58 times, 30.4%). The allergic reactions occurred during the 1st to the 5th course of treatment, with 74 (59.7%) and 31 cases (25.0%) occurring in the 1st and 2nd course of treatment, respectively. DMPS was discontinued in all patients. Of them, 5 patients did not receive any intervention because of mild symptoms and the rest were treated with glucocorticoids and/or antihistamines, and the symptoms of anaphylaxis subsided. The differences in age, DMPS medication history before admission, drug allergy history, and peripheral blood lymphocyte count, ceruloplasmin, alanine aminotransferase (ALT), aspartate aminotrans-ferase, alkaline phosphatase (ALP), γ-glutamyltransferase, lactate dehydrogenase, and blood urea nitrogen levels before DMPS application between the 2 groups were statistically significant (all P<0.05). Binary logistic regression analysis showed that the history of drug allergy ( OR=3.698, 95% CI: 2.233-6.124, P<0.001), the level of ALT before medication ( OR=1.004, 95% CI: 1.000-1.007, P=0.044) and the level of ALP before medication ( OR=1.003, 95% CI: 1.002-1.005, P<0.001) were independent risk factors for allergic reactions caused by DMPS in HLD patients. ROC curve analysis showed that the area under the curve (AUC) of ALT level before medication was 0.613 (95% CI: 0.553-0.673), the cutoff value was 50 U/L, the sensitivity was 0.419, and the specificity was 0.788; the AUC of ALP level before medication was 0.600 (95% CI: 0.537- 0.663), the cutoff value was 202 U/L, the sensitivity was 0.411, and the specificity was 0.816. Allergy history, ALP and ALT levels before medication were converted into joint predictor by logistic regression model. ROC curve analysis showed that the AUC of joint predictor was 0.703 (95% CI: 0.648-0.757), the cutoff value was 0.465, the sensitivity was 0.685, and the specificity was 0.657. Conclusions:The history of drug allergy, the level of ALT and ALP before medication are independent risk factors of anaphylaxis induced by DMPS in HLD patients. The joint predictor has good predictive value for anaphylaxis induced by DMPS in HLD patients.
