Characteristics and risk factors of cefoperazone/sulbactam related coagulation dysfunction in neurosurgery patients
JIN Xing1, LU Xiaoyun1, LI Yamei2
1. Department of Disease Control and Prevention, Xijing Hospital of Air Force Military Medical University, Xi’an 710032, China; 2. Department of Pharmacy, Xi'an No.1 Hospital, Xi’an 710002, China
Abstract:Objective To analyze the characteristics and risk factors of cefoperazone/sulbactam related coagulation dysfunction in neurosurgery patients. Methods A retrospective study was carried out on the neurosurgery patients treated with cefoperazone/sulbactam in the Neurosurgery Department of Xijing Hospital of Air Force Military Medical University from January 2020 to February 2023. The patients were divided into normal group and abnormal group according to whether there was coagulation dysfunction after medication. The risk prediction model was established based on relevant risk factors screened with LASSO regression. Results A total of 108 patients were involved, including 43 cases (39.81%) with abnormal coagulation dysfunction and 65 cases (60.19%) with normal coagulation function. Cefoperazone/sulbactam related coagulation dysfunction was characterized by prolonged PT and APTT, decreased PTA and increased INR. PT, PTA and INR were susceptible to cefoperazone/sulbactam and changed significantly, which could be used as sensitive indicators for risk identification. The risk of coagulation dysfunction after medication was positively correlated with APACHE Ⅱ score (OR=1.133, 95%CI: 1.039-1.234), age (OR=1.024, 95%CI: 0.993-1.054), and negatively correlated with PTA (OR=0.959, 95%CI: 0.929-0.989). Conclusions The use of nomogram for risk assessment to identify high-risk groups and strengthen the monitoring of PT, PTA, and APTT can reduce the occurrence of risk events.
金星, 路晓芸, 李亚美. 头孢哌酮/舒巴坦致神经外科患者凝血功能异常的特征及其风险因素[J]. 武警医学, 2024, 35(6): 511-515.
JIN Xing, LU Xiaoyun, LI Yamei. Characteristics and risk factors of cefoperazone/sulbactam related coagulation dysfunction in neurosurgery patients. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(6): 511-515.
Wang W, Liu Y, Yu C, et al. Cefoperazone-sulbactam and risk of coagulation disorders or bleeding: a retrospective cohort study[J]. Expert Opin Drug Saf, 2020, 19(3): 339-347.
[2]
Song J C, Zhang W, Zhang Z, et al. Consensus of Chinese experts on standardized evaluation of coagulation dysfunction in severe patients[J]. Med J Chin PLA, 2022, 47(2): 107-117.
Wong R, Cheng G, Chan N, et al. Use of cefoperazone still needs a caution for bleeding from induced vitamin K deficiency[J]. Am J Hematol, 2006, 81(1): 76-76.
[7]
陈文彬, 潘祥林. 诊断学[M]. 北京:人民卫生出版社, 2013: 291-292.
[8]
Heinze G, Wallisch C, Dunkler D. Variable selection-A review and recommendations for the practicing statistician[J]. Biometrical J, 2018, 60(3): 431-449.
Wu S X, Wu G, Wu H B. A comparison of coagulation function in patients receiving aspirin and cefoperazone-sulbactam with and without vitamin K1: a retrospective, observational study[J]. Clin Ther, 2021, 43(12): e335-e345.
Knaus W A, Draper E A, Wagner D P, et al. APACHE II: a severity of disease classification system[J]. Crit Care Med, 1985, 13(10): 818-829.
[14]
Retter A, Barrett N A. The management of abnormal haemostasis in the ICU[J]. Anaesthesia, 2015, 70 (Suppl. 1): 121-127.
[15]
Reitberg D P, Marble D A, Schultz R W, et al. Pharmacokinetics of cefoperazone (2.0g) and sulbactam (1.0g) coadministered to subjects with normal renal function, patients with decreased renal function, and patients with end-stage renal disease on hemodialysis[J]. Antimicrob Agents Ch, 1988, 32(4): 503-509.
[16]
Singer M, Deutschman C S, Seymour C W, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3)[J]. JAMA, 2016, 315(8): 775-787.
[17]
Tsao C M, Ho S T, Wu C C. Coagulation abnormalities in sepsis[J]. Acta Anaesthesiol Taiwan, 2015, 53(1): 16-22.