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Clinical efficacy and safety of anticoagulation therapy for Pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome: a retrospective multicenter cohort study

医学 内科学 危险系数 置信区间 回顾性队列研究 累积发病率 胃肠病学 入射(几何) 比例危险模型 外科 队列 光学 物理
作者
Chunyan Peng,Shouxin Zhang,Feng Zhang,Longgen Liu,Youlin Shao,Xiaoxing Xiang,Wei Zhang,Jiangqiang Xiao,Yi Wang,Bin Zhang,Qin Yin,Yuhu Song,Zhe Mo,Xiaoping Zou,Ming Zhang,Yuzheng Zhuge
出处
期刊:European Journal of Gastroenterology & Hepatology [Lippincott Williams & Wilkins]
卷期号:32 (9): 1168-1178 被引量:19
标识
DOI:10.1097/meg.0000000000001630
摘要

Aim Pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome(PA-HSOS) has been reported to have high mortality. We evaluated the efficacy and safety of anticoagulation therapy for the patients with PA-HSOS. Methods We collected clinical data on 249 PA-HSOS patients from January 2012 to December 2017 at four tertiary care hospitals. Among them, 151 patients received anticoagulation therapy, and 98 patients received supportive treatment. The outcomes were analyzed using the Fine and Gray competing risk analysis method and Cox regression model. Results The cumulative complete response rate was higher in the anticoagulation group than in the supportive group (60.9 vs 36.7%; P < 0.0001). The cumulative mortality was 12.6% in the anticoagulation group compared with 43.9% in the supportive group ( P < 0.0001). In subgroup analysis, for mild, moderate, severe, and very severe groups, the adjusted hazard ratios [95% confidence interval (CI)] for complete response rates were 7.05 (3.00–16.59), 5.26 (2.31–12.42), 2.59 (0.85–7.87), and 2.05 (0.61–6.92), respectively; and the adjusted hazard ratios (95% CI) for mortalities were 0.02 (0.01–0.09), 0.04 (0.01–0.14), 0.19 (0.01–3.98), and 0.07 (0.02–1.27), respectively ( P < 0.0001). There was no significant difference between both groups in the incidence of bleeding events ( P = 0.674). Conclusions Anticoagulation therapy improves clinical remission and the survival in selected patients with mild or moderate PA-HSOS. Anticoagulation therapy has a similar safety profile to supportive therapy.
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