A multicenter retrospective cohort study on predicting the risk for amiodarone pulmonary toxicity

Kwok, Wang Chun; Fung, Ting; Chan, Johnny Wai Man; Pang, Herbert; Ho, James Chung Man

doi:10.1186/s12890-022-01926-y

Cited by 10 publications

(5 citation statements)

References 25 publications

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“…The incidence of amiodarone pulmonary toxicity was estimated by Kwok et al on the level of 1.9% [3]. Other reports, however, indicate a higher incidence of pulmonary complications through use of this drug [4].…”

Section: Discussionmentioning

confidence: 99%

Two sides of the coin: Amiodarone-induced lung toxicity – Case Report

Garbacki¹,

Jóźwik²,

Kleczaj³

et al. 2022

J Pre Clin Clin Res.

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Introduction. Amiodarone is often used in the treatment of arrhythmias. Despite its undoubtedly excellent antiarrhythmic effect, its use can also causa serious adverse effects. This case report presents a patient who, after several months of treatment with amiodarone, developed severe pulmonary complications and transient liver injury. Despite discontinuation of the drug and implementation of optimal treatment aimed at harm reduction, a full resolution of the pulmonary lesions was not achieved. Objective. The aim of the report is to draw attention to the risks to the respiratory system associated with the use of amiodarone. It is worth noting that some symptoms of post-amiodarone lung damage may resemble the exacerbation of heart failure, which contributes to the delay of a correct diagnosis and prolongs the time to the start treatment.

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Section: Discussionmentioning

confidence: 99%

Two sides of the coin: Amiodarone-induced lung toxicity – Case Report

Garbacki¹,

Jóźwik²,

Kleczaj³

et al. 2022

J Pre Clin Clin Res.

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“…Variables for univariate and multivariate Cox proportional hazard regression were selected based on previous literature [10,[14][15][16][17] and their clinical signi cance, with an effort to exclude correlated variables wherever feasible, as follows: sex, age, BMI, mMRC, COPD, asthma, rheumatoid arthritis (RA), CRP, BNC, disease extension over three lobes, cystic bronchiectasis, cavity, and P. aeruginosa colonization.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding covariates, we pre-con gured sex, age, BMI, mMRC, smoking history, cystic bronchiectasis and cavities on CT, CRP, BNC, and P. aeruginosa colonization as time-xed covariates by referring to previous studies [10,[14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of non-cystic fibrosis bronchiectasis at a single center in Japan: a retrospective cohort study

Hashimoto,

Abe,

Fukushima

et al. 2024

Preprint

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Background: The characteristics of non-cystic fibrosis bronchiectasis (NCBE) in Asia, including Japan, remain largely unknown. We aimed to provide insights into the clinical characteristics and treatment outcomes of NCBE, especially regarding nontuberculous mycobacteria (NTM) infection, and establish a basis for comparison with global datasets. In addition, long-term macrolide antibiotic use in patients with NCBE and a history of exacerbations is established, but the effects in patients without exacerbations remain unclear. Methods: In this single-center, retrospective study, the medical records of patients who satisfied the NCBE criteria between 1 January 2012 and 31 August 2023 were reviewed. Severe exacerbations and mortality during the observation period were recorded. Baseline characteristics, prognostic factors, and overall survival of patients with and without non-NTM infection were evaluated; effects of long-term macrolide antibiotic use in patients without severe exacerbations were estimated using inverse probability weighting (IPW). Results: In 1044 patients with bronchiectasis, severe exacerbation rates were 22·32%, with mortality rates of 3·16% at 3 years. Notably, the high prevalence of NTM infection (n=458, 43·87%) in this cohort was distinctive. Compared with the NTM group, the non-NTM group had a higher proportion of elevated inflammatory markers, with significant differences in C-reactive protein levels (p=0·0023) and blood neutrophil counts (p<0·001). Pseudomonas aeruginosa was more frequently identified as having colonization and was associated with severe exacerbations (p<0·001) in the non-NTM group. NTM infection was not associated with mortality (p=0·4621, hazard ratio=0·79). Among patients with non-NTM infection and without a history of exacerbation in the past 2 years, 34·3% received long-term macrolide antibiotics that did not invariably reduce severe exacerbations (P=0·3801, IPW P=0·7222). Conclusions: This study highlights NCBE epidemiology in Japan, advising caution in the casual use of macrolides for mild cases. Clinical Trial Registration: UMIN Clinical Trials Registry Number: UMIN000054726 (Registered on 21 June 2024)

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“…Third, we used multivariable logistic regression with Firth biasreducing penalized likelihood method. Different from conventional maximum likelihood estimation, the Firth log likelihood is penalized by the determinant of the information matrix, provides bias reduction for a small number of events, and yields finite and consistent estimates even in the case of separation (48)(49)(50)(51)(52)(53)(54)(55)(56)(57).…”

Section: Discussionmentioning

confidence: 99%

Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study*

Fuller

Pappal

Mohr

et al. 2022

Critical Care Medicine

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OBJECTIVES: In mechanically ventilated patients, awareness with paralysis (AWP) can have devastating consequences, including post-traumatic stress disorder (PTSD), depression, and thoughts of suicide. Single-center data from the emergency department (ED) demonstrate an event rate for AWP factors higher than that reported from the operating room. However, there remains a lack of data on AWP among critically ill, mechanically ventilated patients. The objective was to assess the proportion of ED patients experiencing AWP and investigate modifiable variables associated with its occurrence. DESIGN: An a priori planned secondary analysis of a multicenter, prospective, before-and-after clinical trial. SETTING: The ED of three academic medical centers. PATIENTS: Mechanically ventilated adult patients that received neuromuscular blockers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All data related to sedation and analgesia were collected. AWP was the primary outcome, assessed with the modified Brice questionnaire, and was independently adjudicated by three expert reviewers. Perceived threat, in the causal pathway for PTSD, was the secondary outcome. A total of 388 patients were studied. The proportion of patients experiencing AWP was 3.4% (n = 13), the majority of whom received rocuronium (n = 12/13; 92.3%). Among patients who received rocuronium, 5.5% (n = 12/230) experienced AWP, compared with 0.6% (n = 1/158) among patients who did not receive rocuronium in the ED (odds ratio, 8.64; 95% CI, 1.11–67.15). Patients experiencing AWP had a higher mean (sd) threat perception scale score, compared with patients without AWP (15.6 [5.8] vs 7.7 [6.0]; p < 0.01). CONCLUSIONS: AWP was present in a concerning proportion of mechanically ventilated ED patients, was associated with rocuronium exposure in the ED, and led to increased levels of perceived threat, placing patients at greater risk for PTSD. Studies that aim to further quantify AWP in this vulnerable population and eliminate its occurrence are urgently needed.

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A multicenter retrospective cohort study on predicting the risk for amiodarone pulmonary toxicity

Cited by 10 publications

References 25 publications

Two sides of the coin: Amiodarone-induced lung toxicity – Case Report

Two sides of the coin: Amiodarone-induced lung toxicity – Case Report

Epidemiology of non-cystic fibrosis bronchiectasis at a single center in Japan: a retrospective cohort study

Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study*

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