Neutrophil elastase inhibitor (Sivelestat) in the treatment of acute respiratory distress syndrome induced by COVID-19: a multicenter retrospective cohort study
Abstract Background Recent studies suggest that neutrophil elastase inhibitor (Sivelestat) may improve pulmonary function and reduce mortality in patients with acute respiratory distress syndrome. We examined the association between receipt of sivelestat and improvement in oxygenation among patients...
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BMC
2025-01-01
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| Series: | Respiratory Research |
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| Online Access: | https://doi.org/10.1186/s12931-025-03100-4 |
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| author | Yuting Li Jianjun Zhao Jiahui Wei Yanhong Zhang Haitao Zhang Ying Li Ting Liao Yang Hu Bo Yuan Xinmei Zhang Wanyan Liu Changgang Liu Qingsong Cui Shunzi Wu Hongmei Jiang Wenge Liu Weiheng Liu Hongguang Xu Gang Li Yuyan Cai Liting Chen Bingwei Chen Dong Zhang |
| author_facet | Yuting Li Jianjun Zhao Jiahui Wei Yanhong Zhang Haitao Zhang Ying Li Ting Liao Yang Hu Bo Yuan Xinmei Zhang Wanyan Liu Changgang Liu Qingsong Cui Shunzi Wu Hongmei Jiang Wenge Liu Weiheng Liu Hongguang Xu Gang Li Yuyan Cai Liting Chen Bingwei Chen Dong Zhang |
| author_sort | Yuting Li |
| collection | DOAJ |
| description | Abstract Background Recent studies suggest that neutrophil elastase inhibitor (Sivelestat) may improve pulmonary function and reduce mortality in patients with acute respiratory distress syndrome. We examined the association between receipt of sivelestat and improvement in oxygenation among patients with acute respiratory distress syndrome (ARDS) induced by COVID-19. Methods A large multicentre cohort study of patients with ARDS induced by COVID-19 who had been admitted to intensive care units (ICUs). We used propensity score matching to compare the outcomes of patients treated with sivelestat to those who were not. The differences in continuous outcomes were assessed with the Wilcoxon signed-rank test. Kaplan–Meier method was used to show the 28-day survival curves in the matched cohorts. A log-rank P-test stratified on the matched pairs was used to test the equality of the estimated survival curves. A Cox proportional hazards model that incorporated a robust sandwich-type variance estimator to account for the matched nature of the data was used to estimate hazard ratios (HR). All statistical analyses were performed with SPSS 26.0 and R 4.2.3. A two-sided p-value of < 0.05 was considered statistically significant. Results A total of 387 patients met inclusion criteria, including 259 patients (66.9%) who were treated with sivelestat. In 158 patients matched on the propensity for treatment, receipt of sivelestat was associated with improved oxygenation, decreased Murray lung injury score, increased non-mechanical ventilation time within 28 days, increased alive and ICU-free days within 28 days (HR, 1.85; 95% CI 1.29 to 2.64; log-rank p < 0.001), shortened ICU stay and ultimately improved survival (HR, 2.78; 95% CI 1.32 to 5.88; log-rank p = 0.0074). Conclusions Among patients with ARDS induce by COVID-19, sivelestat administration is associated with improved clinical outcomes. |
| format | Article |
| id | doaj-art-86da30da7c0a4af89474906ec59a0510 |
| institution | Kabale University |
| issn | 1465-993X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj-art-86da30da7c0a4af89474906ec59a05102025-01-19T12:36:28ZengBMCRespiratory Research1465-993X2025-01-0126111010.1186/s12931-025-03100-4Neutrophil elastase inhibitor (Sivelestat) in the treatment of acute respiratory distress syndrome induced by COVID-19: a multicenter retrospective cohort studyYuting Li0Jianjun Zhao1Jiahui Wei2Yanhong Zhang3Haitao Zhang4Ying Li5Ting Liao6Yang Hu7Bo Yuan8Xinmei Zhang9Wanyan Liu10Changgang Liu11Qingsong Cui12Shunzi Wu13Hongmei Jiang14Wenge Liu15Weiheng Liu16Hongguang Xu17Gang Li18Yuyan Cai19Liting Chen20Bingwei Chen21Dong Zhang22Department of Critical Care Medicine, The First Hospital of Jilin UniversityRespiratory Intensive Care Unit, Sino-Japanese Friendship Hospital of Jilin ProvinceRespiratory Intensive Care Unit, Sino-Japanese Friendship Hospital of Jilin ProvinceEmergency Department, Jilin Province People’s HospitalDepartment of Critical Care Medicine, Jilin Province People’s HospitalDepartment of Critical Care Medicine, Tonghua People’s HospitalDepartment of Critical Care Medicine, Tonghua People’s HospitalDepartment of Critical Care Medicine, The Third Affiliated Hospital of Changchun University of Chinese MedicineRespiratory Intensive Care Unit, Siping City Central People’s HospitalDepartment of Critical Care Medicine, Siping City Central People’s HospitalDepartment of Critical Care Medicine, Jilin Hospital of Integrative Chinese and Western MedicineDepartment of Critical Care Medicine, Tonghua Central HospitalDepartment of Critical Care Medicine, Yanbian University Affiliated HospitalDepartment of Critical Care Medicine, People’s Hospital of Hunchun CityDepartment of Critical Care Medicine, Baicheng City HospitalDepartment of Critical Care Medicine, Jilin City Central HospitalDepartment of Critical Care Medicine, Jilin City Central HospitalDepartment of Critical Care Medicine, Jilin City Central HospitalDepartment of Critical Care Medicine, Changchun Central HospitalDepartment of Critical Care Medicine, Jilin City People’s HospitalRespiratory Intensive Care Unit, Jilin City People’s HospitalDepartment of Epidemiology and Biostatistics, School of Public Health, Southeast UniversityDepartment of Critical Care Medicine, The First Hospital of Jilin UniversityAbstract Background Recent studies suggest that neutrophil elastase inhibitor (Sivelestat) may improve pulmonary function and reduce mortality in patients with acute respiratory distress syndrome. We examined the association between receipt of sivelestat and improvement in oxygenation among patients with acute respiratory distress syndrome (ARDS) induced by COVID-19. Methods A large multicentre cohort study of patients with ARDS induced by COVID-19 who had been admitted to intensive care units (ICUs). We used propensity score matching to compare the outcomes of patients treated with sivelestat to those who were not. The differences in continuous outcomes were assessed with the Wilcoxon signed-rank test. Kaplan–Meier method was used to show the 28-day survival curves in the matched cohorts. A log-rank P-test stratified on the matched pairs was used to test the equality of the estimated survival curves. A Cox proportional hazards model that incorporated a robust sandwich-type variance estimator to account for the matched nature of the data was used to estimate hazard ratios (HR). All statistical analyses were performed with SPSS 26.0 and R 4.2.3. A two-sided p-value of < 0.05 was considered statistically significant. Results A total of 387 patients met inclusion criteria, including 259 patients (66.9%) who were treated with sivelestat. In 158 patients matched on the propensity for treatment, receipt of sivelestat was associated with improved oxygenation, decreased Murray lung injury score, increased non-mechanical ventilation time within 28 days, increased alive and ICU-free days within 28 days (HR, 1.85; 95% CI 1.29 to 2.64; log-rank p < 0.001), shortened ICU stay and ultimately improved survival (HR, 2.78; 95% CI 1.32 to 5.88; log-rank p = 0.0074). Conclusions Among patients with ARDS induce by COVID-19, sivelestat administration is associated with improved clinical outcomes.https://doi.org/10.1186/s12931-025-03100-4Acute respiratory distress syndromeCOVID-19Neutrophil elastaseSivelestatSurvival |
| spellingShingle | Yuting Li Jianjun Zhao Jiahui Wei Yanhong Zhang Haitao Zhang Ying Li Ting Liao Yang Hu Bo Yuan Xinmei Zhang Wanyan Liu Changgang Liu Qingsong Cui Shunzi Wu Hongmei Jiang Wenge Liu Weiheng Liu Hongguang Xu Gang Li Yuyan Cai Liting Chen Bingwei Chen Dong Zhang Neutrophil elastase inhibitor (Sivelestat) in the treatment of acute respiratory distress syndrome induced by COVID-19: a multicenter retrospective cohort study Respiratory Research Acute respiratory distress syndrome COVID-19 Neutrophil elastase Sivelestat Survival |
| title | Neutrophil elastase inhibitor (Sivelestat) in the treatment of acute respiratory distress syndrome induced by COVID-19: a multicenter retrospective cohort study |
| title_full | Neutrophil elastase inhibitor (Sivelestat) in the treatment of acute respiratory distress syndrome induced by COVID-19: a multicenter retrospective cohort study |
| title_fullStr | Neutrophil elastase inhibitor (Sivelestat) in the treatment of acute respiratory distress syndrome induced by COVID-19: a multicenter retrospective cohort study |
| title_full_unstemmed | Neutrophil elastase inhibitor (Sivelestat) in the treatment of acute respiratory distress syndrome induced by COVID-19: a multicenter retrospective cohort study |
| title_short | Neutrophil elastase inhibitor (Sivelestat) in the treatment of acute respiratory distress syndrome induced by COVID-19: a multicenter retrospective cohort study |
| title_sort | neutrophil elastase inhibitor sivelestat in the treatment of acute respiratory distress syndrome induced by covid 19 a multicenter retrospective cohort study |
| topic | Acute respiratory distress syndrome COVID-19 Neutrophil elastase Sivelestat Survival |
| url | https://doi.org/10.1186/s12931-025-03100-4 |
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