Analiza zdravljenja s človeškimi albumini in imunoglobulini v Splošni bolnišnici Murska Sobota

Kolar, Tina (author), Vovk, Tomaž (mentor), Markoja, Urška (comentor)

Albumin je najpogostejši plazemski protein, ki se sintetizira v jetrih, imunoglobulini pa protitelesa, ki jih v telesu proizvajajo plazmatke. Človeške albumine (ČA) in intravenske imunoglobuline (IVIG) pridobivajo z izolacijo iz človeške plazme darovalcev. Področje uporabe ČA je v praksi zelo obširno, vendar je glede na smernice omejeno predvsem na aplikacijo po izpraznilni paracentezi pri cirotičnem ascitesu, pri bolnikih s spontanim bakterijskim peritonitisom, kot diagnostično sredstvo pri razlikovanju med hepatorenalnim sindromom (HRS) in prerenalno ledvično okvaro ter v terapiji HRS v kombinaciji z vazokonstriktorjem. Uporaba ČA je v določenih primerih utemeljena tudi pri bolnikih s sepso in hipovolemijo. IVIG se uporabljajo za imunsko modulacijo in kot nadomestno zdravljenje pri imunski pomanjkljivosti. Namen raziskave je bil analizirati uporabo ČA in IVIG v Splošni bolnišnici Murska Sobota v obdobju med 1. 10. 2023 in 31. 3. 2024. Osredotočili smo se na najpogostejše terapevtske indikacije, varnostne izide zdravljenja, porabo po oddelkih in ekonomske vidike zdravljenja. Pri bolnikih, ki so prejemali ČA, smo spremljali tudi predhodno ali sočasno uporabo hidroksietilškroba (HES) in derivatov želatine ter analizirali, kako njihova uporaba vpliva na izide zdravljenja. Ugotovili smo, da uporaba ČA v večini primerov ni sovpadala s področjem uporabe, ki smo si ga zastavili glede na informacije iz smernic in najnovejših raziskav. Med zastavljenimi terapevtskimi indikacijami je bila najpogostejša sepsa. Pri 17,6 % bolnikov je po aplikaciji ČA prišlo do akutne ledvične okvare (ALO), pri 4,9 % bolnikov pa do tromboemboličnega zapleta. Med zdravljenjem ali do 30 dni po zaključku zdravljenja s ČA je umrlo 37,0 % bolnikov. Stroški uporabe ČA so znašali 64.138,96 evra, mediana stroškov zdravljenja na bolnika pa 281,62 evra. Pri bolnikih, ki so predhodno ali sočasno s ČA prejemali še HES, smo ugotovili večjo pojavnost ALO in večjo smrtnost kot pri bolnikih, ki so prejemali samo ČA ali ČA v kombinaciji z derivati želatine. HES je bil glede na priporočila Mednarodne agencije za zdravila nepravilno uporabljen v vsaj 66,7 % primerov. Najpogostejša terapevtska indikacija za uporabo IVIG je bil artritis. Od zapletov, povezanih z uporabo IVIG, smo v dokumentaciji zasledili le slabost in bruhanje pri eni bolnici ter povišanje krvnega tlaka pri enem bolniku. Stroški uporabe IVIG so znašali 117.440,20 evra, mediana stroškov zdravljenja na bolnika pa 8070,74 evra.

• Language: Slovenian
• Keywords: Človeški albumini, intravenski imunoglobulini, derivati želatine, hidroksietilškrob, terapevtske indikacije, akutna ledvična okvara, tromboembolični zaplet, raven serumskih albuminov
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2024
• PID: 20.500.12556/RUL-166117
• Publication date in RUL: 20.12.2024

KOLAR, Tina, 2024, Analiza zdravljenja s človeškimi albumini in imunoglobulini v Splošni bolnišnici Murska Sobota [online]. Master’s thesis. [Accessed 14 April 2025]. Retrieved from: https://repozitorij.uni-lj.si/IzpisGradiva.php?lang=eng&id=166117

Secondary language

• Language: English
• Title: Analysis of treatment with human albumins and immunoglobulins at the Murska Sobota General Hospital

Abstract

Albumin is the most abundant plasma protein synthesized in the liver, while immunoglobulins are antibodies produced by plasma cells in the body. Human albumins (HA) and intravenous immunoglobulins (IVIG) are obtained through isolation from donor plasma. The use of HA is very broad in practice but, according to guidelines, primarily limited to administration after large-volume paracentesis in cirrhotic ascites, in patients with spontaneous bacterial peritonitis, as a diagnostic tool to differentiate between hepatorenal syndrome (HRS) and prerenal kidney injury, and in the treatment of HRS in combination with vasoconstrictor. In certain cases, the use of HA is also justified in patients with sepsis and hypovolemia. IVIG is used for immune modulation and replacement therapy in immunodeficiency disorders. The aim of the study was to analyse the use of HA and IVIG at the Murska Sobota General Hospital from 1 October 2023 to 31 March 2024. The study focused on the most common therapeutic indications, safety outcomes of treatments, usage by departments and economic aspects of therapy. For patients receiving HA, we also monitored prior or concurrent use of hydroxyethyl starch (HES) and gelatine derivates, and analysed how their use influenced treatment outcomes. We found that in most cases the use of HA did not align with the indications based on guidelines and the latest studies. The most common therapeutic indication was sepsis. Acute kidney injury (AKI) occurred in 17.6% of patients treated with HA and 4.9% experienced thromboembolic complications. During treatment or up to 30 days after HA treatment, 37.0% of patients died. The cost of HA therapy amounted to 64,138.96 eur, with a median treatment cost per patient of 281.62 eur. In patients who received HES concurrently or prior to HA, we observed a higher incidence of AKI and increased mortality compared to patients treated only with HA or HA in combination with gelatine derivatives. According to the recommendations of the European Medicines Agency, HES was inappropriately used in at least 66.7% of cases. The most common therapeutic indication for IVIG was arthritis. Among complications associated with IVIG use, the documentation reported only nausea and vomiting in one female patient and elevated blood pressure in one male patient. The cost of IVIG therapy amounted to 117,440.20 eur, with a median treatment cost per patient of 8070.74 eur.

• Keywords: Human albumins, intravenous immunoglobulins, gelatine derivatives, hydroxyethyl starch, therapeutic indications, acute kidney injury, thromboembolic complication, serum albumin levels