The Effectiveness of Topical Cerium Nitrate-Silver Sulfadiazine Application on Overall Outcome in Patients with Calciphylaxis.
Administration, Cutaneous
Aged
Anti-Infective Agents, Local
/ administration & dosage
Calciphylaxis
/ etiology
Cerium
/ administration & dosage
Chelating Agents
Drug Combinations
Female
France
Humans
Kidney Failure, Chronic
/ complications
Male
Middle Aged
Polynesia
Renal Dialysis
Retrospective Studies
Risk Factors
Silver Sulfadiazine
/ administration & dosage
Skin Diseases, Vascular
/ drug therapy
Survival Rate
Thiosulfates
/ therapeutic use
Treatment Outcome
Calciphylaxis
Cerium nitrate-silver sulfadiazine
Outcome
Sodium thiosulfate
Journal
Dermatology (Basel, Switzerland)
ISSN: 1421-9832
Titre abrégé: Dermatology
Pays: Switzerland
ID NLM: 9203244
Informations de publication
Date de publication:
2019
2019
Historique:
received:
09
08
2018
accepted:
24
09
2018
pubmed:
4
1
2019
medline:
14
6
2019
entrez:
4
1
2019
Statut:
ppublish
Résumé
Calciphylaxis (CPX) is a rare and life-threatening disease characterized by vascular calcification and development of painful and necrotizing skin lesions with a challenging management. Mechanisms of CPX are complex and include an imbalance between vascular calcification promoters and inhibitors, and frequently vitamin K deficiency. To describe the various presentations and identify predictive factors of death in patients with CPX. In this multicenter retrospective study, we included 71 CPX patients followed in South-West France (n = 26) and in French Polynesia (n = 45), and who all received sodium thiosulfate (25 g thrice weekly for a median of 61 days). Characteristics at presentation significantly differed between metropolitan and Polynesian French patients. Polynesians were less frequently on regular dialysis at the onset of CPX, had a higher incidence of diabetes mellitus and obesity, more disturbances of calcium-phosphorus metabolism, and received vitamin K antagonists less frequently than patients from South-West France. Despite intensive management, the 1-year mortality rate was 66% and median time to death was 200 days (IQR, 40; 514). The number of body areas involved (i.e., three: OR 2.70 [1.09; 6.65], p = 0.031; four: OR 8.79 [1.54; 50.29], p = 0.015) was the only predictive factor for death, whereas application of topical cerium nitrate-silver sulfadiazine was protective (OR 0.44 [0.20; 0.99], p = 0.046). Surgical debridement, hyperbaric oxygenation therapy, and geographical origin were not associated with overall outcomes. Cerium nitrate may lead to vascular decalcification and chelation of reactive oxygen species, and prevent infection. Cerium nitrate-silver sulfadiazine was associated with better outcomes and should be tested in a prospective comparative trial in CPX patients.
Sections du résumé
BACKGROUND
BACKGROUND
Calciphylaxis (CPX) is a rare and life-threatening disease characterized by vascular calcification and development of painful and necrotizing skin lesions with a challenging management. Mechanisms of CPX are complex and include an imbalance between vascular calcification promoters and inhibitors, and frequently vitamin K deficiency.
OBJECTIVES
OBJECTIVE
To describe the various presentations and identify predictive factors of death in patients with CPX.
METHODS
METHODS
In this multicenter retrospective study, we included 71 CPX patients followed in South-West France (n = 26) and in French Polynesia (n = 45), and who all received sodium thiosulfate (25 g thrice weekly for a median of 61 days).
RESULTS
RESULTS
Characteristics at presentation significantly differed between metropolitan and Polynesian French patients. Polynesians were less frequently on regular dialysis at the onset of CPX, had a higher incidence of diabetes mellitus and obesity, more disturbances of calcium-phosphorus metabolism, and received vitamin K antagonists less frequently than patients from South-West France. Despite intensive management, the 1-year mortality rate was 66% and median time to death was 200 days (IQR, 40; 514). The number of body areas involved (i.e., three: OR 2.70 [1.09; 6.65], p = 0.031; four: OR 8.79 [1.54; 50.29], p = 0.015) was the only predictive factor for death, whereas application of topical cerium nitrate-silver sulfadiazine was protective (OR 0.44 [0.20; 0.99], p = 0.046). Surgical debridement, hyperbaric oxygenation therapy, and geographical origin were not associated with overall outcomes.
CONCLUSIONS
CONCLUSIONS
Cerium nitrate may lead to vascular decalcification and chelation of reactive oxygen species, and prevent infection. Cerium nitrate-silver sulfadiazine was associated with better outcomes and should be tested in a prospective comparative trial in CPX patients.
Identifiants
pubmed: 30605905
pii: 000493975
doi: 10.1159/000493975
doi:
Substances chimiques
Anti-Infective Agents, Local
0
Chelating Agents
0
Drug Combinations
0
Thiosulfates
0
cerium nitrate
17309-53-4
Cerium
30K4522N6T
sodium thiosulfate
HX1032V43M
Silver Sulfadiazine
W46JY43EJR
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
120-129Informations de copyright
© 2019 S. Karger AG, Basel.