Calcineurin Inhibitor Use and Myoclonus Association. Is There a Clinical Implication?  

作　　者：Ricardo E. Verdiner Ruben Casado Arroyo Mohammad Rauf Chaudhry Narjeet Khurmi Karl Poterack Andy Gorlin Arun Jayaraman Gustavo Rodriguez Ricardo E. Verdiner;Ruben Casado Arroyo;Mohammad Rauf Chaudhry;Narjeet Khurmi;Karl Poterack;Andy Gorlin;Arun Jayaraman;Gustavo Rodriguez(Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, USA;Department of Medicine, Universite Libre de Bruxelles, Brussels, Belgium;Department of Neurology, Texas Tech University, Lubbock, USA;Department of Neurology, Texas Tech University, Health Science Center of El Paso, Lubbock, USA)

机构地区：[1]Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, USA [2]Department of Medicine, Universite Libre de Bruxelles, Brussels, Belgium [3]Department of Neurology, Texas Tech University, Lubbock, USA [4]Department of Neurology, Texas Tech University, Health Science Center of El Paso, Lubbock, USA

出　　处：《Open Journal of Anesthesiology》2021年第4期85-98,共14页麻醉学期刊（英文）

摘　　要：<b>Background:</b> Calcineurin Inhibitors (CNIs) play a pivotal role in anti rejection therapy for transplant patients. Neurotoxicity is a known side effect that usually manifests as encephalopathy but myoclonus has also been described. Perioperative myoclonus as a manifestation of neurotoxicity, has not been well studied. <b>Methods:</b> We retrospectively reviewed data from 842,762 patients from the Nationwide Inpatient Sample (NIS) database from January 2011 to December 2014. Of those records we compared 56,423 patients requiring CNIs and undergoing Heart Transplant (HT) with 786,339 patients undergoing Coronary Artery Bypass Graft (CABG) surgery as controls. The objective was to study the rates of myoclonus in patients undergoing cardiac surgery, especially those requiring CNIs, and study the outcome of those patients with myoclonus. The NIS database from January 2011 to December 2014 was the source for the analysis. Patients with underlying epilepsy or hypo-ischemic encephalopathy based on ICD-9-CM codes were excluded from the study. <b>Results:</b> A total of 147 patients (0.26%) were found to have myoclonus in the HT group versus 338 patients (0.04%) in the CABG group, p < 0.0001. No differences in the demographics were seen except for kidney disease which was higher in the HT group. The difference remained statistically significant after adjusting for confounders. Patients with myoclonus in both groups were more likely to have acute kidney injury and have a prolonged length of stay. Only patients with myoclonus in the CABG group had higher rates of discharge disposition to a nursing home and higher rates of in-Hospital mortality. A trend towards higher in-Hospital mortality was found in patients with myoclonus in the HT group. <b>Conclusion:</b> In this study we have compared the rate of myoclonus found in HT patients versus CABG patients. We have identified calcineurin inhibitors as potentially contributing to myoclonus due to its neurotoxic effects. The study also suggests that other disease processes l<b>Background:</b> Calcineurin Inhibitors (CNIs) play a pivotal role in anti rejection therapy for transplant patients. Neurotoxicity is a known side effect that usually manifests as encephalopathy but myoclonus has also been described. Perioperative myoclonus as a manifestation of neurotoxicity, has not been well studied. <b>Methods:</b> We retrospectively reviewed data from 842,762 patients from the Nationwide Inpatient Sample (NIS) database from January 2011 to December 2014. Of those records we compared 56,423 patients requiring CNIs and undergoing Heart Transplant (HT) with 786,339 patients undergoing Coronary Artery Bypass Graft (CABG) surgery as controls. The objective was to study the rates of myoclonus in patients undergoing cardiac surgery, especially those requiring CNIs, and study the outcome of those patients with myoclonus. The NIS database from January 2011 to December 2014 was the source for the analysis. Patients with underlying epilepsy or hypo-ischemic encephalopathy based on ICD-9-CM codes were excluded from the study. <b>Results:</b> A total of 147 patients (0.26%) were found to have myoclonus in the HT group versus 338 patients (0.04%) in the CABG group, p < 0.0001. No differences in the demographics were seen except for kidney disease which was higher in the HT group. The difference remained statistically significant after adjusting for confounders. Patients with myoclonus in both groups were more likely to have acute kidney injury and have a prolonged length of stay. Only patients with myoclonus in the CABG group had higher rates of discharge disposition to a nursing home and higher rates of in-Hospital mortality. A trend towards higher in-Hospital mortality was found in patients with myoclonus in the HT group. <b>Conclusion:</b> In this study we have compared the rate of myoclonus found in HT patients versus CABG patients. We have identified calcineurin inhibitors as potentially contributing to myoclonus due to its neurotoxic effects. The study also suggests that other disease processes l

关 键 词：Calcineurin Inhibitors MYOCLONUS NEUROTOXICITY Perioperative Mortality Renal Failure TACROLIMUS MYCOPHENOLATE Endothelial Health Blood Brain Barrier 

分 类 号：R65[医药卫生—外科学]