title: Predictors of the therapeutic effect of sivelestat in patients with acute lung injury associated with systemic inflammatory response syndrome.
abstract: BACKGROUND
  Sivelestat, a neutrophil elastase inhibitor, was previously approved in Japan for the treatment of acute lung injury associated with systemic inflammatory response syndrome. However, sivelestat produced inconsistent therapeutic benefits. This study aimed to identify factors predicting the therapeutic effects of sivelestat.
  
  
  METHODS
  We enrolled 53 mechanically ventilated patients who received sivelestat. The patients were classified as effective (n = 28) if they were weaned from the ventilator within 28 days, or as ineffective groups (n = 25). Patient characteristics were compared between these groups and multivariate logistic regression analysis was used to identify predictive factors. A validation study was then conducted in sivelestat-free patients.
  
  
  RESULTS
  A high red blood cell count and low hydrogen ion concentration were significantly associated with a higher ventilator weaning rate in patients receiving sivelestat. The validation study revealed that the hydrogen ion concentration value also significantly associated with ventilator weaning in patients who did not receive sivelestat.
  
  
  CONCLUSIONS
  Although hydrogen ion concentration was inversely associated with the ventilator weaning rate, it did not predict sivelestat efficacy. This study indicated that acute lung injury patients with a high red blood cell count would derive the most benefit from sivelestat administration.
authors: Department of Pharmacy, Kan-etsu Hospital, 145-1 Suneori, Tsuruashima-shi, Saitama, 350-2213 Japan.
authors: Takuma
authors: T
authors: Ozawa
authors: Research Center for Clinical Pharmacy, Faculty of Pharmacy, Musashino University, 1-1-20 Shinmachi, Nishitokyo-shi, Tokyo, 202-8585 Japan.
authors: Kiyoshi
authors: K
authors: Mihara
authors: Department of Pharmacy, Kan-etsu Hospital, 145-1 Suneori, Tsuruashima-shi, Saitama, 350-2213 Japan.
authors: Nobuhiro
authors: N
authors: Yasuno
keywords: Acute lung injury; Efficacy prediction; Logistic regression analysis; Red blood cell; Sivelestat