title: Efficacy of early sivelestat administration on acute lung injury and acute respiratory distress syndrome.
abstract: The efficacy of sivelestat, a neutrophil elastase inhibitor, for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) remains controversial. We investigated the role of sivelestat in ALI/ARDS patients on mortality as an end point between the sivelestat group and the non-sivelestat group within 7 days of admission.
  
  
  
  This study was performed using the Japanese nationwide administrative database (Diagnostic Procedure Combination; DPC) in 2012. We employed the propensity score weighting method with a Cox proportional hazards model to compare the mortality between the sivelestat group and the non-sivelestat group.
  
  
  
  A total of 4276 patients were eligible for this study; 1997 patients were treated with sivelestat and 2279 patients did not receive sivelestat within 7 days of admission. After adjusting for confounds, the mortality within 3 months was significantly lower in the sivelestat group compared with the non-sivelestat group (weighted hazard ratio: 0.83; 95% CI: 0.75-0.93; P < 0.002). Multiple regression analysis revealed that younger age, absence of cancer, no need for haemodialysis and no use of high-dose methylprednisolone were significantly correlated with treatment success (survive).
  
  
  
  These results of this retrospective and observational study suggest that administration of sivelestat within 7 days of admission may improve the prognosis of patients with ALI/ARDS. To our knowledge, this is the largest study to evaluate the efficacy of sivelestat on ALI/ARDS.
authors.affiliation: Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.|Department of Emergency Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kido
authors.affiliation: Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Muramatsu
authors.affiliation: Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yatera
authors.affiliation: Department of Information Systems Center, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Asakawa
authors.affiliation: Department of Emergency Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Otsubo
authors.affiliation: Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kubo
authors.affiliation: Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Fujino
authors.affiliation: Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.affiliation: Department of Emergency Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Mayumi
authors.affiliation: Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mukae
mesh_terms: D055371:Acute Lung Injury / Q000188:drug therapy*; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005998:Glycine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000188:drug therapy*; D012189:Retrospective Studies; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage; D013449:Sulfonamides / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015842:Serine Proteinase Inhibitors; D013449:Sulfonamides; C069195:sivelestat; D005998:Glycine
keywords: acute lung injury; acute respiratory distress syndrome; inverse probability of treatment weighting; nationwide administrative database; sivelestat