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Pancreatitis aguda asociada a errores de dosificación de L-asparaginasa en pacientes pediátricos con leucemia linfoblástica aguda en terapia de inducción: estudio exploratorio
Acute pancreatitis associated to dosing errors of L-asparaginase in pediatric patients with acute lymphoblastic leukemia on induction therapy: exploratory study
Pancreatite aguda associada a erros de dosagem de L-asparaginase em pacientes pediátricos com leucemia linfoblástica aguda em terapia de indução: estudo exploratório
DOI:
https://doi.org/10.15446/rcciquifa.v51n1.102686Palabras clave:
Pancreatitis, errores de medicación, asparaginasa, leucemia, eventos adversos, seguridad del paciente (es)Pancreatite, erros de medicação, eventos adversos, leucemia, segurança do paciente, asparaginase (pt)
Pancreatitis, medication errors, adverse events, leukemia, patient safety, asparaginase (en)
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Objetivo: explorar si la presencia de errores de dosificación con L-asparaginasa se asocia con la ocurrencia de pancreatitis asociada a L-asparaginasa (PAA) durante la terapia de la inducción a la remisión en pacientes pediátricos con leucemia linfoblástica aguda (LLA). Metodología: se realizó un análisis secundario de una cohorte retrolectiva en pacientes con LLA que recibieron tratamiento de inducción entre 2015 y 2017. Se consideró un error de dosificación una desviación absoluta mayor a 10% de la dosis requerida. Los casos de PAA se capturaron desde los expedientes. Se calcularon riesgos relativos (RR) con intervalos de confianza para el error de dosificación, subdosis y sobredosis. Resultados: se incluyeron 181 pacientes. Se documentaron 5 (1,1%) casos de PAA y 18 (9,9%) pacientes presentaron errores de dosificación con L-asparaginasa anteriores a la PAA. Se observó una asociación estadísticamente significativa entre la presencia de errores de dosificación (RR=6,04; 1,08-33,77) y la sobredosis (RR=10,67; 1,33-85,46). Conclusiones: se observó una posible asociación entre los errores de dosificación con L-asparaginasa y PAA. Sin embargo, se requieren estudios con un enfoque estadístico y un ajuste por variables confusoras.
Aim: To explore whether the presence of dosing errors with L-asparaginase is associated with the occurrence of L-asparaginase-associated pancreatitis (PAA) during remission induction therapy in pediatric patients with acute lymphoblastic leukemia (ALL). Methodology: A secondary analysis of a retrospective cohort was performed in patients with ALL who received induction treatment between 2015 and 2017. An absolute deviation greater than 10% of the required dose was considered a dosage error. PAA cases were captured from the files. Relative risks (RR) with confidence intervals for dosage error, underdose, and overdose were calculated. Results: 181 patients were included. 5 cases of PAA (1.1%) were documented and 18 (9.9%) patients had dosing errors with L-asparaginase prior to PAA. A statistically significant association was observed between the presence of dosage errors (RR=6.04; 1.08-33.77) and overdose (RR=10.67; 1.33-85.46). Conclusions: a possible association between dosage errors with L-asparaginase and PAA was observed. However, studies with a statistical approach and an adjustment for confounding variables are required.
Objetivo: explorar se a presença de erros de dosagem com L-asparaginase está associada à ocorrência de pancreatite associada à L-asparaginase (PAA) durante a terapia de indução de remissão em pacientes pediátricos com leucemia linfoblástica aguda (LLA). Metodologia: uma análise secundária de uma coorte retrospectiva foi realizada em pacientes com LLA que receberam tratamento de indução entre 2015 e 2017. Um desvio absoluto maior que 10% da dose necessária foi considerado um erro de dosagem. Os casos de PAA foram capturados dos arquivos. Os riscos relativos (RR) com intervalos de confiança para erro de dosagem, subdosagem e overdose foram calculados. Resultados: 181 pacientes foram incluídos. 5 casos de PAA (1,1%) foram documentados e 18 (9,9%) pacientes tiveram erros de dosagem com L-asparaginase antes do PAA. Foi observada associação estatisticamente significativa entre a presença de erros de dosagem (RR=6,04; 1,08-33,77) e superdosagem (RR=10,67; 1,33-85,46). Conclusões: foi observada uma possível associação entre erros de dosagem com L asparaginase e PAA. No entanto, estudos com abordagem estatística e o ajuste para variáveis de confusão são necessários.
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