Morphine consumption is associated with systemic inflammation in children undergoing allogeneic hematopoietic stem cell transplantation
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Morphine consumption is associated with systemic inflammation in children undergoing allogeneic hematopoietic stem cell transplantation. / De Pietri, Silvia; Nielsen, Bettina Nygaard; Ifversen, Marianne; Kielsen, Katrine; Müller, Klaus Gottlob.
I: Immunopharmacology and Immunotoxicology, Bind 41, Nr. 2, 2019, s. 285-291.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Morphine consumption is associated with systemic inflammation in children undergoing allogeneic hematopoietic stem cell transplantation
AU - De Pietri, Silvia
AU - Nielsen, Bettina Nygaard
AU - Ifversen, Marianne
AU - Kielsen, Katrine
AU - Müller, Klaus Gottlob
PY - 2019
Y1 - 2019
N2 - Background: The majority of children undergoing allogenic hematopoietic stem cell transplantation (HSCT) experience severe pain due to chemotherapy-induced gastrointestinal toxicity. Inter-individual differences in pain perceived and opioid consumption remain unexplained, limiting the possibility for individualized pain control. The aim of this study was to investigate the associations between opioid consumption and markers of gastrointestinal toxicity (plasma citrulline) and systemic inflammation (plasma CRP and IL-6) in these patients. Methods: We retrospectively included 38 children undergoing HSCT in Denmark in 2010–2012. Opioids doses on days 0–21 post-HSCT were registered as intravenous morphine equivalents (MEs). CRP was measured daily on days 0–21. IL-6 was measured on day 7. Citrulline was measured before conditioning, on days 7 and 21. Results: Out of 38 children, 37 (97%) received opioids during days 0–21. CRP level and ME dose peaked on days 9–10 while citrulline level reached a nadir on day 7 indicating maximum enterocyte loss. CRP was associated with ME dose, with an estimated increase of 0.030 mg/kg (95% CI 0.024–0.035) in ME for a 50% increase in CRP level on the same day (p <.001). IL-6 was correlated with ME on day 7 (rho = 0.55, p =.002). Citrulline did not correlate with ME. Conclusions: Opioid consumption in the early post-HSCT period is associated with the degree of chemotherapy-induced systemic inflammation and not with the extent of enterocyte loss. These findings contribute to our understanding of mucositis-related pain and may be of interest for future studies on therapeutic strategies.
AB - Background: The majority of children undergoing allogenic hematopoietic stem cell transplantation (HSCT) experience severe pain due to chemotherapy-induced gastrointestinal toxicity. Inter-individual differences in pain perceived and opioid consumption remain unexplained, limiting the possibility for individualized pain control. The aim of this study was to investigate the associations between opioid consumption and markers of gastrointestinal toxicity (plasma citrulline) and systemic inflammation (plasma CRP and IL-6) in these patients. Methods: We retrospectively included 38 children undergoing HSCT in Denmark in 2010–2012. Opioids doses on days 0–21 post-HSCT were registered as intravenous morphine equivalents (MEs). CRP was measured daily on days 0–21. IL-6 was measured on day 7. Citrulline was measured before conditioning, on days 7 and 21. Results: Out of 38 children, 37 (97%) received opioids during days 0–21. CRP level and ME dose peaked on days 9–10 while citrulline level reached a nadir on day 7 indicating maximum enterocyte loss. CRP was associated with ME dose, with an estimated increase of 0.030 mg/kg (95% CI 0.024–0.035) in ME for a 50% increase in CRP level on the same day (p <.001). IL-6 was correlated with ME on day 7 (rho = 0.55, p =.002). Citrulline did not correlate with ME. Conclusions: Opioid consumption in the early post-HSCT period is associated with the degree of chemotherapy-induced systemic inflammation and not with the extent of enterocyte loss. These findings contribute to our understanding of mucositis-related pain and may be of interest for future studies on therapeutic strategies.
KW - citrulline
KW - Hematopoietic stem cell transplantation
KW - inflammation
KW - morphine
KW - mucositis
KW - opioids
KW - pain
U2 - 10.1080/08923973.2019.1590846
DO - 10.1080/08923973.2019.1590846
M3 - Journal article
C2 - 30892107
AN - SCOPUS:85063155679
VL - 41
SP - 285
EP - 291
JO - Immunopharmacology and Immunotoxicology
JF - Immunopharmacology and Immunotoxicology
SN - 0892-3973
IS - 2
ER -
ID: 240687751