ArticleJournal of intensive care2014
Effect of a selective neutrophil elastase inhibitor on mortality and ventilator-free days in patients with increased extravascular lung water: a post hoc analysis of the PiCCO Pulmonary Edema Study.
Article in Journal of intensive care, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
44 citing papers in PubMed, 106 citations in OpenAlex.
- Neutrophil extracellular traps in thrombosis of hematologic malignancies: Underlying mechanisms and therapeutic opportunities (Review).International journal of molecular medicine · 2026Review
- NETosis associates with human TB lung tissue destruction and disease pathogenesis.EMBO molecular medicine · 2026Article
- Research progress on the effect of neutrophil elastase and its inhibitors in respiratory diseases.The Journal of international medical research · 2025Review
- NETosis: A key player in autoimmunity, COVID-19, and long COVID.Journal of translational autoimmunity · 2025Review
- Influence of alcohol on in-hospital survival rate among patients with traumatic brain injury: a nationwide cohort study.Critical care (London, England) · 2025Article
- "The NET effect": Neutrophil extracellular traps-a potential key component of the dysregulated host immune response in sepsis.Critical care (London, England) · 2025Review
- Blocking HXAmBio · 2024Article
- Blocking HXAbioRxiv : the preprint server for biology · 2024Article
- Neutrophil-Derived Proteases in Lung Inflammation: Old Players and New Prospects.International journal of molecular sciences · 2024Review
- Balancing the functions of DNA extracellular traps in intracellular parasite infections: implications for host defense, disease pathology and therapy.Cell death & disease · 2023Review
- NETs-Induced Thrombosis Impacts on Cardiovascular and Chronic Kidney Disease.Circulation research · 2023Review
- The interplay between inflammation and thrombosis in COVID-19: Mechanisms, therapeutic strategies, and challenges.Thrombosis update · 2022Review
- Casting a wide NET: an update on uncontrolled NETosis in response to COVID-19 infection.Clinical science (London, England : 1979) · 2022Article
- Scientific premise for the involvement of neutrophil extracellular traps (NETs) in vaccine-induced thrombotic thrombocytopenia (VITT).Journal of leukocyte biology · 2022Review
- Article
- Article
- Neutrophil Extracellular Traps, Sepsis and COVID-19 - A Tripod Stand.Frontiers in immunology · 2022Review
- Pharmacologic therapies of ARDS: From natural herb to nanomedicine.Frontiers in pharmacology · 2022Review
- Activated neutrophils in the initiation and progression of COVID-19: hyperinflammation and immunothrombosis in COVID-19.American journal of translational research · 2022Review
- On the Origin of Neutrophil Extracellular Traps in COVID-19.Frontiers in immunology · 2022Review
Corrections and comments
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Authors and funding
25 authors at 20 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNeutrophil elastase plays an important role in the development and progression of acute respiratory distress syndrome (ARDS). Although the selective elastase inhibitor, sivelestat, is widely used in Japan for treating ARDS patients, its effectiveness remains controversial. The aim of the current study was to investigate the effects of sivelestat in ARDS patients with evidence of increased extravascular lung water by re-analyzing a large multicenter study database.
methodsA post hoc analysis of the PiCCO Pulmonary Edema Study was conducted. This multicenter prospective cohort study included 23 institutions in Japan. Adult mechanically ventilated ARDS patients with an extravascular lung water index of >10 mL/kg were included and propensity score analyses were performed. The endpoints were 28-day mortality and ventilator-free days (VFDs).
resultsPatients were categorized into sivelestat (n = 87) and control (n = 77) groups, from which 329 inverse probability-weighted group patients (162 vs. 167) were generated. The overall 28-day mortality was 31.1% (51/164). There was no significant difference in 28-day mortality between the study groups (sivelestat vs. control; unmatched: 29.9% vs. 32.5%; difference, -2.6%, 95% confidence interval (CI), -16.8 to 14.2; inverse probability-weighted: 24.7% vs. 29.5%, difference, -4.8%, 95% CI, -14.4 to 9.6). Although administration of sivelestat did not alter the number of ventilator-free days (VFDs) in the unmatched (9.6 vs. 9.7 days; difference, 0.1, 95% CI, -3.0 to 3.1), the inverse probability-weighted analysis identified significantly more VFDs in the sivelestat group than in the control group (10.7 vs. 8.4 days, difference, -2.3, 95% CI, -4.4 to -0.2).
conclusionsAlthough sivelestat did not significantly affect 28-day mortality, this treatment may have the potential to increase VFDs in ARDS patients with increased extravascular lung water. Prospective randomized controlled studies are required to confirm the results of the current study.
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