万古霉素相关急性肾损伤的危险因素分析

目的:对万古霉素相关急性肾损伤(AKI)的危险因素进行分析,为临床提供安全用药数据。方法:采用回顾性研究方法,收集2012年1月-2015年6月某院使用万古霉素成人患者的数据,根据2012年发布的KDIGO AKI临床指南标准,对使用万古霉素前后的患者血肌酐进行比较,分为AKI组和非AKI组,对比2组患者基础生理、病理状态、疾病程度、感染部位、是否入住重症监护室(ICU)、万古霉素谷浓度、用药剂量、用药疗程、联合用药等多种因素,分析发生AKI的危险因素。结果:373名使用万古霉素的患者中有62例发生AKI,发生率为16.62%,采用单因素方差分析比较AKI组和非AKI组,发现万古霉素谷浓度、用药疗程、是否联合使用呋塞米、患者是否有心功能不全(IV级)、呼吸衰竭(I/II型)、休克、是否入住ICU,2组差异有统计学意义(P<0.05),以上因素通过Logistic回归分析进一步得到万古霉素谷浓度、联合使用呋塞米、是否入住ICU以及休克是引起万古霉素相关AKI的独立危险因素。经ROC曲线分析得到本研究中万古霉素发生AKI的血药谷浓度折点为19.50 mg·L^-1,在此基础上,分析万古霉素谷浓度10~20 mg·L^-1和>20 mg·L^-1亚组结果显示:2组的独立危险因素略有差别,10~20 mg·L^-1亚组万古霉素相关AKI的独立危险因素是联合使用呋塞米,而>20 mg·L^-1亚组中万古霉素谷浓度则为独立危险因素。结论:万古霉素谷浓度监测是避免发生万古霉素相关AKI的重要防治措施之一,临床药师应协助临床医师全程监护该药使用情况,尤其关注高龄、入住ICU患者、以及联合应用呋塞米的患者,保证临床用药安全。

Risk factors of vancomycin-related acute kidney injury

OBJECTIVE To explore correlation of vancomycin with renal injury and analyze risk factors of vancomycin-related acute kidney injury (AKI). METHODS A retrospective study was performed to collect data in adult patients receiving vancomycin from January 2012 to June 2015. Patients were divided into AKI and non AKI groups according to clinical criteria of KDIGO AKI to compare serum creatinine before and after vancomycin was administered, basic physiological and pathological parameters, severity of disease, infection site, whether admitted into ICU, vancomycin though concentration, dose, course of drug treatment, and drug combination between two groups. Risk factors for acute kidney injury were analyzed. RESULTS Of 373 patients receiving vancomycin, 62 patients had AKI with an incidence of 16.62%. Univariate analysis indicated that risk factors of AKI included vancomycin though concentration, course of treatment,vancomycin combined with furosemide, concurrent diseases including heart failure, respiratory failure or shock, and admission into ICU. Logistic analysis showed that independent risk factor was vancomycin though concentration, vancomycin combined with furosemide, admission into ICU, and concurrent shock. ROC curve showed cut off concentration was 19.50 mg·L^-1 for vancomycin related AKI. Vancomycin blood concentrations of 10-20 mg·L^-1 and > 20 mg·L^-1 showed different independent risk factors, 10-20 mg·L^-1 was vancomycin combined with furosemide, and > 20 mg·L^-1 was vancomycin though concentration. CONCLUSION Vancomycin though concentration monitoring is one of the important measures to prevent and control AKI. During vancomycin individualized medication, clinical pharmacists should help clinicians pay attentions to monitor patients treated with vancomycin, particularly the elderly, those admitted into ICU, those combining furosemide, to ensure safety of drug use.