地高辛血药浓度超出安全限值风险预测模型的建立与评估

目的:探讨地高辛血药浓度超出安全限值(2.0 ng·mL-1)的影响因素并构建相关风险预测模型,为地高辛的安全合理用药提供参考.方法:回顾性分析2019年1月至2020年12月安徽医科大学附属六安医院服用地高辛进行治疗并接受血药浓度监测的153例住院患者的临床资料,将所纳入患者按地高辛血药浓度监测值分为达标组(0.5 ...

Establishment and evaluations of risk prediction model of digoxin blood concentration exceeding a safe limit

OBJECTIVE To explore the influencing factors of digoxin blood concentration exceeding a safe limit and establish a risk prediction model to provide reference for safe and rational dosing of digoxin.METHODS Clinical data were retrospectively reviewed for 153 patients on digoxin therapy and blood concentration was monitored from January 2019 to December 2020. They were divided into goal-attaining group (0.5 ng·mL^-1≤blood concentration≤2.0 ng·mL^-1) and over-limit group (blood concentration >2.0 ng·mL^-1) according to the levels of blood digoxin concentration. Gender, age, body mass index (BMI), kidney damage, daily dose and combined drug dosing of two groups were screened by Logistic regression analysis for independent influencing factors of blood digoxin concentration exceeding a safe limit. A nomogram prediction model was established on the basis of screened independent influencing factors.RESULTS Gender (OR=0.379, 95%CI: 0.244-0.589), kidney damage (OR=0.252, 95%CI:0.162-0.391), daily dose (OR=0.438, 95%CI:0.279-0.689), combination of gastroprokinetic agents (OR=1.975, 95%CI:1.294-3.013), combination of antibiotics (OR=0.471, 95%CI:0.299-0.741), combination of β-receptor blockers (OR=0.454, 95%CI:0.277-0.642) and Qili Qiangxin capsule (OR=0.096, 95%CI:0.026-0.353) were independent influencing factors of blood digoxin concentration exceeding a safe limit. Based upon seven independent influencing factors, a nomogram prediction model for blood digoxin concentration exceeding a safe limit was established. C-index of the model was 0.742, indicating that the nomogram model had a decent discrimination. The validation of the model showed that the predicted and observed values were basically consistent, indicating that the nomogram prediction model had a decent consistency.CONCLUSION The nomogram model based upon independent influencing factors has showed excellent discrimination and consistency. With clinical value in screening patients with a high risk of blood digoxin concentration exceeding a safe limit, it is of great significance to prepare treatment protocols for these patients.