重症患者万古霉素相关急性肾损伤的发生状况及危险因素分析

目的：对重症患者发生万古霉素相关急性肾损伤（vancomycin-induced acute kidney injury，VI-AKI）的危险因素进行分析，为临床安全用药提供参考。方法：收集2017年1月至2020年8月某院重症医学科（intensive care unit，ICU）接受万古霉素治疗的患者病历资料进行回顾性分析，根据是否发生急性肾损伤（acute kidney injury，AKI）将患者分为发生AKI组和非AKI组，采用单因素分析方法比较2组患者的临床资料，多因素Logistic回归分析方法分析重症患者发生VI-AKI的危险因素。结果：共纳入294名重症患者，发生AKI者51例，发生率为17.3%。通过单因素分析，发现2组间万古霉素血药谷浓度、是否联用袢利尿剂及是否联用哌拉西林他唑巴坦差异具有统计学意义（P<0.05）。通过多因素Logistic回归分析，发现万古霉素血药谷浓度>18.75 mg·L^-1（OR=16.007，P<0.001）、联合使用袢利尿剂（OR=4.418，P=0.001）及联合使用哌拉西林他唑巴坦（OR=2.243，P=0.044）是重症患者发生VI-AKI的独立危险因素。结论：万古霉素血药谷浓度>18.75 mg·L^-1、联用袢利尿剂或哌拉西林他唑巴坦将增加重症患者发生VI-AKI的风险。

Analysis of occurrence and risk factors for vancomycin-induced acute kidney injury in ICU patients

OBJECTIVE To explore the risk factors of vancomycin-induced acute kidney injury (VI-AKI) in critical patients.METHODS Medical records of 294 patients in intensive care unit (ICU) receiving vancomycin from January 2017 to August 2020 were retrospectively reviewed. They were divided into AKI and non-AKI groups according to the occurrence of AKI. Clinical data of two groups were compared by univariate analysis. And risk factors of VI-AKI in ICU patients were analyzed by multivariate Logistic regression.RESULTS Among them, 51 patients had AKI with an incidence of 17.3%. Univariate analysis revealed significant inter-group differences in blood trough concentration of vancomycin, vancomycin plus loop diuretics and piperacillin tazobactam (P<0.05). Multivariate Logistic regression analysis indicated that trough concentration of vancomycin >18.75 mg·L^-1 (OR=16.007, P<0.001), vancomycin plus loop diuretics (OR=4.418, P=0.001) and vancomycin plus piperacillin tazobactam (OR=2.243, P=0.044) were independent risk factors for VI-AKI in ICU patients.CONCLUSION Trough concentration of vancomycin >18.75 mg·L^-1 and vancomycin plus loop diuretics or piperacillin tazobactam elevate the risk of VI-AKI in ICU patients.