PREDICTIVE PERFORMANCE OF EQUATIONS TO ESTIMATE CREATININE CLEARANCE IN HOSPITALIZED ELDERLY PATIENTS
PREDICTIVE PERFORMANCE OF EQUATIONS TO ESTIMATE CREATININE CLEARANCE IN HOSPITALIZED ELDERLY PATIENTS
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DOI：
10.1177/106002809202600503
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发表时间：
1992-05-01
影响因子：
2.9
通讯作者：
BANNICKMOHRLAND, SD
中科院分区：
文献类型：
--
作者：
OCONNELL, MB;DWINELL, AM;BANNICKMOHRLAND, SD
目的：确定用于预测住院老年患者的正确用药剂量的肌酐清除量方程的临床准确性。设计：使用总的和改进的理想体重设置，对由8个方程得出的24小时肌酐清除量估算值进行比较：一家县医院的非重症监护内外科患者：15名留有导尿管的患者分别来自三个年龄组：65-75岁，76-85岁，大于或等于86岁。主要结果测量：药物剂量预测，偏差，精确度，绝对误差结果：各方程的偏差为-4.0~42.0m L/m in(-0.0 7~0.70 m L/S)，精密度为10.8~47.4m L/m in(0.18~0.88m L/S)。The Jelliffe 1973，Hull et al.和Mawer et al.方程的偏差最小，而1973年的Jelliffe方程最精确，其次是Mawer等人、Hull等人和Cockcroft-Gault方程。Jelliffe 1973年的绝对百分比误差为38%，Mawer等人的绝对误差百分比为36%，Hull等人的绝对误差百分比为40%，其他方程的绝对误差百分比为50%。1973年Jelliffe的患者获得正确药物剂量的比例为67%，盖茨为58%，Mawer等人为51%。和Hull等人，以及其他方程的50%。在不同的年龄、肾功能、血肌酐和白蛋白亚组中，Jelliffe 1973年的估计偏差最小，最精确，其次是Cockcroft-Gault估计。结论：修正后的Jelliffe-1973方程效果最好，其次是Cockcroft-Gault方程。即使有了最好的方程式，33%的患者也会得到错误的药物剂量。因此，一些老年患者可能仍然需要测量肌酐清除量。
OBJECTIVE: To ascertain the clinical accuracy of equations that estimate creatinine clearance to predict the correct drug doses in hospitalized elderly patients DESIGN: Single 24-hour creatinine clearance measurement compared with estimated creatinine clearances derived from eight equations using total and modified ideal body weight SETTING: Nonintensive care medical and surgical units at a county hospital PATIENTS: 15 patients with urethral catheters were enrolled in each of three age groups: 65-75, 76-85, and greater-than-or-equal-to 86 years MAIN OUTCOME MEASUREMENTS: Drug-dose predictions, bias, precision, and absolute errors RESULTS: The bias for all equations was -4.0-42.0 mL/min (-0.07-0.70 mL/s) and the precision was 10.8-47.4 mL/min (0.18-0.88 mL/s). The Jelliffe 1973, Hull et al., and Mawer et al. equations were the least biased and the Jelliffe 1973 was the most precise, followed by the Mawer et al., Hull et al., and Cockcroft-Gault equations. The percent of patients with absolute percent errors > 20 percent were 38 percent for Jelliffe 1973, 36 percent for Mawer et al., 40 percent for Hull et al., and > 50 percent for the other equations. The percent of patients receiving correct drug doses was 67 percent for Jelliffe 1973, 58 percent for Gates, 51 percent for Mawer et al. and Hull et al., and < 50 percent for the other equations. Within various age, renal function, serum creatinine, and albumin subgroups, the Jelliffe 1973 estimates were least biased and most precise, followed by the Cockcroft-Gault estimates. Generally, estimates using modified lean body weight performed better than did those using total body weight.CONCLUSIONS: The Jelliffe 1973 equation with modified lean body weight was the best equation, followed by the Cockcroft-Gault equation. Even with the best equation, 33 percent of the patients would have received an incorrect drug dose. Therefore, some elderly patients may still require a measured creatinine clearance.