A Risk Prediction Flowchart of Vancomycin-Induced Acute Kidney Injury to Use When Starting Vancomycin Administration: A Multicenter Retrospective Study
A Risk Prediction Flowchart of Vancomycin-Induced Acute Kidney Injury to Use When Starting Vancomycin Administration: A Multicenter Retrospective Study
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DOI：
10.3390/antibiotics9120920
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发表时间：
2020-12-18
期刊：
影响因子：
--
通讯作者：
Sugawara M
中科院分区：
文献类型：
--
作者：
Miyai T;Imai S;Kashiwagi H;Sato Y;Kadomura S;Yoshida K;Yoshimura E;Teraya T;Tsujimoto T;Kawamoto Y;Itoh T;Ueno H;Goto Y;Takekuma Y;Sugawara M
我们先前构建了一个万古霉素（VCM）相关肾毒性的风险预测模型，用于进行初始治疗药物监测（TDM）时，使用决策树分析。然而，由于样本量不足，我们无法构建初始给药时使用的模型。因此，我们在日本的四家医院进行了一项多中心研究。我们研究了从2011年11月至2019年3月从第一天到初始TDM以标准剂量静脉注射VCM的患者。急性肾损伤（阿基）是根据“肾脏疾病：改善全球结局”小组制定的标准定义的。我们提取了可以在首次给药当天进行评估的潜在风险因素，并使用卡方自动交互检测算法构建了流程图。在843例患者中，115例（13.6%）发生阿基。该流程图包括3个分裂变量（伴随药物（血管加压药和他唑巴坦/哌拉西林）和体重指数≥ 30）和4个亚组。阿基的发生率范围为9.34%至36.8%，并将其分为低风险、中等风险和高风险组。流程图的准确性被认为是适当的（86.4%）。我们成功构建了一个简单的流程图，预测VCM诱导的阿基，用于开始VCM给药时。
We previously constructed a risk prediction model of vancomycin (VCM)-associated nephrotoxicity for use when performing initial therapeutic drug monitoring (TDM), using decision tree analysis. However, we could not build a model to be used at the time of initial administration due to insufficient sample size. Therefore, we performed a multicenter study at four hospitals in Japan. We investigated patients who received VCM intravenously at a standard dose from the first day until the initial TDM from November 2011 to March 2019. Acute kidney injury (AKI) was defined according to the criteria established by the “Kidney disease: Improving global outcomes” group. We extracted potential risk factors that could be evaluated on the day of initial administration and constructed a flowchart using a chi-squared automatic interaction detection algorithm. Among 843 patients, 115 (13.6%) developed AKI. The flowchart comprised three splitting variables (concomitant drugs (vasopressor drugs and tazobactam/piperacillin) and body mass index ≥ 30) and four subgroups. The incidence rates of AKI ranged from 9.34 to 36.8%, and they were classified as low-, intermediate-, and high-risk groups. The accuracy of flowchart was judged appropriate (86.4%). We successfully constructed a simple flowchart predicting VCM-induced AKI to be used when starting VCM administration.
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