Non‐recovery of vancomycin‐associated nephrotoxicity is related to worsening survival outcomes: Combined retrospective analyses of two real‐world databases
Non‐recovery of vancomycin‐associated nephrotoxicity is related to worsening survival outcomes: Combined retrospective analyses of two real‐world databases
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DOI：
10.1111/bcpt.13799
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发表时间：
2022-09
影响因子：
3.1
通讯作者：
M. Chuma;H. Hamano;Takashi Bando;M. Kondo;Naoto Okada;Yuki Izumi;Shunsuke Ishida;T. Yoshioka;Mizuho Asada;T. Niimura;Y. Zamami;K. Takechi;M. Goda;Koji Miyata;Kenta Yagi;Sachiko Kasamo;Y. Izawa-Ishizawa;M. Azuma;H. Yanagawa;Yoshikazu Tasaki;K. Ishizawa
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作者：
M. Chuma;H. Hamano;Takashi Bando;M. Kondo;Naoto Okada;Yuki Izumi;Shunsuke Ishida;T. Yoshioka;Mizuho Asada;T. Niimura;Y. Zamami;K. Takechi;M. Goda;Koji Miyata;Kenta Yagi;Sachiko Kasamo;Y. Izawa-Ishizawa;M. Azuma;H. Yanagawa;Yoshikazu Tasaki;K. Ishizawa
人们越来越担心万古霉素相关肾毒性（VAN）发作后生存率和肾脏结局恶化，但与这些现象相关的因素仍不清楚。为了检查这些因素，我们结合对两个现实世界数据库的分析进行了回顾性研究。最初，FDA 不良事件报告系统 (FAERS) 使用优势比 (OR) 和 95% 置信区间 (CI) 来评估 VAN 与死亡率之间的关系。接下来，在更强大的队列中检查电子病历 (EMR)，使用 Cox 比例风险回归模型评估肾脏结局与生存恶化之间的关联。 FAERS 分析显示 VAN 发生与死亡率增加之间存在显着相关性（OR：1.30；95% CI：1.17-1.46）。 EMR 分析显示，VAN 未康复与医院死亡率（风险比 [HR]：4.05；95% CI：2.42-6.77）和 1 年死亡率（HR：3.03，95% CI：1.98-4.64）增加相关。对于急性肾损伤 (AKI) ≥2 期的患者，VAN 恢复的 HR 较低（HR：0.09；95% CI：0.02-0.40）。因此，生存结果恶化与 VAN 未恢复相关，其中 AKI ≥2 期是一个重要的危险因素。应防止进展为严重 VAN，以获得更好的生存结果。
There has been growing concern in worsening survival and renal outcomes following vancomycin‐associated nephrotoxicity (VAN) onset, but the factors associated with these phenomena remain unclear. To examine these factors, we performed a retrospective study combining the analysis of two real‐world databases. Initially, the FDA Adverse Event Reporting System (FAERS) was used to evaluate the relationship between VAN and mortality using odds ratios (ORs) and 95% confidence intervals (CIs). Next, electronic medical records (EMRs) were examined in a more robust cohort for evaluation of the association between renal outcomes and worsening survival using Cox proportional hazards regression models. FAERS analysis revealed a significant correlation between VAN occurrence and increased mortality (OR: 1.30; 95% CI: 1.17–1.46). EMR analysis showed that non‐recovery of VAN was associated with increased hospital mortality (hazard ratio [HR]: 4.05; 95% CI: 2.42–6.77) and 1‐year mortality (HR: 3.03, 95% CI: 1.98–4.64). The HR for VAN recovery was lower for patients with acute kidney injury (AKI) stage ≥2 (HR: 0.09; 95% CI: 0.02–0.40). Thus, worsening survival outcomes were associated with non‐recovery of VAN, whereby AKI stage ≥2 was a significant risk factor. Progression to severe VAN should be prevented for better survival outcomes.