Vancomycin-associated acute kidney injury: A cross-sectional study from a single center in China.
Vancomycin-associated acute kidney injury: A cross-sectional study from a single center in China.
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DOI：
10.1371/journal.pone.0175688
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Cui Y
中科院分区：
文献类型：
--
作者：
Pan K;Ma L;Xiang Q;Li X;Li H;Zhou Y;Yang L;Cui Y
本研究的目的是调查中国万古霉素（货车）相关急性肾损伤（VA-AKI）的现状，识别VA-AKI的危险因素，并全面检查与合并用药相关的风险。此外，我们评估了发生VA-AKI的患者的结局以及这些结局的风险因素。最后，为我国VA-AKI的防治工作提出建议。我们对2013年1月至2013年12月在北京大学第一医院接受货车治疗的住院患者进行了回顾性观察研究。阿基定义为48小时内SCr升高≥0.3 mg/dl（≥26.5 μmol/l），或在过去7天内肯定或推测升高至基线的≥1.5倍。VA-AKI定义为货车治疗期间或货车治疗终止后7天内发生阿基。此外，我们还将住院期间未发生阿基的NO-AKI患者与VA-AKI患者进行了比较。在住院期间接受货车治疗的934例患者中，740例纳入本研究。在排除的患者中，38.1%（74/194）因缺乏血清肌酐（SCr）数据而被排除。在纳入的患者中，有120例确诊VA-AKI，发生率为16.2%（120/740）。多元逻辑回归分析显示，基线估计肾小球滤过率（eGFR）升高（比值比[OR] = 1.009; p = 0.017）和伴随血管加压药治疗（OR = 2.942; p = 0.009），硝酸盐使用（OR = 2.869; p = 0.007），亚胺培南-西司他丁治疗（OR = 4.708; p = 0.000）和造影剂给药（OR = 6.609 p = 0.005）是VA-AKI的独立风险因素;此外，接受骨科/创伤/烧伤手术（OR = 0.3575; p = 0.011）和合并使用的化合物β-内酰胺酶（OR = 0.290; p = 0.017）是VA-AKI的独立保护因素。多元logistic回归分析也表明，在发生VA-AKI的患者中，冠心病（CHD）（OR = 12.6; p = 0.006）和伴随血管加压治疗（OR = 15.4; p = 0.001）是死亡的独立危险因素。并对影响肾功能改善的因素进行了评价。多因素Logistic回归分析显示，冠心病（OR = 8.858，p = 0.019）和伴随造影剂使用（OR = 9.779，p = 0.005）是肾功能改善的独立危险因素，同时β受体阻滞剂治疗（OR = 0.124，p = 0.001）是肾功能改善的独立保护因素。接受货车治疗的患者SCr监测不足，治疗药物监测不足。建议医院加大对临床药师的投入。基线eGFR升高和伴随血管加压药治疗、硝酸盐使用、亚胺培南-西司他丁治疗和造影剂给药是VA-AKI的独立风险因素;此外，骨科/创伤/烧伤手术和伴随化合物治疗是VA-AKI的独立保护因素。
The objective of this study was to investigate the current situation of vancomycin (VAN)-associated acute kidney injury (VA-AKI) in China and identify the risk factors for VA-AKI, as well as to comprehensively examine the risk related to concurrent drug use. Further, we assessed the outcomes of patients who developed VA-AKI and the risk factors for these outcomes. Finally, we aimed to provide suggestions for improving the prevention and treatment of VA-AKI in China. We conducted a retrospective observational study of inpatients who had been treated with VAN between January 2013 and December 2013 at Peking University First Hospital. AKI was defined as an increase in SCr of ≥0.3 mg/dl (≥26.5 μmol/l) within 48 hours or an increase to ≥1.5 times the baseline certainly or presumably within the past 7 days. VA-AKI was defined as the development of AKI during VAN therapy or within 7 days following the termination of VAN therapy. In addition, we compared patients with NO-AKI, who did not develop AKI during their hospitalization, with those with VA-AKI. Of the 934 patients treated with VAN during their hospital stay, 740 were included in this study. Among those excluded, 38.1% (74/194) were excluded because of a lack of data on serum creatinine (SCr). Among the included patients, 120 had confirmed VA-AKI, with an incidence of 16.2% (120/740). Multiple logistic regression analysis revealed that an elevated baseline estimated glomerular filtration rate (eGFR) (odds ratio [OR] = 1.009; p = 0.017) and concomitant vasopressor therapy (OR = 2.942; p = 0.009), nitrate use (OR = 2.869; p = 0.007), imipenem-cilastatin treatment (OR = 4.708; p = 0.000), and contrast medium administration (OR = 6.609 p = 0.005) were independent risk factors for VA-AKI; in addition, the receipt of orthopedic/trauma/burn surgery (OR = 0.3575; p = 0.011) and concomitant compound glycyrrhizin use (OR = 0.290; p = 0.017) were independent protective factors for VA-AKI. Multiple logistic regression analysis also demonstrated that among the patients who developed VA-AKI, coronary heart disease (CHD) (OR = 12.6; p = 0.006) and concomitant vasopressor therapy (OR = 15.4; p = 0.001) were independent risk factors for death. We also evaluated the factors influencing improvement of renal function. Multiple logistic regression analysis demonstrated that CHD (OR = 8.858, p = 0.019) and concomitant contrast medium administration (OR = 9.779, p = 0.005) were independent risk factors and that simultaneous β-blocker treatment (OR = 0.124, p = 0.001) was an independent protective factor for improvement of renal function. Patients treated with VAN received insufficient monitoring of SCr and inadequate therapeutic drug monitoring. We recommend that hospitals increase their investment in clinical pharmacists. An elevated baseline eGFR and concomitant vasopressor therapy, nitrate use, imipenem-cilastatin treatment, and contrast medium administration were independent risk factors for VA-AKI; in addition, orthopedic/trauma/burn surgery and concomitant compound glycyrrhizin use were independent protective factors for VA-AKI.