免费万古霉素个体化给药软件预测谷浓度的效能评估

Evaluation of the ability of open-access vancomycin dosing software in prediction of serum trough concentration

目的:评价免费万古霉素个体化给药软件在中国人群中预测万古霉素稳态谷浓度的临床效用。方法:搜集国内外万古霉素个体化给药软件,根据患者基本信息(性别、年龄、身高、体质量、血肌酐)和用药方案,分别计算万古霉素预测谷浓度,比较各软件预测浓度与实测浓度的相关性和差别。结果:共纳入ClinCalc,Vancomycin-Calculator,UCSF和TDMS2000 4个免费万古霉素个体化给药软件进行分析,收集到196例患者292个谷浓度数据。各软件的预测值与实测值均存在相关性(r=0.590,P<0.01;r=0.640,P<0.01;r=0.606,P<0.01;r=0.621,P<0.01);基于Vancomycin-Calculator和TDMS2000的平均预测误差(MPE),平均绝对误差(MAE)分别为0.63(-0.55～1.81),6.99(6.13～7.86);-1.52(-2.64～0.39),7.12(6.33～7.90)μg·mL-1优于ClinCalc和UCSF软件。其中Vancomycin-Calculator软件尤为适用体质量偏轻的患者,TDMS2000软件尤为适用肥胖患者。结论:Vancomycin-Calculator和TDMS2000软件可以用于万古霉素稳态谷浓度的预测,协助个体化给药方案的制定。

OBJECTIVE To investigate the clinical efficiency of open-access vancomycin dosing software to predict serum steady trough concentrations of vancomycin.METHODS The open-access vancomycin dosing software was used to calculate the predicted vancomycin trough concentrations based on patient information,including gender,age,height,weight and serum creatinine through the software.Finally,the correlations and distinctions between predicted and measured trough concentrations were analyzed.RESULTS Four open-access vancomycin dosing softwares(ClinCalc,Vancomycin-Calculator,UCSF and TDMS2000)were included for comparison.Totally 292 blood samples with serum trough concentrations of vancomycin were collected from 196 patients.For all softwares,there were correlation between predicted and measured trough concentrations(r=0.590,P<0.01;r=0.640,P<0.01;r=0.606,P<0.01;r=0.621,P<0.01).Besides,the errors of mean predictive error(MPE)and mean absolute error(MAE)were 0.63(-0.55-1.81),6.99(6.13-7.86);-1.52(-2.64-0.39),7.12(6.33-7.90)μg·mL-1 for Vancomycin-Calculator and TDMS2000 software,respectively,superior to ClinCalc and UCSF software in accuracy and precision.Vancomycin-Calculator software was suitable for underweight patients and TDMS2000 software was suitable for obese patients.CONCLUSION Vancomycin-Calculator and TDMS2000 have positive prediction for the samples of trough concentrations,and can help assist clinical individualized application of vancomycin.