重症患者肾功能亢进对万古霉素血药谷浓度的影响

Influence of augmented renal clearance on serum trough concentrations of vancomycin in critically ill patients

目的 探讨重症患者肾功能亢进(ARC)对万古霉素血药谷浓度(C_(min))的影响;计算CockcroftGault法估算的肌酐清除率(Ccr_(C-G))、血清肌酐(Scr)与C_(min)的相关性。方法 采用回顾性观察性研究方法,选取2018年4月至2023年5月北京积水潭医院ICU入住的重症感染患者,经验性或治疗性应用万古霉素抗感染的Ccr_(C-G)≥60 mL/min且进行C_(min)监测的患者为研究对象。将患者按Ccr_(C-G)是否>120 mL/min,分为ARC(Ccr_(C-G)≥120 mL/min)组和非ARC(Ccr_(C-G)<120mL/min)组,收集各项指标并进行比较。结果 共纳入114例重症感染患者,其中ARC组67例,非ARC组47例。两组患者的Ccr_(C-G)平均值分别为(205.2±90.8)mL/min及(89.4±14.4)mL/min。ARC组患者年龄较非ARC组更年轻[(48.0±14.7)岁比(68.3±11.2)岁,P<0.001],较非ARC组C_(min)更低[(9.51±5.42)μg/mL比(17.09±8.70)μg/mL,P<0.001],较非ARC组C_(min)<10μg/mL的患者比例更高(61.2%比21.3%,P<0.001)。Spearman相关性分析显示,C_(min)与Ccr_(C-G)呈负相关(r=-0.466,P<0.001),与Scr呈正相关(r=0.213,P=0.023),但相关性弱。ARC组患者的C_(min)与Ccr_(C-G)呈负相关(r=-0.424,P<0.001),与Scr无相关性(P=0.436);非ARC组的C_(min)与Ccr_(C-G)、Scr均无相关性(P=0.189、0.749)。结论 ARC患者的C_(min)达标率低,C_(min)与Ccr_(C-G)相关,与Scr相关性较弱;非ARC患者的C_(min)与Ccr_(C-G)及Scr均无相关性。

Objective To investigate the impact of augmented renal clearance(ARC)on serum trough concentration(C_(min))of vancomycin in critically ill patients,and to evaluate the correlations between creatinine clearance estimated by the Cockcroft-Gault formula(CcrC-G),serum creatinine(Scr)and C_(min).Methods A retrospective observational study was conducted among critically ill patients with infections admitted to the ICU of Beijing Jishuitan Hospital from April 2018 to May 2023 who received empirical or therapeutic vancomycin therapy with CcrC-G≥60 mL/min and underwent C_(min) monitoring.Patients were divided into ARC(CcrC-G≥120 mL/min)and non-ARC(CcrC-G<120 mL/min)groups based on their CcrC-G values.Various indicators were collected and compared between the two groups.Results A total of 114 patients with severe infection were included,with 67 cases in the ARC group and 47 cases in the non-ARC group.The mean CcrC-G values were(205.2±90.8)mL/min and(89.4±14.4)mL/min,respectively.Patients in the ARC group were younger[(48.0±14.7)years vs(68.3±11.2)years,P<0.001]and had lower C_(min)[(9.51±5.42)μg/mL vs(17.09±8.70)μg/mL,P<0.001]compared to the non-ARC group.A higher proportion of patients in the ARC group had C_(min)<10μg/mL(61.2%vs 21.3%,P<0.001).Spearman correlation analysis showed a negative correlation between C_(min) and CcrC-G(r=-0.466,P<0.001)and a weak positive correlation between C_(min) and Scr(r=0.213,P=0.023).In the ARC group,C_(min) was negatively correlated with CcrC-G(r=-0.424,P<0.001),but not with Scr(P=0.436).In the non-ARC group,no correlation was found between C_(min) and either CcrC-G or Scr(P=0.189 and 0.749,respectively).Conclusion Patients with ARC have a lower achievement rate of the C_(min) target.C_(min) was correlated with CcrC-G but weakly correlated with Scr in ARC patients.No correlation was observed between C_(min) and CcrC-G or Scr in non-ARC patients.