Pre-treatment serum C-reactive protein level is an independent risk factor for development of nephrotoxicity in patients receiving high-dose vancomycin
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- 英文论文题名：Pre-treatment serum C-reactive protein level is an independent risk factor for development of nephrotoxicity in patients receiving high-dose vancomycin
- 论文作者：He Juan ; Mao En-Qiang ; Jing Feng ; Jiang Hui-Ting ; Yang Wan-Hua ; Chen Er-Zhen
- 英文论文作者：He Juan ; Mao En-Qiang ; Jing Feng ; Jiang Hui-Ting ; Yang Wan-Hua ; Chen Er-Zhen ; Department of Pharmacy Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine ; EICU of Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine
- 年：2016
- 作者机构：Department of Pharmacy Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine;EICU of Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine;
- 英文论文关键词：vancomycin ; nephrotoxicity ; C-reactive protein ; risk ; biomarker
- 会议召开时间：2016-09-27
- 会议录名称：中国药学会第十三届青年药学科研成果交流会论文集
- 语种：英文
- 分类号：R969
- 学会代码：YYWS
- 会议名称：中国药学会第十三届青年药学科研成果交流会
- 会议地点：中国江西南昌
- 主办单位：中国药学会
- 学会名称：中国药学会
- 页数：11
- 文件大小：577k
- 原文格式：O
- 会议级别：全国
摘要
High-dose vancomycin treatment increases the likelihood of vancomycin-related nephrotoxicity.C-reactive protein(CRP) is a sensitive marker of systemic inflammation.In the present study,we evaluated the pre-treatment serum CRP level as a risk factor of the development of nephrotoxicity in patients receiving total daily doses of ≥4g of vancomycin.Data extracted from medical records for 174 patients who received total daily doses of ≥4g of intravenous vancomycin for a minimum of 48 hours and had their serum CRP level and erythrocyte sedimentation rate(ESR) tested within 24 hours before vancomycin treatment were subject to final analyses.Univariate analyses showed that patients who developed nephrotoxicity during vancomycin treatment had significantly higher median vancomycin serum concentration,duration of vancomycin treatment,and the serum CRP level within 24 hours before vancomycin treatment than the non-nephrotoxicity group.Multivariate logistic regression analysis showed that after adjusting for potential confounders including age,sex,body mass index,median vancomycin serum concentration,average vancomycin daily dose,duration of vancomycin treatment,ICU admission status,administration of intravenous contrast or nephrotoxic agents,administration of vasopressors,serum CRP level and ESR within 24 hours before vancomycin treatment,and co-morbidities,median vancomycin serum concentration,duration of treatment,serum CRP level within24 hours before vancomycin treatment,and nephrotoxic medication were found significantly associated with the development of nephrotoxicity.This was confirmed by multivariate hazard ratio analysis after adjusting for the above potential confounders.In conclusion,this study provides the first evidence supporting that the serum CRP level within24 hours before vancomycin treatment is an independent risk factor for the development of nephrotoxicity in patients receiving total daily doses of >4g of vancomycin.Therefore,the serum CRP level within 24 hours before vancomycin treatment could be a potential biomarker or prognostic factor for the development of vancomycin nephrotoxicity.
High-dose vancomycin treatment increases the likelihood of vancomycin-related nephrotoxicity.C-reactive protein(CRP) is a sensitive marker of systemic inflammation.In the present study,we evaluated the pre-treatment serum CRP level as a risk factor of the development of nephrotoxicity in patients receiving total daily doses of ≥4g of vancomycin.Data extracted from medical records for 174 patients who received total daily doses of ≥4g of intravenous vancomycin for a minimum of 48 hours and had their serum CRP level and erythrocyte sedimentation rate(ESR) tested within 24 hours before vancomycin treatment were subject to final analyses.Univariate analyses showed that patients who developed nephrotoxicity during vancomycin treatment had significantly higher median vancomycin serum concentration,duration of vancomycin treatment,and the serum CRP level within 24 hours before vancomycin treatment than the non-nephrotoxicity group.Multivariate logistic regression analysis showed that after adjusting for potential confounders including age,sex,body mass index,median vancomycin serum concentration,average vancomycin daily dose,duration of vancomycin treatment,ICU admission status,administration of intravenous contrast or nephrotoxic agents,administration of vasopressors,serum CRP level and ESR within 24 hours before vancomycin treatment,and co-morbidities,median vancomycin serum concentration,duration of treatment,serum CRP level within24 hours before vancomycin treatment,and nephrotoxic medication were found significantly associated with the development of nephrotoxicity.This was confirmed by multivariate hazard ratio analysis after adjusting for the above potential confounders.In conclusion,this study provides the first evidence supporting that the serum CRP level within24 hours before vancomycin treatment is an independent risk factor for the development of nephrotoxicity in patients receiving total daily doses of >4g of vancomycin.Therefore,the serum CRP level within 24 hours before vancomycin treatment could be a potential biomarker or prognostic factor for the development of vancomycin nephrotoxicity.
High-dose vancomycin treatment increases the likelihood of vancomycin-related nephrotoxicity.C-reactive protein(CRP) is a sensitive marker of systemic inflammation.In the present study,we evaluated the pre-treatment serum CRP level as a risk factor of the development of nephrotoxicity in patients receiving total daily doses of ≥4g of vancomycin.Data extracted from medical records for 174 patients who received total daily doses of ≥4g of intravenous vancomycin for a minimum of 48 hours and had their serum CRP level and erythrocyte sedimentation rate(ESR) tested within 24 hours before vancomycin treatment were subject to final analyses.Univariate analyses showed that patients who developed nephrotoxicity during vancomycin treatment had significantly higher median vancomycin serum concentration,duration of vancomycin treatment,and the serum CRP level within 24 hours before vancomycin treatment than the non-nephrotoxicity group.Multivariate logistic regression analysis showed that after adjusting for potential confounders including age,sex,body mass index,median vancomycin serum concentration,average vancomycin daily dose,duration of vancomycin treatment,ICU admission status,administration of intravenous contrast or nephrotoxic agents,administration of vasopressors,serum CRP level and ESR within 24 hours before vancomycin treatment,and co-morbidities,median vancomycin serum concentration,duration of treatment,serum CRP level within24 hours before vancomycin treatment,and nephrotoxic medication were found significantly associated with the development of nephrotoxicity.This was confirmed by multivariate hazard ratio analysis after adjusting for the above potential confounders.In conclusion,this study provides the first evidence supporting that the serum CRP level within24 hours before vancomycin treatment is an independent risk factor for the development of nephrotoxicity in patients receiving total daily doses of >4g of vancomycin.Therefore,the serum CRP level within 24 hours before vancomycin treatment could be a potential biomarker or prognostic factor for the development of vancomycin nephrotoxicity.
引文
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4.Rostas SE,Kubiak DW and Calderwood MS:High-dose intravenous vancomycin therapy and the risk of nephrotoxicity.Clin Ther 36:1098-1101,2014.
5.Vincent JL,Rello J,Marshall J,Silva E,Anzueto A,Martin CD,Moreno R,Lipman J,Gomersall C,Sakr Y,et al:EPICⅡGroup of Investigators International study of the prevalence and outcomes of infection in intensive care units.JAMA 302:2323-2329,2009.
6.Lodise TP,Lomaestro B,Graves J and Drusano GL:Larger vancomycin doses(at least four grams per day)are associated with an increased incidence of nephrotoxicity.Antimicrob Agents Chemother 52:1330-1336,2008.
7.Pritchard L,Baker C,Leggett J,Sehdev P,Brown A and Bayley KB:Increasing vancomycin serum trough concentrations and incidence of nephrotoxicity.Am J Med 123:1143-1149,2010.
8.Capodanno D,Di Salvo ME,Cincotta G,Miano M,Tamburino C and Tamburino C:Usefulness of the SYNTAX score for predicting clinical outcome after percutaneous coronary intervention of unprotected left main coronary artery disease.Circ Cardiovasc Interv 2:302-308,2009.
9.Huang G,Zhao JL,Du H,Lan XB and Yin YH:Coronary score adds prognostic information for patients with acute coronary syndrome.Circ J 74:490-495,2010.
10.Liu S,Ren J,Xia Q,Wu X,Han G,Ren H,Yan D,Wang G,Gu G and Li J:Preliminary case-control study to evaluate diagnostic values of C-reactive protein and erythrocyte sedimentation rate in differentiating active Crohn's disease from intestinal lymphoma,intestinal tuberculosis and Behcet's syndrome.Am J Med Sci 346:467-472,2013.
11.Turner CL,Budohoski K,Smith C,Hutchinson PJ and Kirkpatrick PJ:Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage:Data From the Simvastatin in Aneurysmal Subarachnoid Hemorrhage(STASH)Trial.Neurosurgery,2015.[Epub ahead of print]
12.Tang LQ,Hu DP,Chen QY,Zhang L,Lai XP,He Y,Xu YX,Wen SH,Peng YT,Chen WH,et al:Elevated highsensitivity C-reactive protein levels predict decreased survival for nasopharyngeal carcinoma patients in the intensitymodulated radiotherapy era.PLoS One 10:e0122965,2015.
13.Rybak M,Lomaestro B,Rotschafer JC,Moellering R Jr,Craig W,Billeter M,Dalovisio JR and Levine DP:Therapeutic monitoring of vancomycin in adult patients:a consensus review of the American Society of Health-System Pharmacists,the Infectious Diseases Society of America,and the Society of Infectious Diseases Pharmacists.Am J Health Syst Pharm 66:82-98,2009.
14.Chertow GM,Burdick E,Honour M,Bonventre JV and Bates DW:Acute kidney injury,mortality,length of stay,and costs in hospitalized patients.J Am Soc Nephrol 16:3 365-3370,2005.
15.Yan Y:Logistic regression analysis.In:Medical statistics(2~(nd)edition).Sun ZQ,Xu YY(eds.)People's Medical Publishing House,Beijing,pp292,2010.(in Chinese)
16.Hanrahan TP,Harlow G,Hutchinson J,Dulhunty JM,Lipman J,Whitehouse T and Roberts JA:Vancomycinassociated nephrotoxicity in the critically ill:a retrospective multivariate regression analysis.Crit Care Med 42:2527-2536,2014.
2.van Duijn PJ,Dautzenberg MJ and Oostdijk EA:Recent trends in antibiotic resistance in European ICUs.Curr Opin Crit Care 17:658-665,2011.
3.Sinclair EA,Yenokyan G,McMunn A,Fadrowski JJ,Milstone AM and Lee CK:Factors associated with acute kidney injury in children receiving vancomycin.Ann Pharmacother 48:1555-1562,2014.
4.Rostas SE,Kubiak DW and Calderwood MS:High-dose intravenous vancomycin therapy and the risk of nephrotoxicity.Clin Ther 36:1098-1101,2014.
5.Vincent JL,Rello J,Marshall J,Silva E,Anzueto A,Martin CD,Moreno R,Lipman J,Gomersall C,Sakr Y,et al:EPICⅡGroup of Investigators International study of the prevalence and outcomes of infection in intensive care units.JAMA 302:2323-2329,2009.
6.Lodise TP,Lomaestro B,Graves J and Drusano GL:Larger vancomycin doses(at least four grams per day)are associated with an increased incidence of nephrotoxicity.Antimicrob Agents Chemother 52:1330-1336,2008.
7.Pritchard L,Baker C,Leggett J,Sehdev P,Brown A and Bayley KB:Increasing vancomycin serum trough concentrations and incidence of nephrotoxicity.Am J Med 123:1143-1149,2010.
8.Capodanno D,Di Salvo ME,Cincotta G,Miano M,Tamburino C and Tamburino C:Usefulness of the SYNTAX score for predicting clinical outcome after percutaneous coronary intervention of unprotected left main coronary artery disease.Circ Cardiovasc Interv 2:302-308,2009.
9.Huang G,Zhao JL,Du H,Lan XB and Yin YH:Coronary score adds prognostic information for patients with acute coronary syndrome.Circ J 74:490-495,2010.
10.Liu S,Ren J,Xia Q,Wu X,Han G,Ren H,Yan D,Wang G,Gu G and Li J:Preliminary case-control study to evaluate diagnostic values of C-reactive protein and erythrocyte sedimentation rate in differentiating active Crohn's disease from intestinal lymphoma,intestinal tuberculosis and Behcet's syndrome.Am J Med Sci 346:467-472,2013.
11.Turner CL,Budohoski K,Smith C,Hutchinson PJ and Kirkpatrick PJ:Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage:Data From the Simvastatin in Aneurysmal Subarachnoid Hemorrhage(STASH)Trial.Neurosurgery,2015.[Epub ahead of print]
12.Tang LQ,Hu DP,Chen QY,Zhang L,Lai XP,He Y,Xu YX,Wen SH,Peng YT,Chen WH,et al:Elevated highsensitivity C-reactive protein levels predict decreased survival for nasopharyngeal carcinoma patients in the intensitymodulated radiotherapy era.PLoS One 10:e0122965,2015.
13.Rybak M,Lomaestro B,Rotschafer JC,Moellering R Jr,Craig W,Billeter M,Dalovisio JR and Levine DP:Therapeutic monitoring of vancomycin in adult patients:a consensus review of the American Society of Health-System Pharmacists,the Infectious Diseases Society of America,and the Society of Infectious Diseases Pharmacists.Am J Health Syst Pharm 66:82-98,2009.
14.Chertow GM,Burdick E,Honour M,Bonventre JV and Bates DW:Acute kidney injury,mortality,length of stay,and costs in hospitalized patients.J Am Soc Nephrol 16:3 365-3370,2005.
15.Yan Y:Logistic regression analysis.In:Medical statistics(2~(nd)edition).Sun ZQ,Xu YY(eds.)People's Medical Publishing House,Beijing,pp292,2010.(in Chinese)
16.Hanrahan TP,Harlow G,Hutchinson J,Dulhunty JM,Lipman J,Whitehouse T and Roberts JA:Vancomycinassociated nephrotoxicity in the critically ill:a retrospective multivariate regression analysis.Crit Care Med 42:2527-2536,2014.
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