Department of Clinical Pharmacy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
J Clin Pharm Ther. 2013 Dec;38(6):462-7. doi: 10.1111/jcpt.12088. Epub 2013 Aug 8.
Augmented renal clearance (ARC) is a new phenomenon in patients' pathophysiology without universally accepted aetiology and with various incidence rates most often described in critically ill patients in the Intensive Care Unit (ICU). The objective of this retrospective observational comparative study was to estimate the incidence rate of ARC in patients with different medical conditions employing steady state trough vancomycin serum concentrations (VSCss) for analysis.
All patients tested for VCSss during two years (2010-2011) in a tertiary level hospital were analysed and 77 VSCs were eligible for analysis: 38 (50%) and 39 cases were assigned to the ARC (eCrClCG (creatinine clearance, estimated by Cockcroft-Gault) > 130 mL/min) and the control groups (eCrClCG in the range 90-130 mL/min) respectively.
Patients' age, mechanical ventilation and haemodynamically unstable status had significant association with ARC occurrence (P < 0.05). Majority of ARC patients (11 patients (61 %)) were managed in non-ICU settings. ARC event showed statistically significant higher risk for under dosage (RR (relative risk for subtherapeutic VSCss), 1.84; 95% CI, 1.23\x962.74; P = 0.011), and the correlation between different thresholds (eCrClCG >130 mL/min, ≥140 mL/min and ≥150 mL/min) for ARC and VSCss allows to predict decrease of VSCss in case of eCrClCG ≥150 mL/min: every increase of eCrClCG by 40 mL/min predicts clinically relevant decrease of VSCss by 1 mmol/L (1.49 mg/mL).
ARC cases lead to the doubled risk of subtherapeutic VSC, and this phenomenon is a significant event in patients in any hospital department. Investigation of medical patients' status relevant to this phenomenon needs to be continued.
增强的肾清除率（ARC）是一种新的患者病理生理学现象，其病因尚未被普遍接受，且其发生率在重症监护病房（ICU）的危重症患者中最为常见。本回顾性观察性对比研究的目的是通过分析稳态谷浓度万古霉素血清浓度（VSCss）来估计不同医疗条件下 ARC 的发生率。
对 2 年内（2010-2011 年）在一家三级医院接受 VCSss 检测的所有患者进行了分析，77 个 VSC 符合分析标准：38 例（50%）和 39 例分别被分配到 ARC（eCrClCG（肌酐清除率，估计用 Cockcroft-Gault）>130mL/min）和对照组（eCrClCG 范围为 90-130mL/min）。
患者的年龄、机械通气和血流动力学不稳定状态与 ARC 发生有显著相关性（P <0.05）。大多数 ARC 患者（11 例（61%））在非 ICU 环境中接受治疗。ARC 事件发生的风险显著较高，剂量不足（RR（治疗性 VSCss 的相对风险），1.84；95%CI，1.23-2.74；P=0.011）。ARC 与不同阈值（eCrClCG >130mL/min、≥140mL/min 和≥150mL/min）之间的相关性允许预测 eCrClCG≥150mL/min 时 VSCss 的下降：eCrClCG 每增加 40mL/min，VSCss 就会相应地下降 1mmol/L（1.49mg/mL）。
ARC 病例导致治疗性 VSC 风险增加一倍，这种现象在任何医院科室的患者中都是一个重要事件。需要继续研究与这一现象相关的患者状况。
