住院患者与门诊患者血清丙戊酸游离分数浓度的比较。

Comparison of free fraction serum valproic acid concentrations between inpatients and outpatients.

作者信息

Gibbs Haley G, Zimmerman David E, Shermock Kenneth M, Clarke William, Mirski Marek A, Lewin John J

机构信息

Haley G. Gibbs, Pharm. D., is Clinical Pharmacy Specialist, Department of Pharmacy, Johns Hopkins Hospital (JHH), Baltimore, MD. David E. Zimmerman, Pharm.D., is Assistant Professor of Pharmacy, Department of Clinical, Social, and Administrative Sciences, Mylan School of Pharmacy, Duquesne University, Pittsburgh, PA. Kenneth M. Shermock, Pharm.D., Ph. D., is Director of the Center for Medication Quality and Outcomes, Department of Pharmacy; William Clarke, Ph.D., is Associate Professor, Director of Clinical Toxicology, Department of Clinical Toxicology; Marek A. Mirski, M.D., Ph.D., is Vice-Chair and Director, Neuroscience Critical Care Unit, Department of Anesthesiology and Critical Care Medicine; and John J. Lewin III, Pharm.D., M.B.A., is Division Director, Critical Care and Surgery Pharmacy, Department of Pharmacy, and Adjunct Assistant Professor, Department of Anesthesiology and Critical Care Medicine, JHH.

出版信息

Am J Health Syst Pharm. 2015 Jan 15;72(2):121-6. doi: 10.2146/ajhp140191.

DOI:10.2146/ajhp140191

PMID:25550135

Abstract

PURPOSE

The differences in free fraction serum valproic acid concentrations between inpatients and outpatients were compared, and factors associated with therapeutic discordance were evaluated.

METHODS

This retrospective, single-center, cross-sectional study included patients with both a free and a total valproic acid concentration drawn within 30 minutes of each other between January 7, 2003, and June 1, 2011. Serum valproic acid concentrations were stratified by admission status (inpatient versus outpatient). In the primary analysis, for patients who had multiple paired concentrations drawn, one free valproic acid level and one total valproic acid level (i.e., one pair) were chosen at random for each inpatient. Information regarding patient demographics, laboratory data, and concomitant medication therapy was collected. Single and multivariable logistic regressions were performed to determine the odds of therapeutic discordance.

RESULTS

During the study period, inpatient concentrations were measured in 220 patients, and outpatient concentrations were measured in 41 patients. The median total valproic acid concentration in the inpatient group was significantly lower than that in the outpatient group (54 μg/mL versus 83 μg/mL, p < 0.001). The median free fraction of inpatient levels was nearly twice as high as that of outpatient levels (28.8% versus 15.5%, p < 0.001). Levels drawn in inpatients were therapeutically discordant 63% of the time compared to only 19% in outpatients (p < 0.001). Multivariable logistic regression identified low albumin as an independent risk factor for therapeutic discordance.

CONCLUSION

The median free fraction of valproic acid was significantly higher in inpatients than in outpatients. Low albumin concentration was a predictor of discordance between free and total valproic acid concentrations.

摘要

目的

比较住院患者和门诊患者血清丙戊酸游离分数浓度的差异，并评估与治疗不一致相关的因素。

方法

这项回顾性、单中心横断面研究纳入了在2003年1月7日至2011年6月1日期间，在30分钟内同时检测了游离和总丙戊酸浓度的患者。血清丙戊酸浓度按入院状态（住院患者与门诊患者）分层。在初步分析中，对于有多对检测浓度的患者，为每位住院患者随机选择一个游离丙戊酸水平和一个总丙戊酸水平（即一对）。收集了患者人口统计学、实验室数据和伴随药物治疗的信息。进行单变量和多变量逻辑回归以确定治疗不一致的几率。

结果

在研究期间，对220例患者进行了住院浓度检测，对41例患者进行了门诊浓度检测。住院组总丙戊酸浓度中位数显著低于门诊组（54μg/mL对83μg/mL，p<0.001）。住院患者水平的游离分数中位数几乎是门诊患者的两倍（28.8%对15.5%，p<0.001）。住院患者检测的水平有63%在治疗上不一致，而门诊患者仅为19%（p<0.001）。多变量逻辑回归确定低白蛋白是治疗不一致的独立危险因素。