Lee Yu-Ji, Wi Yu Mi, Kwon Yun Jae, Kim Sung Rok, Chang Se-Ho, Cho Seong
1Division of Nephrology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea. 2Department of Medicine, the Graduate School, Gyeongsang National University, Jinju, Korea. 3Division of Infectious Disease, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea. 4Departments of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
Crit Care Med. 2015 Jun;43(6):1187-93. doi: 10.1097/CCM.0000000000000931.
To investigate the development of nephrotoxicity associated with colistin dose, and whether this relationship differs depending on renal function.
A retrospective cohort study of patients who received intravenous colistin to treat infections caused by extensively drug-resistant Gram-negative microorganisms. Adult patients receiving colistin for 72 hours or longer were included in this study. Patients who received renal replacement therapy at baseline or were administered colistin for less than 3 days were excluded. Colistin-induced nephrotoxicity was defined as a doubling of baseline serum creatinine. Colistin dosing was evaluated based on both actual body weight and ideal body weight.
Single general hospital between 2010 and 2013.
A total number of 475 patients received colistin therapy. Of these patients, 329 met the inclusion criteria and were included in the analysis.
None.
One hundred forty-three patients (43.5%) experienced nephrotoxicity during colistin treatment. The median onset time of nephrotoxicity was 6 days (interquartile range, 4-8 days). The patients with nephrotoxicity were older. Hematocrit and serum albumin levels were lower in patients with nephrotoxicity. Median daily dosing of colistin based on ideal body weight was significantly higher in patients with nephrotoxicity than in those without nephrotoxicity (4.55 vs 4.43 mg/kg/d, respectively; p=0.021). The cumulative dose was not different between patients with and without nephrotoxicity. In multiple logistic regression analysis, daily colistin dosing based on ideal body weight was only significantly associated with the development of nephrotoxicity in patients with an estimated glomerular filtration rate<60 mL/min/1.73 m2 (odds ratio, 2.34; 95% CI, 1.22-4.5). In these affected patients, based on a receiver operating characteristic plot, the optimal predictive cutoff of colistin dose for the development of nephrotoxicity was 2.87 mg/kg/d of colistin, with a sensitivity of 92.3% and a specificity of 76.7%. In patients with estimated glomerular filtration rate≥60 mL/min/1.73 m, age, serum albumin, hematocrit, and use of glycopeptide were associated with the development of nephrotoxicity.
Development of nephrotoxicity was significantly more strongly associated with the dose of colistin, but only in patients with an estimated glomerular filtration rate<60 mL/min/1.73 m2 and not in those with normal renal function.
研究与多粘菌素剂量相关的肾毒性的发展情况，以及这种关系是否因肾功能不同而有所差异。
一项回顾性队列研究，研究对象为接受静脉注射多粘菌素治疗广泛耐药革兰氏阴性微生物引起的感染的患者。纳入本研究的为接受多粘菌素治疗72小时或更长时间的成年患者。排除基线时接受肾脏替代治疗或多粘菌素给药少于3天的患者。多粘菌素诱导的肾毒性定义为基线血清肌酐水平翻倍。根据实际体重和理想体重评估多粘菌素剂量。
2010年至2013年期间的一家综合医院。
共有475例患者接受了多粘菌素治疗。其中，329例符合纳入标准并纳入分析。
无。
143例患者（43.5%）在多粘菌素治疗期间出现肾毒性。肾毒性的中位发病时间为6天（四分位间距，4 - 8天）。出现肾毒性的患者年龄较大。出现肾毒性的患者血细胞比容和血清白蛋白水平较低。基于理想体重的多粘菌素每日中位剂量在出现肾毒性的患者中显著高于未出现肾毒性的患者（分别为4.55 vs 4.43 mg/kg/d；p = 0.021）。出现和未出现肾毒性的患者累积剂量无差异。在多因素逻辑回归分析中，基于理想体重的多粘菌素每日剂量仅在估计肾小球滤过率<60 mL/min/1.73 m²的患者中与肾毒性的发生显著相关（比值比，2.34；95%置信区间，1.22 - 4.5）。在这些受影响的患者中，根据受试者工作特征曲线，多粘菌素剂量导致肾毒性发生的最佳预测临界值为2.87 mg/kg/d，敏感性为92.3%，特异性为76.7%。在估计肾小球滤过率≥60 mL/min/1.73 m²的患者中，年龄、血清白蛋白、血细胞比容和糖肽的使用与肾毒性的发生相关。
肾毒性的发生与多粘菌素剂量显著相关，但仅在估计肾小球滤过率<60 mL/min/1.73 m²的患者中如此，而在肾功能正常的患者中并非如此。
