Rodvold K A, Pryka R D, Garrison M, Rotschafer J C
Department of Pharmacy Practice, College of Pharmacy, University of Illinois, Chicago 60612.
Ther Drug Monit. 1989;11(3):269-75. doi: 10.1097/00007691-198905000-00009.
The application of a two-compartment Bayesian forecasting program for vancomycin was tested retrospectively in 45 adult patients with stable renal function. Serial blood samples from 25 of these patients were used to determine population-based parameter estimates. The predictive performance of the Bayesian program was assessed by using both non-steady-state and steady-state vancomycin concentrations as feedback information. Overall, the program tended to underpredict peak and trough steady-state vancomycin serum concentrations. A larger mean prediction error (ME) was seen when non-steady-state feedback serum concentrations were used compared with using population-based parameter estimates (no feedback). In contrast, a marked improvement in ME (peaks: -1.03 versus -2.61; troughs: -1.60 versus -2.07) was seen when steady-state feedback serum concentrations were used compared with no feedback data. Precision improved when either feedback serum concentrations were used to predict steady-state peak and trough vancomycin concentrations. The results from this clinical evaluation demonstrate that the initial pharmacokinetic parameter estimates for a two-compartment Bayesian model provided accurate prediction of steady-state vancomycin concentrations. Prediction bias and precision were improved when steady-state vancomycin concentrations were used to determine individualized pharmacokinetic parameters.
在45例肾功能稳定的成年患者中，对一种用于万古霉素的两室贝叶斯预测程序进行了回顾性测试。其中25例患者的系列血样用于确定基于群体的参数估计值。通过使用非稳态和稳态万古霉素浓度作为反馈信息，评估了贝叶斯程序的预测性能。总体而言，该程序往往会低估稳态万古霉素血清浓度的峰值和谷值。与使用基于群体的参数估计值（无反馈）相比，使用非稳态反馈血清浓度时观察到更大的平均预测误差（ME）。相比之下，与无反馈数据相比，使用稳态反馈血清浓度时，ME有显著改善（峰值：-1.03对-2.61；谷值：-1.60对-2.07）。当使用任何一种反馈血清浓度来预测稳态万古霉素浓度的峰值和谷值时，精密度都有所提高。该临床评估结果表明，两室贝叶斯模型的初始药代动力学参数估计值能够准确预测稳态万古霉素浓度。当使用稳态万古霉素浓度来确定个体化药代动力学参数时，预测偏差和精密度得到了改善。
