重症监护病房中黏菌素的肾毒性：老年患者中是否有所不同？

Colistin nephrotoxicity in the ICU: Is it different in the geriatric patients?

机构信息

Intensive Care Unit, Denizli State Hospital, Denizli, Turkey.

Surgical Intensive Care Unit, Clinic of Pulmonary Medicine, Dışkapı Yıldırım Beyazıt Research and Education Hospital, Ankara, Turkey.

出版信息

Aging Clin Exp Res. 2018 Jun;30(6):573-580. doi: 10.1007/s40520-017-0827-3. Epub 2017 Sep 2.

DOI:10.1007/s40520-017-0827-3

PMID:28866836

Abstract

OBJECTIVE

Most significant side effect of colistin therapy which is used for the treatment of multi-drug resistant Gram-negative infections is nephrotoxicity. Our aim was to investigate the differences of colistin nephrotoxicity between the geriatric age group (≥65 years) and the younger age group (<65 years) in critically ill medical intensive care unit (ICU) patients.

MATERIAL AND METHOD

The medical records of the 76 patients who were taken colistin therapy due to multi-resistant Gram-negative infections between January 2010 and June 2014 in the our medical ICU were retrospectively investigated. Demographic characteristics, reasons for colistin use, daily colistin dose, duration of colistin use were recorded. Colistin-dependent renal dysfunction was evaluated according to the risk, injury, failure, loss and end-stage renal failure (RIFLE) criterias.

RESULTS

The median age of the patients was 65 (65.8% male). Nephrotoxicity was developed in 36 (47.4%) patients. Thirty-nine (51.3%) patients were in geriatric age group, 37 (48.7%) were in younger age group. In geriatric age group, the rates of male gender (53.8 vs 78.4%, p = 0.031), pulmonary (48.7 vs 16.2%, p = 0.003) and cardiac diseases (71.8 vs 29.7%, p < 0.001), post-nephrotoxicity BUN levels (p = 0.023) and urine output during nephrotoxicity (p = 0.016) were higher than younger age group. Nephrotoxicity was developed in 22 (56.4%) patients of geriatric age group, and in 14 (37.8%) patients in younger age group (p = 0.115). The presence of cardiac disease, renal pathology and high creatinin value on admission, daily amount of colistin per body mass, total amount of colistin, use of colistin for pulmonary infection, use of amphotericin and vasopressor on admission were found as risk factors for colistin nephrotoxicity development in all study group; the daily amount of colistin per body mass (risk ratio:0.41; 95% CI 0.19-0.89) and vasopressor use during hospitalization were found independent risk factors (risk ratio:13.54; 95% CI 2.21-83.09).

CONCLUSION

In our study, in geriatric patient group colistin nephrotoxicity was not different from the younger age group. In the ICU, the age for nephrotoxicity does not appear to be a point to be considered for the initiation of colistin.

摘要

目的

多黏菌素治疗的最主要副作用是肾毒性，常用于治疗多重耐药革兰氏阴性感染。本研究旨在比较重症医学科（ICU）老年（≥65 岁）和非老年（<65 岁）患者使用多黏菌素治疗后肾毒性的差异。

材料和方法

回顾性分析 2010 年 1 月至 2014 年 6 月期间在我院 ICU 因多重耐药革兰氏阴性感染而接受多黏菌素治疗的 76 例患者的病历资料。记录患者的一般人口统计学特征、使用多黏菌素的原因、多黏菌素的日剂量、多黏菌素使用时间。根据风险、损伤、衰竭、丧失和终末期肾病（RIFLE）标准评估多黏菌素相关性肾损伤。

结果

患者的中位年龄为 65 岁（65.8%为男性）。36 例（47.4%）患者发生肾毒性。39 例（51.3%）患者为老年组，37 例（48.7%）为非老年组。老年组中，男性（53.8%比 78.4%，p=0.031）、肺部（48.7%比 16.2%，p=0.003）和心脏疾病（71.8%比 29.7%，p<0.001）、肾毒性后 BUN 水平（p=0.023）和肾毒性期间尿量（p=0.016）较高。老年组中 22 例（56.4%）患者发生肾毒性，而非老年组中 14 例（37.8%）患者发生肾毒性（p=0.115）。所有研究组中，入院时存在心脏疾病、肾脏疾病、肌酐值升高、多黏菌素日剂量/体质量、多黏菌素总剂量、肺部感染时使用多黏菌素、入院时使用两性霉素和血管加压素是多黏菌素肾毒性发生的危险因素；多黏菌素日剂量/体质量（风险比：0.41；95%CI 0.19-0.89）和住院期间使用血管加压素是独立的危险因素（风险比：13.54；95%CI 2.21-83.09）。