a Department of Pharmacy Practice , Texas Tech University Health Sciences Center , Dallas , TX , USA.
b Department of Medical Service for RGH, EMM; Department of Pharmacy Service for CAA , VA North Texas Health Care System , Dallas , TX , USA.
Expert Rev Clin Pharmacol. 2018 Jun;11(6):651-654. doi: 10.1080/17512433.2018.1471984. Epub 2018 May 10.
The impact of total body weight (TBW) on the development of acute kidney injury (AKI) associated with gram-negative bacteremia has not been previously evaluated.
The cohort included 323 patients >/ = 18 years old with gram-negative bacteremia (1/1/2008-8/31/2011) who received >/ = 48 hours of antibiotics. We compared the incidence of AKI in patients with a TBW </ = 80kg vs. >80kg with a multivariable stepwise logistic regression adjusting for age >/ = 70 years, baseline serum creatinine of > 2.0 mg/dl, and receipt of a vasopressor. AKI was defined as an increase of 0.5 mg/dL or a > 50% increase from baseline for at least two consecutive days.
The cohort was 62% TBW </ = 80kg and 38% TBW >80kg. TBW >80kg patients had higher risk of AKI (24% vs. 9%, p < 0.001), which was significant in the multivariable analysis (OR 3.41, 95% CI 1.73-6.73). A baseline serum creatinine of > 2.0 mg/dl and vasopressor use were also independently associated with AKI.
TBW >80kg was associated with the development of AKI. However, the mechanism for this association is not clear.
全身体重（TBW）对革兰氏阴性菌血症相关急性肾损伤（AKI）的发展的影响尚未被评估。
该队列纳入了 323 例年龄大于等于 18 岁，革兰氏阴性菌血症（1/1/2008-8/31/2011），接受大于等于 48 小时抗生素治疗的患者。我们比较了 TBW 小于等于 80kg 和大于 80kg 的患者中 AKI 的发生率，使用多变量逐步逻辑回归调整年龄大于等于 70 岁、基线血清肌酐大于 2.0mg/dl 和血管加压药的使用。AKI 定义为连续两天至少增加 0.5mg/dL 或基线增加大于 50%。
队列中 62%的 TBW 小于等于 80kg，38%的 TBW 大于 80kg。TBW 大于 80kg 的患者 AKI 的风险更高（24%比 9%，p<0.001），多变量分析显示这是显著的（OR 3.41，95% CI 1.73-6.73）。基线血清肌酐大于 2.0mg/dl 和血管加压药的使用也是 AKI 的独立相关因素。
TBW 大于 80kg 与 AKI 的发生有关。然而，这种关联的机制尚不清楚。
