Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan.
Department of Emergency and Critical Care Center, Kochi Health Sciences Center, Kochi, Japan.
PLoS One. 2018 Dec 10;13(12):e0208742. doi: 10.1371/journal.pone.0208742. eCollection 2018.
Recently, augmented renal clearance (ARC), which accelerates glomerular filtration of renally eliminated drugs thereby reducing the systemic exposure to these drugs, has started to receive attention. However, the clinical features associated with ARC are still not well understood, especially in the Japanese population. This study aimed to evaluate the clinical characteristics and outcomes of ARC patients with infections in Japanese intensive care unit (ICU) settings. We conducted a retrospective observational study from April 2013 to May 2017 at two tertiary level ICUs in Japan, which included 280 patients with infections (median age 74 years; interquartile range, 64-83 years). We evaluated the estimated glomerular filtration rate (eGFR) at ICU admission using the Japanese equation, and ARC was defined as eGFR >130 mL/min/1.73 m2. Multivariable logistic regression analysis was performed to identify the independent risk factors for ARC and to determine if it was a predictor of ICU mortality. In addition, a receiver operating curve (ROC) analysis was performed, and the area under the ROC (AUROC) was determined to examine the significant variables that predict ARC. In total, 19 patients (6.8%) manifested ARC. Multivariable logistic regression analysis identified younger age as an independent risk factor for ARC (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.91-0.96). However, ARC was not found to be a predictor of ICU mortality (OR, 0.57; 95% CI, 0.11-2.92). In addition, the AUROC of age was 0.79 (95% CI, 0.68-0.91), and the optimal cut off age for ARC was ≤63 years (sensitivity, 68.4%; specificity, 78.9%). The incidence of ARC was, therefore, low among patients with infections in the Japanese ICUs. Although younger age was associated with the incidence of ARC, it was not an independent predictor of ICU mortality.
最近，加速肾脏清除率（ARC）引起了人们的关注，ARC 可加速经肾脏排泄的药物的肾小球滤过，从而降低这些药物的全身暴露。然而，与 ARC 相关的临床特征仍未被很好地理解，特别是在日本人群中。本研究旨在评估日本重症监护病房（ICU）中感染合并 ARC 患者的临床特征和结局。我们进行了一项回顾性观察性研究，纳入了 2013 年 4 月至 2017 年 5 月日本两家三级医院 ICU 中 280 例感染患者（中位年龄 74 岁；四分位间距 64-83 岁）。我们使用日本方程评估 ICU 入院时的估算肾小球滤过率（eGFR），并将 eGFR＞130 mL/min/1.73 m2 定义为 ARC。采用多变量 logistic 回归分析确定 ARC 的独立危险因素，并确定其是否为 ICU 死亡率的预测因素。此外，我们还进行了受试者工作特征曲线（ROC）分析，并确定了预测 ARC 的显著变量的 ROC 曲线下面积（AUROC）。共有 19 例（6.8%）患者表现为 ARC。多变量 logistic 回归分析发现年龄较小是 ARC 的独立危险因素（比值比 [OR]，0.94；95%置信区间 [CI]，0.91-0.96）。然而，ARC 并非 ICU 死亡率的预测因素（OR，0.57；95% CI，0.11-2.92）。此外，年龄的 AUROC 为 0.79（95% CI，0.68-0.91），ARC 的最佳截断年龄为≤63 岁（灵敏度，68.4%；特异性，78.9%）。因此，日本 ICU 中感染患者的 ARC 发生率较低。尽管年龄较小与 ARC 的发生有关，但它不是 ICU 死亡率的独立预测因素。
