Aljefri Doaa M, Avedissian Sean N, Rhodes Nathaniel J, Postelnick Michael J, Nguyen Kevin, Scheetz Marc H
Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois.
Department of Pharmacy, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
Clin Infect Dis. 2019 Nov 13;69(11):1881-1887. doi: 10.1093/cid/ciz051.
This study analyzed the relationship between vancomycin area under the concentration-time curve (AUC) and acute kidney injury (AKI) reported across recent studies.
A systematic review of PubMed, Medline, Scopus, and compiled references was conducted. We included randomized cohort and case-control studies that reported vancomycin AUCs and risk of AKI (from 1990 to 2018). The primary outcome was AKI, defined as an increase in serum creatinine of ≥0.5 mg/L or a 50% increase from baseline on ≥2 consecutive measurements. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Primary analyses compared the impact of AUC cutpoint (greater than ~650 mg × hour/L) and AKI. Additional analysis compared AUC vs trough-guided monitoring on AKI incidence.
Eight observational studies met inclusion/exclusion criteria with data for 2491 patients. Five studies reported first-24-hour AUCs (AUC0-24) and AKI, 2 studies reported 24- to 48-hour AUCs (AUC24-48) and AKI, and 2 studies reported AKI associated with AUC- vs trough-guided monitoring. AUC less than approximately 650 mg × hour/L was associated with decreased AKI for AUC0-24 (OR, 0.36 [95% CI, .23-.56]) as well as AUC24-48 (OR, 0.45 [95% CI, .27-.75]). AKI associated with the AUC monitoring strategy was significantly lower than trough-guided monitoring (OR, 0.68 [95% CI, .46-.99]).
AUCs measured in the first or second 24 hours and lower than approximately 650 mg × hour/L may result in a decreased risk of AKI. Vancomycin AUC monitoring strategy may result in less vancomycin-associated AKI. Additional investigations are warranted.
本研究分析了近期各项研究中报道的万古霉素浓度-时间曲线下面积（AUC）与急性肾损伤（AKI）之间的关系。
对PubMed、Medline、Scopus以及汇总参考文献进行了系统综述。我们纳入了报告万古霉素AUC及AKI风险的随机队列研究和病例对照研究（时间范围为1990年至2018年）。主要结局为AKI，定义为血清肌酐升高≥0.5mg/L或连续≥2次测量较基线水平升高50%。计算了具有95%置信区间（CI）的比值比（OR）。主要分析比较了AUC切点（大于约650mg×小时/L）与AKI的影响。额外分析比较了AUC与谷浓度指导监测对AKI发生率的影响。
八项观察性研究符合纳入/排除标准，涉及2491例患者的数据。五项研究报告了首24小时AUC（AUC0 - 24）与AKI，两项研究报告了24至48小时AUC（AUC24 - 48）与AKI，两项研究报告了AUC指导监测与谷浓度指导监测相关的AKI。对于AUC0 - 24（OR，0.36 [95% CI，0.23 - 0.56]）以及AUC24 - 48（OR，0.45 [95% CI，0.27 - 0.75]），AUC小于约650mg×小时/L与AKI风险降低相关。与AUC监测策略相关的AKI显著低于谷浓度指导监测（OR，0.68 [95% CI，0.46 - 0.99]）。
在首24小时或次24小时测量的且低于约650mg×小时/L的AUC可能会降低AKI风险。万古霉素AUC监测策略可能会减少与万古霉素相关的AKI。有必要进行更多研究。
