Department of Pharmacy, National Hospital Organization Sendai Medical Center, Sendai, Japan.
J Clin Pharm Ther. 2020 Oct;45(5):1120-1126. doi: 10.1111/jcpt.13193. Epub 2020 Jun 4.
Augmented renal clearance (ARC; hyperfiltration with over 130 mL/min/1.73 m of creatinine clearance (CL )) commonly occurs in critically ill patients. Recent reports indicate that ARC also occurs in haematologic malignancies. However, the risk factors for ARC in haematologic malignancies remain unknown, and there is no established method to predict ARC in haematologic malignancies. Our objective was to explore the risk factors for ARC retrospectively and develop a scoring method to predict ARC.
A single-centre, retrospective, observational cohort study was conducted at the Sendai Medical Center (Sendai, Japan); 133 patients (April 2017-March 2019) and 41 patients (April-November 2019) with haematopoietic tumours who were administered vancomycin were enrolled in the analysis and validation cohorts, respectively. To define ARC, we calculated the vancomycin serum concentration when CL = 130 mL/min/1.73 m using a one-compartment model. Patients with ARC were defined as those whose actual concentration of vancomycin remained lower than the calculated concentration. Using the analysis cohort, we explored risk factors of ARC and developed a scoring method to predict ARC in haematologic malignancies. The reproducibility of the scoring system was demonstrated using the validation cohort.
Through multivariate analysis, young age (P < .001), leukaemia (P = .001) and low serum creatinine (P < .001) were identified as risk factors. According to this result, we established the ARC detection method: age ≤ 50 years = 3 points, 50 years < age ≤65 years = 1 point, leukaemia = 2 points, low SCr = 2 points; patients scoring ≥ 5 points represent the ARC high-risk group. Using this scoring system, we could detect ARC with a sensitivity and specificity of 60.0% and 89.7% in the analysis cohort and 90.0% and 90.9% in the validation cohort, respectively.
Our scoring method could predict ARC in haematologic malignancies and is useful as a simple screening tool for ARC.
增强的肾清除率（ARC；超过 130ml/min/1.73m 肌酐清除率（CL）的超滤）在危重病患者中常发生。最近的报告表明，ARC 也发生在血液恶性肿瘤中。然而，血液恶性肿瘤中 ARC 的危险因素尚不清楚，也没有建立预测血液恶性肿瘤中 ARC 的方法。我们的目的是回顾性探讨 ARC 的危险因素，并建立预测 ARC 的评分方法。
这是一项单中心、回顾性、观察性队列研究，在仙台医疗中心（日本仙台）进行；分析队列纳入了 133 例（2017 年 4 月至 2019 年 3 月）和 41 例（2019 年 4 月至 11 月）接受万古霉素治疗的血液肿瘤患者，验证队列纳入了分别。为了定义 ARC，我们使用单室模型计算 CL=130ml/min/1.73m 时的万古霉素血清浓度。将实际万古霉素浓度低于计算浓度的患者定义为 ARC 患者。使用分析队列，我们探讨了 ARC 的危险因素，并建立了预测血液恶性肿瘤中 ARC 的评分方法。使用验证队列证明了评分系统的重现性。
通过多变量分析，年轻年龄（P<0.001）、白血病（P=0.001）和低血清肌酐（P<0.001）被确定为危险因素。根据这一结果，我们建立了 ARC 检测方法：年龄≤50 岁=3 分，50 岁<年龄≤65 岁=1 分，白血病=2 分，低 SCr=2 分；评分≥5 分的患者为 ARC 高危组。使用该评分系统，我们在分析队列中检测 ARC 的灵敏度和特异性分别为 60.0%和 89.7%，在验证队列中分别为 90.0%和 90.9%。
我们的评分系统可预测血液恶性肿瘤中的 ARC，可作为 ARC 的简单筛查工具。
