持续静静脉血液滤过对危重症儿童万古霉素谷浓度的影响。

Effects of continuous venovenous hemofiltration on vancomycin trough concentrations in critically ill children.

作者信息

Peng Lengyue, Gao Yawen, Zhang Guangli, Tian Xiaoyin, Xu Huiting, Yu Qinghong, Cheng Jie, Li Yuanyuan, Li Qinyuan, Chen Yingfu, Zhao Wei, Luo Zhengxiu

机构信息

Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.

Department of Pediatric Intensive Care Unit Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.

出版信息

Ann Transl Med. 2021 Feb;9(3):224. doi: 10.21037/atm-20-4005.

DOI:10.21037/atm-20-4005

PMID:33708851

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7940948/

Abstract

BACKGROUND

Vancomycin trough concentrations are associated with clinical outcomes and drug adverse effects. This study investigates the effects of continuous venovenous hemofiltration (CVVH) on vancomycin trough concentrations in critically ill children with a vancomycin dosage of 40-60 mg/kg/day.

METHODS

Children with steady-state vancomycin trough concentrations admitted to the pediatric intensive care unit (PICU) between January 2016 and December 2019 were retrospectively enrolled. Patients were divided into CVVH and non-CVVH groups according to treatment differences and renal function. Vancomycin trough concentrations were then compared between the groups, and risk factors for supratherapeutic trough concentrations (>20 mg/L) were analyzed with logistic regression.

RESULTS

Of the 119 patients included, 35 were enrolled in the CVVH group and 84 in the non-CVVH group. Median vancomycin trough concentrations were significantly higher in the CVVH group than those in the non-CVVH group [14.9 (IQR =9.6-19.6) 9.3 (IQR =7.0-13.4), P<0.001] and the proportion of therapeutic trough concentrations (10-20 mg/L) was similar between CVVH and non-CVVH groups (54.3% 39.3%, P=0.133). However, CVVH therapy patients had a significantly higher proportion of supratherapeutic trough concentrations (20.0% 1.2%, P=0.001) compared to the non-CVVH group. Multivariate analysis demonstrated that the Pediatric Risk of Mortality (PRISM) III score ≥28 (OR =13.7; 95% CI, 1.4-137.0; P=0.026] was an independent risk factor for supratherapeutic trough concentrations in critically ill patients.

CONCLUSIONS

CVVH therapy affects vancomycin trough concentrations and is associated with supratherapeutic concentrations with a 40-60 mg/kg/day vancomycin dosage. PRISM III scores ≥28 may serve as an independent risk factor for supratherapeutic trough concentrations in children receiving CVVH therapy.

摘要

背景

万古霉素谷浓度与临床疗效和药物不良反应相关。本研究探讨持续静静脉血液滤过（CVVH）对万古霉素剂量为40 - 60mg/kg/天的危重症儿童万古霉素谷浓度的影响。

方法

回顾性纳入2016年1月至2019年12月入住儿科重症监护病房（PICU）且万古霉素谷浓度处于稳态的儿童。根据治疗差异和肾功能将患者分为CVVH组和非CVVH组。然后比较两组之间的万古霉素谷浓度，并通过逻辑回归分析谷浓度高于治疗水平（>20mg/L）的危险因素。

结果

纳入的119例患者中，35例纳入CVVH组，84例纳入非CVVH组。CVVH组的万古霉素谷浓度中位数显著高于非CVVH组[14.9（四分位间距=9.6 - 19.6）对9.3（四分位间距=7.0 - 13.4），P<0.001]，且CVVH组和非CVVH组治疗性谷浓度（10 - 20mg/L）的比例相似（54.3%对39.3%，P = 0.133）。然而，与非CVVH组相比，接受CVVH治疗的患者谷浓度高于治疗水平的比例显著更高（20.0%对1.2%，P = 0.001）。多因素分析表明，儿科死亡风险（PRISM）III评分≥28（比值比=13.7；95%置信区间，1.4 - 137.0；P = 0.026）是危重症患者谷浓度高于治疗水平的独立危险因素。