Department of Pharmacy, McGill University Health Center, Royal Victoria Hospital, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
Département de Pharmacie, Centre Hospitalier de Montpellier, 91 av. du Doyen Giraud, 34295, Montpellier cedex 5, France.
Int J Clin Pharm. 2022 Dec;44(6):1277-1286. doi: 10.1007/s11096-022-01458-9. Epub 2022 Jul 14.
Augmented renal clearance is increasingly recognized in critically ill patients. This condition may lead to suboptimal dosing of renally excreted medications.
Our primary objective was to identify demographic and clinical factors associated with augmented renal clearance in a mixed critically ill population.
This retrospective single center observational cohort study evaluated patients admitted in a mixed adult intensive care unit for augmented renal clearance, defined as a creatinine clearance of ≥ 130 ml/min/1.73m through weekly 24-h urine collection. Variables associated with augmented renal clearance were identified using univariate analysis, then served as covariates in a backward stepwise logistic regression. Goodness-of-fit of the model was assessed and receiver operating characteristic curve was generated.
Augmented renal clearance was observed in 25.3% of the study cohort (n = 324). Age below 50 years (adjusted odds ratio 7.32; 95% CI 4.03-13.29, p < 0.001), lower serum creatinine at intensive care admission (adjusted odds ratio 0.97; 95% CI 0.96-0.99, p < 0.001) and trauma admission (adjusted odds ratio 2.26; 95% CI 1.12-4.54, p = 0.022) were identified as independent risk factors. Our model showed acceptable discrimination in predicting augmented renal clearance (Area under receiver operating characteristic curve (0.810; 95% CI 0.756-0.864, p < 0.001)).
We identified age below 50 years, lower serum creatinine upon intensive care admission and trauma as independent risk factors for augmented renal clearance, consistent with the literature suggesting that patients with low serum creatinine upon admission could have a higher risk of developing augmented renal clearance.
在危重症患者中，日益认识到增强的肾清除率。这种情况可能导致肾排泄药物的剂量不足。
我们的主要目的是确定混合危重症人群中与增强的肾清除率相关的人口统计学和临床因素。
这项回顾性单中心观察性队列研究评估了在混合成人重症监护病房中因增强的肾清除率而住院的患者，定义为通过每周 24 小时尿液收集，肌酐清除率≥130ml/min/1.73m。使用单因素分析确定与增强的肾清除率相关的变量，然后将这些变量作为向后逐步逻辑回归的协变量。评估模型的拟合优度并生成受试者工作特征曲线。
研究队列中观察到增强的肾清除率为 25.3%（n=324）。50 岁以下的年龄（调整后的优势比 7.32；95%置信区间 4.03-13.29，p<0.001）、重症监护入院时较低的血清肌酐（调整后的优势比 0.97；95%置信区间 0.96-0.99，p<0.001）和创伤入院（调整后的优势比 2.26；95%置信区间 1.12-4.54，p=0.022）被确定为独立危险因素。我们的模型在预测增强的肾清除率方面表现出可接受的区分度（接受者操作特征曲线下面积（0.810；95%置信区间 0.756-0.864，p<0.001））。
我们确定了 50 岁以下的年龄、重症监护入院时较低的血清肌酐和创伤是增强的肾清除率的独立危险因素，这与文献一致，表明入院时血清肌酐较低的患者可能有更高的发展增强的肾清除率的风险。
