万古霉素相关性肾毒性与老年患者万古霉素谷浓度的关系：一项回顾性观察研究。
Relationship between vancomycin-induced nephrotoxicity and vancomycin trough concentration in older adults: A retrospective observational study.
机构信息
Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
出版信息
Indian J Pharmacol. 2023 May-Jun;55(3):155-161. doi: 10.4103/ijp.ijp_634_22.
OBJECTIVES
The objective of the study is to investigate the risk factors of vancomycin-induced renal toxicity in older adults, especially in those with chronic kidney disease (CKD) Stages 3-5.
METHODS
In this retrospective observational study, serum vancomycin trough concentrations (VTCs) in patients aged g65 years treated with vancomycin were analyzed, and independent risk factors of vancomycin-induced nephrotoxicity (VIN) were determined by logistic regression analysis.
RESULTS
In total, 321 patients were included in this study. Serum VTC was an independent risk factor for vancomycin-induced renal toxicity in total cohort (odds ratio [OR], 1.07; P = 0.004) as well as in the cohort with CKD Stages 3-5 (OR, 1.09; P = 0.010). A daily dose of vancomycin and Charlson comorbidity index was an independent risk factor for vancomycin-induced renal toxicity in total cohort (OR, 3.63; P = 0.006) and in the cohort with CKD Stage 3-5 (OR, 1.83; P = 0.002), respectively. In older adults with CKD Stages 3a and 3b-5, the VTCs associated with higher risk for vancomycin-induced renal toxicity were 21.5 mg/L and 16.5 mg/L, respectively.
CONCLUSIONS
In older adults, serum VTC is an independent risk factor for VIN. VTCs over 21.5 mg/L and 16.5 mg/L are associated with increased risk of VIN in this population with CKD Stage 3a and 3b-5, respectively.
目的
本研究旨在探讨老年患者（尤其是慢性肾脏病（CKD）3-5 期患者）应用万古霉素时发生肾毒性的危险因素。
方法
本回顾性观察性研究分析了年龄≥65 岁应用万古霉素患者的血清万古霉素谷浓度（VTC），并通过 logistic 回归分析确定万古霉素相关性肾毒性（VIN）的独立危险因素。
结果
共纳入 321 例患者。血清 VTC 是全队列（比值比 [OR]，1.07；P=0.004）及 CKD 3-5 期队列（OR，1.09；P=0.010）患者发生万古霉素相关性肾毒性的独立危险因素。万古霉素日剂量和 Charlson 合并症指数是全队列（OR，3.63；P=0.006）及 CKD 3-5 期队列（OR，1.83；P=0.002）患者发生万古霉素相关性肾毒性的独立危险因素。在 CKD 3a 期和 3b-5 期的老年患者中，VTC 与 VIN 风险增加相关的切点值分别为 21.5 mg/L 和 16.5 mg/L。
结论
在老年患者中，血清 VTC 是 VIN 的独立危险因素。VTC 超过 21.5 mg/L 和 16.5 mg/L 分别与 CKD 3a 期和 3b-5 期患者发生 VIN 的风险增加相关。
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