Shi Yan, Yin Zongqi, Zhang Qin, Yi Lei, Dou Yi
Department of Burn, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Front Pharmacol. 2024 Dec 12;15:1377930. doi: 10.3389/fphar.2024.1377930. eCollection 2024.
To analyze factors influencing the vancomycin trough concentration in burn patients to provide a basis for the more rational use of vancomycin in these patients.
We collected the clinical data of adult burn patients treated with vancomycin in a Chinese hospital. Vancomycin was administered at a dosing regimen of 1.0 g q12 h. Patients were divided into a therapeutic group with vancomycin trough concentration in the target therapeutic range (10-20 μg/mL) and a subtherapeutic group with vancomycin trough concentration in the subtherapeutic range (<10 μg/mL).
The therapeutic group included 14 patients (17.5%), with an average trough concentration of 14.36 ± 2.82 μg/mL; the subtherapeutic group included 66 patients (82.5%), with an average trough concentration of 5.18 ± 2.77 μg/mL. The serum creatinine level was significantly higher in the therapeutic group (84.93 ± 47.26 μmol/L) than that in the subtherapeutic group (62.44 ± 14.49 μmol/L) ( < 0.01). Serum albumin levels were significantly lower in the therapeutic group (30.50 ± 2.28 g/L) than those in the subtherapeutic group (34.00 ± 6.22 g/L) ( < 0.05). Using receiver operating characteristic (ROC) curve analysis, for serum albumin, the area under the ROC curve (AUC) (95% confidence interval [CI]) was 0.67 (0.553, 0.788); the optimal cut-off point was 34.50 g/L ( = 0.046), the sensitivity was 0.379, and the specificity was 1.0. For creatinine clearance, the AUC (95% CI) was 0.72 (0.537, 0.902); the optimal cut-off point was 76.64 mL/min ( = 0.01), the sensitivity was 0.985, and the specificity was 0.5. The linear stepwise regression equation was as follows: trough concentration = 0.14 × age + 0.071 × serum creatinine -4.196.
In this study, a high proportion of burn patients had a vancomycin trough concentration below the standard range. Serum creatinine clearance and albumin levels are important indicators for predicting whether the vancomycin trough concentration is within the standard range. Using a linear stepwise regression equation, the vancomycin trough concentration can be estimated using the patient's age and serum creatinine level.
分析影响烧伤患者万古霉素谷浓度的因素，为这些患者更合理使用万古霉素提供依据。
我们收集了一家中国医院接受万古霉素治疗的成年烧伤患者的临床资料。万古霉素给药方案为1.0 g每12小时一次。患者分为治疗组（万古霉素谷浓度在目标治疗范围10 - 20μg/mL）和亚治疗组（万古霉素谷浓度在亚治疗范围<10μg/mL）。
治疗组包括14例患者（17.5%），平均谷浓度为14.36±2.82μg/mL；亚治疗组包括66例患者（82.5%），平均谷浓度为5.18±2.77μg/mL。治疗组血清肌酐水平（84.93±47.26μmol/L）显著高于亚治疗组（62.44±14.49μmol/L）（<0.01）。治疗组血清白蛋白水平（30.50±2.28 g/L）显著低于亚治疗组（34.00±6.22 g/L）（<0.05）。采用受试者工作特征（ROC）曲线分析，对于血清白蛋白，ROC曲线下面积（AUC）（95%置信区间[CI]）为0.67（0.553，0.788）；最佳截断点为34.50 g/L（P = 0.046），敏感性为0.379，特异性为1.0。对于肌酐清除率，AUC（95%CI）为0.72（0.537，0.902）；最佳截断点为76.64 mL/min（P = 0.01），敏感性为0.985，特异性为0.5。线性逐步回归方程如下：谷浓度 = 0.14×年龄 + 0.071×血清肌酐 - 4.196。
在本研究中，高比例的烧伤患者万古霉素谷浓度低于标准范围。血清肌酐清除率和白蛋白水平是预测万古霉素谷浓度是否在标准范围内的重要指标。使用线性逐步回归方程，可根据患者年龄和血清肌酐水平估算万古霉素谷浓度。
