估计肾小球滤过率升高与接受万古霉素治疗的社区获得性细菌性脑膜炎儿科患者临床预后不良之间的关联：一项十年回顾性队列研究。

The Association Between Elevated Estimated Glomerular Filtration Rate and Poor Clinical Outcomes of Pediatric Patients with Community-Acquired Bacterial Meningitis Receiving Vancomycin: A Ten-Year Retrospective Cohort Study.

作者信息

He Cuiyao, Deng Yuhua, Li Tingsong, Deng Dongmei, Lv Fengjun, Qu Yuan, Jiang Li, Hong Siqi, Hu Xiaogang, Luo Yuanyuan

机构信息

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

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

出版信息

Infect Dis Ther. 2025 Jul 18. doi: 10.1007/s40121-025-01196-1.

DOI:10.1007/s40121-025-01196-1

PMID:40679785

Abstract

INTRODUCTION

This study aimed to explore the association between elevated estimated glomerular filtration rate (eGFR) and poor prognosis in pediatric patients with community-acquired bacterial meningitis (BM) receiving vancomycin.

METHODS

This retrospective cohort study included children aged 1 month to 18 years with community-acquired BM admitted to the Department of Neurology, Children's Hospital of Chongqing Medical University (CHCMU) from 2013 to 2023. Relevant information for all patients was collected, and clinical outcomes were assessed using the Glasgow Outcome Scale (GOS) at the time of discharge. Logistic regression analysis, receiver operating characteristic (ROC) curve analysis, integrated discrimination improvement (IDI), net reclassification improvement (NRI) indices, and survival curve analysis were employed to investigate the associations between elevated eGFR and poor clinical outcomes in pediatric patients with community-acquired BM.

RESULTS

A total of 119 patients were included. Significant differences in the eGFR were observed among pediatric patients with different prognoses (P < 0.05). The initial vancomycin trough concentration in the elevated eGFR group was significantly lower than that in the normal eGFR group [5.600 (4.590; 8.060) mg/L vs. 9.205 (7.500; 12.070) mg/L]. At discharge, the GOS scores of the two groups also significantly differed (P < 0.05). In the analysis of factors influencing poor prognosis in pediatric patients with BM, an eGFR ≥ 169.21 mL/min/1.73 m was identified as an important factor associated with poor clinical outcomes in both univariate and multivariate analyses. Incorporating the elevated eGFR factor into the predictive model significantly improved its diagnostic performance (NRI 0.624, P = 0.00297; IDI 0.1057, P = 0.00414). Kaplan‒Meier survival analysis also revealed that an eGFR ≥ 169.21 mL/min/1.73 m was associated with a greater likelihood of poor outcomes (P = 0.0092).

CONCLUSION

Elevated eGFR is associated with an increased risk of poor clinical outcomes in community-acquired BM in children.

摘要

引言

本研究旨在探讨接受万古霉素治疗的社区获得性细菌性脑膜炎（BM）儿科患者中，估算肾小球滤过率（eGFR）升高与预后不良之间的关联。

方法

这项回顾性队列研究纳入了2013年至2023年在重庆医科大学附属儿童医院神经内科住院的1个月至18岁社区获得性BM患儿。收集了所有患者的相关信息，并在出院时使用格拉斯哥预后量表（GOS）评估临床结局。采用逻辑回归分析、受试者工作特征（ROC）曲线分析、综合判别改善（IDI）、净重新分类改善（NRI）指数和生存曲线分析，以研究社区获得性BM儿科患者中eGFR升高与不良临床结局之间的关联。

结果

共纳入119例患者。不同预后的儿科患者eGFR存在显著差异（P<0.05）。eGFR升高组的初始万古霉素谷浓度显著低于正常eGFR组[5.600（4.590；8.060）mg/L对9.205（7.500；12.070）mg/L]。出院时，两组的GOS评分也有显著差异（P<0.05）。在对BM儿科患者预后不良影响因素的分析中，单因素和多因素分析均确定eGFR≥169.21 mL/min/1.73 m²是与不良临床结局相关的重要因素。将eGFR升高因素纳入预测模型显著提高了其诊断性能（NRI 0.624，P=0.00297；IDI 0.1057，P=0.00414）。Kaplan-Meier生存分析还显示，eGFR≥169.21 mL/min/1.73 m²与不良结局的可能性更大相关（P=0.0092）。