Abstract
Vancomycin-associated acute kidney injury (AKI) remains a major challenge for patients and clinicians. This study aimed to construct a risk scoring system for vancomycin-associated AKI. We retrospectively reviewed medical records of patients who underwent therapeutic drug monitoring for vancomycin from June 2018 to July 2019. We selected possible risk factors for AKI by univariate and multivariable logistic regression analyses and developed a scoring system for vancomycin-associated AKI. Machine learning methods were utilized to predict risk factors for the occurrence of AKI. The incidence of vancomycin-associated AKI was 31.7% among 104 patients included in this study. A bodyweight ≤60 kg (two points), a Charlson comorbidity index ≥3 (two points), a vancomycin trough serum level >15 μg/ml (one point), and concomitant use of ≥6 nephrotoxic agents (two points) were included to construct a risk scoring system based on the coefficient from the logistic regression model. The area under the receiver operating characteristic curve (AUROC) (mean, 95% confidence interval (CI)) across 10 random iterations using five-fold cross-validated multivariate logistic regression, elastic net, random forest, support vector machine (SVM)-linear kernel, and SVM-radial kernel models was 0.735 (0.638–0.833), 0.737 (0.638–0.835), 0.721 (0.610–0.833), 0.739 (0.648–0.829), and 0.733 (0.640–0.826), respectively. For total scores of 0–1, 2–3, 4–5, 6–7, the risk of vancomycin-associated AKI was 5, 25, 45, and 65%, respectively. Our scoring system can be applied to clinical settings in which several nephrotoxic agents are used along with vancomycin therapy.
Highlights
Vancomycin (VCM) is used for the treatment of severe infections such as sepsis, endocarditis, osteomyelitis, or meningitis caused by methicillin-resistant Staphylococcus aureus (Deresinski, 2009)
Data were obtained for 788 patients, of whom 684 were excluded; 335 did not have any therapeutic drug monitoring (TDM) course, 215 had insufficient records, 35 had duplicate courses, 92 had a hospital length of stay
Significant factors for acute kidney injury (AKI) were a bodyweight of 60 kg or less, a Charlson comorbidity index (CCI) of three or higher, concomitant use of six or more nephrotoxic agents, and a serum trough level of VCM of higher than 15 μg/ml with odds ratio (OR) values of 3.03 (1.28–7.14), 4.46 (1.85–10.75), 2.80 (1.17–6.74), and 2.37 (1.01–5.54), respectively (Table 2)
Summary
Vancomycin (VCM) is used for the treatment of severe infections such as sepsis, endocarditis, osteomyelitis, or meningitis caused by methicillin-resistant Staphylococcus aureus (Deresinski, 2009). VCM-associated nephrotoxicity such as acute kidney injury (AKI) is thought to be related to the serum trough level of the drug and/or the area under the curve (AUC) measured in the first 24 h of VCM use (AUC0-24 h) (Bosso et al, 2011; van Hal et al, 2013; Finch et al, 2017; Ghasemiyeh et al, 2020; Poston-Blahnik and Moenster, 2021). Vancomycin-Associated Acute Kidney Injury the risk of nephrotoxicity of the VCM (Rutter et al, 2017; Gyamlani et al, 2019; Qin et al, 2020). VCM-associated AKI has been reported to worsen patients’ clinical outcomes such as the length of hospital stay, mortality, treatment failure, or economic burden (Wang et al, 2012; Jeffres, 2017). Many attempts have been made to reduce the incidence of nephrotoxicity associated with the use of VCM, the incidence and severity of nephrotoxicity caused by VCM use are still difficult to predict (Mehta et al, 2015; Filippone et al, 2017)
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