Development and Validation of a Risk Prediction Model of Vancomycin‐Associated Nephrotoxicity in Elderly Patients: A Pilot Study

Pan, Chen; Wen, Aiping; Li, Xingang; Li, Dandan; Zhang, Yang; Liao, Yin Tzu; Ren, Yue; Shen, Su

doi:10.1111/cts.12731

Cited by 12 publications

(13 citation statements)

References 32 publications

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“…The proportion of average VCM concentrations ≥20 mg/L was only 15.7% (1146/7306 patients) and was not as high as those previously reported. 35,36 The median averages of VCM concentrations were 17.0 and 13.7 mg/L for patients with and without VIN, respectively. These values resembled those of our previous studies.…”

Section: Discussionmentioning

confidence: 96%

Using Japanese big data to investigate novel factors and their high‐risk combinations that affect vancomycin‐induced nephrotoxicity

Imai

Kadomura

Miyai

et al. 2022

Brit J Clinical Pharma

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Aims Several factors related to vancomycin‐induced nephrotoxicity (VIN) have not yet been clarified. In the present study, we used Japanese big data to investigate novel factors and their high‐risk combinations that influence VIN. Methods We employed a large Japanese electronic medical record database and included patients who had been administered intravenous vancomycin between June 2000 and December 2020. VIN was defined as an increase in serum creatinine ≥0.5 mg/dL or 1.5‐fold higher than the baseline. The outcomes were: (1) factors affecting VIN that were identified using multiple logistic regression analysis, and (2) combinations of factors that affect the risk of VIN according to a decision tree analysis, which is a typical machine learning method. Results Of the 7306 patients that were enrolled, VIN occurred in 14.2% of them (1035). A multivariate analysis extracted 22 variables as independent factors. Concomitant ramelteon use (odds ratio 0.701, 95% confidence interval 0.512‐0.959), ward pharmacy service (0.741, 0.638‐0.861), duration of VCM < 7 days (0.748, 0.623‐0.899) and trough concentrations 10‐15 mg/L (0.668, 0.556‐0.802) reduce the risk of VIN. Meanwhile, concomitant piperacillin‐tazobactam use (2.056, 1.754‐2.409) and piperacillin use (2.868, 1.298‐6.338) increase the risk. The decision tree analysis showed that a combination of vancomycin trough concentrations ≥20 mg/L and concomitant piperacillin‐tazobactam use was associated with the highest risk. Conclusions We revealed that the concomitant ramelteon use and ward pharmacy service may decrease the risk of VIN, while the concomitant use of not only piperacillin‐tazobactam but also piperacillin may increase the risk.

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Section: Discussionmentioning

confidence: 96%

Using Japanese big data to investigate novel factors and their high‐risk combinations that affect vancomycin‐induced nephrotoxicity

Imai

Kadomura

Miyai

et al. 2022

Brit J Clinical Pharma

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“…Similar results were reported by Chuma et al; 31 the rate of vancomycin-associated nephrotoxicity in patients with initial trough levels ≥20 µg/mL (31.3%) was significantly higher than that of patients with initial trough levels <10 µg/mL (6.3%). Moreover, a study by Pan et al 32 of patients aged ≥60 years found that VTC ≥20 µg/mL was an independent risk factor for vancomycin-associated nephrotoxicity and led to a 3-fold increased risk of nephrotoxicity. The present study is consistent with the clinical studies described above.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Nephrotoxicity Associated with Vancomycin Treatment in Patients 80 Years and Older

Wang¹,

Dai²,

Wei³

et al. 2021

CIA

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Purpose This retrospective observational study investigated the efficacy and safety of vancomycin to treat patients aged 80 years and older. In particular, the associations between vancomycin trough concentration (VTC) and treatment outcomes or nephrotoxicity were explored. Patients and Methods Patients aged ≥80 years had received ≥3 vancomycin treatments and ≥1 detection of VTC. Treatment outcomes were defined as success or failure. Nephrotoxicity was considered an increase in serum creatinine ≥ 44.2 mmol/L, or 50% above baseline, for ≥2 consecutive days. Univariate and multivariate analyses were performed to identify risk factors for treatment failure and nephrotoxicity. Results Of 349 patients, 120 (34.4%) experienced treatment failure. For patients with VTCs at <10, 10–15, 15–20, and ≥20 µg/mL, the clinical response rates were, respectively, 77.8, 77.0, 80.5, and 61.0%; the 30-day mortality rates were 2.8, 15.0, 15.3, and 37.8%; and the rates of persistent bacteremia were 16.7, 12.4, 11.9, and 11.0%. The multivariate analysis indicated that blood urea nitrogen ≥11 g/dL and heart failure were independently associated with treatment failure; but not VTC ( P = 0.004, 0.016, 0.828, respectively). During vancomycin treatment, 42 (12.0%) patients experienced nephrotoxicity with recovery time 7.5 ± 4.5 days. Fewer than half of patients with nephrotoxicity recovered after suspending vancomycin application. The variables found independently associated with increased nephrotoxicity were: VTC ≥15 µg/mL; treatment duration ≥15 d; and concomitant aminoglycosides administration ( P = 0.024, 0.035, 0.029). Conclusion In patients aged 80 years and older, elevated VTC level was not associated with favorable treatment outcomes. Patients with VTC ≥20 µg/mL appear to suggest a worsened prognosis compared with lower VTCs. The risk of nephrotoxicity increases with elevated VTC, longer treatment time, and concomitant aminoglycoside administration.

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“…piperacillintazobactam, aminoglycosides) and renal insufficiency. Higher Charlson comorbidities, association with piperacillin-tazobactam or aminoglycosides, diuretics and previous renal insufficiency are related to vancomycin toxicity and unpredictable serum levels 29,32 .…”

Section: Discussionmentioning

confidence: 99%

A atuação do enfermeiro e dos cuidadores na assistência ao paciente portador de demência / The performance of nurses and caregivers in care for patients with dementia

Schiochet¹,

Dubena²,

Argenton³

2021

Braz. J. Hea. Rev.

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Development and Validation of a Risk Prediction Model of Vancomycin‐Associated Nephrotoxicity in Elderly Patients: A Pilot Study

Cited by 12 publications

References 32 publications

Using Japanese big data to investigate novel factors and their high‐risk combinations that affect vancomycin‐induced nephrotoxicity

Using Japanese big data to investigate novel factors and their high‐risk combinations that affect vancomycin‐induced nephrotoxicity

Outcomes and Nephrotoxicity Associated with Vancomycin Treatment in Patients 80 Years and Older

A atuação do enfermeiro e dos cuidadores na assistência ao paciente portador de demência / The performance of nurses and caregivers in care for patients with dementia

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