Validation of the Augmented Renal Clearance in Trauma Intensive Care scoring system for augmented renal clearance prediction in a trauma subgroup of a mixed
            <scp>ICU</scp>
            population

Jabamikos, Caren; Fang, Yi Tong; Nguyen, Kim-Dan; Sananikone, Alice; Archambault, Kym; Bing, Emily; Chagnon, Miguel; Husainalamoodi, Omar; Marsot, Amélie; Duceppe, Marc‐Alexandre; Perreault, Marc M.

doi:10.1111/jcpt.13695

Cited by 4 publications

(2 citation statements)

References 36 publications

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“…All patients aged over 18 years who required vancomycin therapy were assessed for the probability of ARC. The probability was checked by the ARC and ARCTIC (Augmented Renal Clearance in Trauma Intensive Care) scores (Table 1) (Barletta et al, 2017;Jabamikos et al, 2022).…”

Section: Patientsmentioning

confidence: 99%

Evaluation of vancomycin pharmacokinetics in patients with augmented renal clearances: A randomized clinical trial

et al. 2022

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Purpose: Vancomycin is a narrow therapeutic window glycopeptide antibiotic that acts against Gram-positive bacteria. As it is renally eliminated, therapeutic drug monitoring is recommended for vancomycin, especially in case of kidney function alteration. Augmented renal clearance (ARC), defined as a creatinine clearance of more than 130 ml/min, is a risk factor for sub-therapeutic concentrations of vancomycin. This study aimed to evaluate the vancomycin pharmacokinetics following the administration of two different regimens in ARC patients.Methods: A randomized clinical trial (IRCT20180802040665N1) was conducted on patients in need of vancomycin therapy. Eight hours of urine was collected and 56 patients divided into two groups with creatinine clearance of more than 130 ml/min were included in the study. The first group received 15 mg/kg of vancomycin every 12 h and the second group 15 mg/kg every 8 h. After four doses, the peak and trough concentrations were measured from two blood samples. The primary outcome was the percentage of patients who attainted AUC more than 400. The occurrence of acute kidney injury also was evaluated after seven days.Results: The mean age of patients in the every 12 h and every 8 h groups was 44.04 ± 16.55 and 42.86 ± 11.83 years, respectively. While neurosurgical issues were the most common causes of hospitalization, central nervous infections were the most common indications for vancomycin initiation. Urinary creatinine clearance was 166.94 ± 41.32 ml/min in the every 12 h group and 171.78 ± 48.56 ml/min in the every 8 h group. 46.42% of patients in the every 12 h group and 82.14% of patients in the every 8 h group attained AUC/MIC of more than 400 mg × hr/L. None of the patients in the every 12 h group reached more than 15 mcg/ml concentration. At the 7-day follow-up, 10.7% patients in the BD group and 28.6% patients in the TDS group developed acute kidney injury (p = 0.089).Conclusion: Administration of vancomycin at a dose of 15 mg/kg every 8 h is associated with higher pharmacokinetic attainment in ARC patients. The occurrence of acute kidney injury also was not significantly higher in this therapeutic regimen. AUC/MIC monitoring is necessary in this population.

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Section: Patientsmentioning

confidence: 99%

Evaluation of vancomycin pharmacokinetics in patients with augmented renal clearances: A randomized clinical trial

et al. 2022

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“…Additionally, the Augmented Renal Clearance of Trauma in Intensive Care (ARCTIC) score proposed by Barletta et al is also point-based [ 9 ]. Recently externally validated [ 11 ], the ARCTIC score showed decent discrimination with an AUROC of 0.765 and 0.748 in the trauma and medical/surgical subgroups, respectively. Finally, the ARC predictor that was developed to predict the presence of ARC on the next intensive care unit (ICU) day outperformed the two existing models (ARC Score [ 8 ] and ARCTIC Score [ 9 ]) in the validation cohort [ 10 ] and has been made publicly available as an online calculator [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

External Validation of the Augmented Renal Clearance Predictor in Critically Ill COVID-19 Patients

et al. 2023

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The ARC predictor is a prediction model for augmented renal clearance (ARC) on the next intensive care unit (ICU) day that showed good performance in a general ICU setting. In this study, we performed a retrospective external validation of the ARC predictor in critically ill coronavirus disease 19 (COVID-19) patients admitted to the ICU of the University Hospitals Leuven from February 2020 to January 2021. All patient-days that had serum creatinine levels available and measured creatinine clearance on the next ICU day were enrolled. The performance of the ARC predictor was evaluated using discrimination, calibration, and decision curves. A total of 120 patients (1064 patient-days) were included, and ARC was found in 57 (47.5%) patients, corresponding to 246 (23.1%) patient-days. The ARC predictor demonstrated good discrimination and calibration (AUROC of 0.86, calibration slope of 1.18, and calibration-in-the-large of 0.14) and a wide clinical-usefulness range. At the default classification threshold of 20% in the original study, the sensitivity and specificity were 72% and 81%, respectively. The ARC predictor is able to accurately predict ARC in critically ill COVID-19 patients. These results support the potential of the ARC predictor to optimize renally cleared drug dosages in this specific ICU population. Investigation of dosing regimen improvement was not included in this study and remains a challenge for future studies.

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Augmented renal clearance in neurocritical care patients: A retrospective cohort study

Ramírez-Guerrero,

Vera-Calzaretta,

Torres-Cifuentes

et al. 2024

J Transl Crit Care Med

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Background: Augmented renal clearance (ARC) in critical patients is concerning because it is associated with subtherapeutic antimicrobial or antiepileptic drug concentrations, increased length of stay, and possibly higher mortality. This study aimed to describe the characteristics between ARTIC score and estimated glomerular filtration rate (eGFR) in the neurocritical care population. Methods: A retrospective cohort study was conducted in the neurocritical care unit. Patients admitted to the neurocritical care unit between 2016 and 2018 with a stay longer than 48 h were retrospectively analyzed regarding the incidence, risk factors, and outcomes of ARC. Results: An ARTIC score of 6 or higher was present in 54.2% of patients, and 5.0% met the criteria for ARC due to eGFRCKD-EPI. The incidence of AKI was 23.5%. Polyuria was observed in 50.0% of patients, and hyponatremia and hypernatremia were observed in 16.9% and 40.9% of patients, respectively. Conclusion: ARC is a common phenomenon in the neurocritical care unit, especially in younger patients without cardiovascular comorbidities, and was associated with less acute kidney injury and less mortality.

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Validation of the Augmented Renal Clearance in Trauma Intensive Care scoring system for augmented renal clearance prediction in a trauma subgroup of a mixed ICU population

Cited by 4 publications

References 36 publications

Evaluation of vancomycin pharmacokinetics in patients with augmented renal clearances: A randomized clinical trial

Evaluation of vancomycin pharmacokinetics in patients with augmented renal clearances: A randomized clinical trial

External Validation of the Augmented Renal Clearance Predictor in Critically Ill COVID-19 Patients

Augmented renal clearance in neurocritical care patients: A retrospective cohort study

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