摘要
目的 评价Vancomycin Calculator ClinCalc.com计算万古霉素初始剂量在中国高龄老年患者中的适用性。方法 本研究为前瞻-回顾性队列研究,纳入于首都医科大学附属北京友谊医院老年医学科住院并静脉应用万古霉素≥80岁的高龄患者。试验组前瞻性纳入2020年6月至2021年10月应用ClinCalc.com计算的万古霉素初始剂量进行治疗的患者,对照组回顾性纳入2017年1月至2019年12月应用万古霉素经验性治疗的患者。比较两组万古霉素血清谷浓度达标率、用药7 d内急性肾损伤(AKI)及用药后30 d内的全因死亡情况。结果 共纳入291例患者(试验组36例,对照组255例)。两组万古霉素血清谷浓度达标率(61.1%vs.58.0%,P>0.05)、AKI发生率及30 d死亡率差异均无统计学意义(P>0.05)。多因素Logistics回归分析显示,万古霉素谷血清浓度(OR=1.068,95%CI:1.027~1.110,P=0.001)、合并恶性肿瘤(OR=2.684,95%CI:41.129~6.380,P=0.025)是AKI发生的独立危险因素,而血清白蛋白水平(OR=0.902,95%CI:0.820~0.992,P=0.033)、发生AKI(OR=1.171,95%CI:1.129~9.207,P=0.029)是30 d全因死亡的独立危险因素。结论 高龄患者应用Vancomycin Calculator ClinCalc.com计算万古霉素初始剂量,其谷浓度达标率及药物安全性与经验性用药相比未见显著提升。
Objective To evaluate the applicability of Vancomycin Calculator ClinCalc.com for calculating vancomycin initial dose in Chinese elderly patients. Methods This was a prospective-retrospective cohort study. Elderly patients ≥80 years old admitted to the Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University and receiving intravenous vancomycin were included. The calculator group prospectively enrolled patients who were treated with the initial dose of vancomycin calculated by ClinCalc.com from June 2020 to October 2021, and the control group retrospectively enrolled patients treated with empirical initial dose of vancomycin from January 2017 to December 2019. The serum trough concentration compliance rate of vancomycin, acute kidney injury(AKI) within 7 days of treatment and all-cause mortality within 30 days after treatment were compared between the two groups. Results A total of 291 patients were enrolled, with 36 in calculator group and 225 in control group. No significant differences in the trough concentration compliance rate(61.1%vs.58.0%, P>0.05), AKI incidence, or 30 days all-cause mortality were found between the two groups. Multivariate logistic regression analysis showed that trough vancomycin concentration(OR=1.068, 95%CI: 1.027-1.110, P=0.001) and combined tumor(OR=2.684, 95%CI: 41.129-6.380, P=0.025) were independent risk factors for AKI, while albumin(OR=0.902, 95%CI: 0.820-0.992, P=0.033) and AKI(OR=1.171, 95%CI: 1.129-9.207, P=0.029) were independent risk factors for 30 days all-cause mortality. Conclusion The serum trough concentration compliance rate and drug safety of vancomycin in elderly patients using Vancomycin Calculator ClinCalc.com to calculate the initial dose are not significantly improved than those using empirical dose therapy.
作者
汤雯
汪云超
田瑛
姜春燕
TANG Wen;WANG Yun-chao;TIAN Ying(Department of Internal Medicine and Geriatrics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《临床和实验医学杂志》
2023年第1期31-35,共5页
Journal of Clinical and Experimental Medicine
基金
首都卫生发展科研专项资助项目(编号:首发2020-2-1101)。
