Objective To construct a prediction model of vancomycin-related nephrotoxicity in patients with methicillin-resistant Staphylococcus aureus(MRSA)bloodstream infection.Methods The clinical data of 128 patients with MRSA bloodstream infection treated with vancomycin from January 2019 to January 2023 in Tianjin Medical University General Hospital were retrospectively analyzed.There were 66 males and 62 females,aged(61.47±10.25)years.According to whether the patients developed vancomycin-related acute kidney injury(AKI),they were divided into an AKI group(32 cases)and a non-AKI group(96 cases).The gender,age,body mass index(BMI),shock,white blood cell count(WBC),procalcitonin,hypersensitive C-reactive protein(hs-CRP),Sequential Organ Failure Assessment(SOFA)score,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,combined underlying diseases(diabetes mellitus,hypertension,and coronary heart disease),serum creatinine,use of nonsteroidal anti-inflammatory drugs,use of aminoglycosides,use of vasoactive drugs,types of nephrotoxic drugs used,glomerular filtration rate(GFR),treatment dose,administration interval,duration of treatment,cumulative dose,area under the curve(AUC)of vancomycin,and other data were compared between the two groups.Logistic regression equation was used to analyze the risk factors of vancomycin-related nephrotoxicity in patients with MRSA bloodstream infection.A risk nomogram model of vancomycin-related nephrotoxicity was constructed based on the risk factors,and the constructed model was validated and its predictive efficacy was evaluated.Independent sample t test,Mann-Whitney U test,x2 test,and Hosmer-Lemeshow test were used.Results The age,serum creatinine level,vancomycin AUC,and proportions of number of nephrotoxic drugs ≥2 and GFR ≤60 ml/min in the AKI group were higher than those in the non-AKI group(all P＜0.05).Logistic regression analysis showed that age ≥60 years old,serum creatinine ≥95.42 μmol/L,number of nephrotoxic drugs ≥2,GFR ≤60 ml/min,and vancomycin AUC ≥30 g/L were all independent risk factors for AKI in patients with MRSA bloodstream infection treated with vancomycin(all P＜0.05).Hosmer-Lemeshow goodness of fit test showed that the nomogram model had a good agreement in predicting the risk of AKI in patients with MRSA bloodstream infection treated with vancomycin(x2=3.571,P=0.672).The internal verification results of Bootstrap method showed that the C-index of the nomogram prediction model was 0.785(95％CI 0.678-0.889),indicating that the model had good differentiation.The receiver operating characteristic curve(ROC)results showed that the AUC(95％CI),sensitivity,and specificity of the nomogram risk model for predicting AKI in patients with MRSA bloodstream infection treated with vancomycin were 0.859(0.618-0.979),94.50％,and 78.30％,respectively(all P＜0.001).Conclusions Age ≥60 years old,serum creatinine ≥95.42 μmol/L,number of nephrotoxic drugs ≥2,GFR ≤60 ml/min,and vancomycin AUC ≥30 g/L are all independent risk factors for AKI in patients with MRSA bloodstream infection treated with vancomycin.The risk nomogram model based on the above risk factors has a high predictive value for AKI in patients with MRSA bloodstream infection treated with vancomycin.
维普
万方数据
