Influence of augmented renal clearance on serum trough concentrations of vancomycin in critically ill patients
Objective To investigate the impact of augmented renal clearance(ARC)on serum trough concentration(Cmin)of vancomycin in critically ill patients,and to evaluate the correlations between creatinine clearance estimated by the Cockcroft-Gault formula(CcrC-G),serum creatinine(Scr)and Cmin.Methods A retrospective observational study was conducted among critically ill patients with infections admitted to the ICU of Beijing Jishuitan Hospital from April 2018 to May 2023 who received empirical or therapeutic vancomycin therapy with CcrC-G≥60 mL/min and underwent Cmin monitoring.Patients were divided into ARC(CcrC-G≥120 mL/min)and non-ARC(CcrC-G<120 mL/min)groups based on their CcrC-G values.Various indicators were collected and compared between the two groups.Results A total of 114 patients with severe infection were included,with 67 cases in the ARC group and 47 cases in the non-ARC group.The mean CcrC-G values were(205.2±90.8)mL/min and(89.4±14.4)mL/min,respectively.Patients in the ARC group were younger[(48.0±14.7)years vs(68.3±11.2)years,P<0.001]and had lower Cmin[(9.51±5.42)μg/mL vs(17.09±8.70)μg/mL,P<0.001]compared to the non-ARC group.A higher proportion of patients in the ARC group had Cmin<10 μg/mL(61.2%vs 21.3%,P<0.001).Spearman correlation analysis showed a negative correlation between Cmin and CcrC-G(r=-0.466,P<0.001)and a weak positive correlation between Cmin and Scr(r=0.213,P=0.023).In the ARC group,Cmin was negatively correlated with CcrC-G(r=-0.424,P<0.001),but not with Scr(P=0.436).In the non-ARC group,no correlation was found between Cmin and either CcrC-G or Scr(P=0.189 and 0.749,respectively).Conclusion Patients with ARC have a lower achievement rate of the Cmin target.Cmin was correlated with CcrC-G but weakly correlated with Scr in ARC patients.No correlation was observed between Cmin and CcrC-G or Scr in non-ARC patients.
augmented renal clearanceserum trough concentration of vancomycincreatinine clearance
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