Cystatin C and/or creatinine-based estimated glomerular filtration rate for prediction of vancomycin clearance in long-stay critically ill patients with persistent inflammation, immunosuppression and catabolism syndrome (PICS) : a population pharmacokinetics analysis

© 2021. Società Italiana di Medicina Interna (SIMI)..

Persistent inflammation, immunosuppression and catabolism syndrome (PICS) in critically ill patients are associated with unreliable creatinine (Cr)-based estimated glomerular filtration rate (eGFR) and alteration in vancomycin clearance (CL) due to ongoing muscle wasting and renal dysfunction (RD). Currently, cystatin C (Cys) is of great interest for eGFR due to its muscle independence. Patients receiving intravenous vancomycin with trough concentration monitoring after intensive care unit stay ≥ 14 days were retrospectively enrolled. Those with C-reactive protein > 30.0 mg/L, lymphocytes count < 0.80 × 109, albumin < 30 mg/L and weight loss > 10% were diagnosed with PICS. Impact of PICS on vancomycin trough achievement was analyzed. Plasma Cys and Cr levels with their eGFRs in RD were compared in patients with and without PICS. Furthermore, the performance of eGFRs in predicting vancomycin CL was quantificationally evaluated by population pharmacokinetics (PPK) analysis using the Phoenix NLME software. Of 69 enrolled patients, 32 (46.4%) were PICS. PICS was predictive of Cr-guided vancomycin supratherapeutic trough concentrations (OR = 5.26, P = 0.013). Significant elevation of Cys, not of Cr, was observed in patients with PICS suffering from RD (P = 0.022), causing substantial differences among eGFRs. Fifty-two and 17 patients were enrolled for the modeling group and validation group, respectively. A one-compartment PPK model with first-order elimination adequately described the data of 126 Ctrough. Prediction of vancomycin CL with Cys and Cr-based eGFR (CKD-EPIcys-cr) significantly reduced the interindividual variability of CL (from 75.6 to 28.5%). External validation with 34 Ctrough showed the robustness and accuracy of this model. This study showed the negative impact of PICS on Cr-guided vancomycin trough achievement. PPK model with CKD-EPIcys-cr can be used to optimize vancomycin dosage in patients with PICS.

Errataetall:

CommentIn: Intern Emerg Med. 2021 Oct;16(7):1751-1753. - PMID 34057652

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:16

Enthalten in:

Internal and emergency medicine - 16(2021), 7 vom: 15. Okt., Seite 1883-1893

Sprache:

Englisch

Beteiligte Personen:

Huang, Jingjing [VerfasserIn]
Wang, Xiaoli [VerfasserIn]
Hao, Chenxia [VerfasserIn]
Yang, Wanhua [VerfasserIn]
Zhang, Weixia [VerfasserIn]
Liu, Jialin [VerfasserIn]
Qu, Hongping [VerfasserIn]

Links:

Volltext

Themen:

6Q205EH1VU
AYI8EX34EU
Anti-Bacterial Agents
CST3 protein, human
Creatinine
Critically ill
Cystatin C
Estimated glomerular filtration rate
Journal Article
PICS
Population pharmacokinetics
Vancomycin

Anmerkungen:

Date Completed 22.11.2021

Date Revised 04.12.2021

published: Print-Electronic

CommentIn: Intern Emerg Med. 2021 Oct;16(7):1751-1753. - PMID 34057652

Citation Status MEDLINE

doi:

10.1007/s11739-021-02699-8

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM322852102