重症患者万古霉素相关急性肾损伤发生现状及相关因素分析 点击下载
| 论文标题： | 重症患者万古霉素相关急性肾损伤发生现状及相关因素分析 |
| 英文标题： | |
| 中文摘要： | 目的 探讨重症患者发生万古霉素相关急性肾损伤（VA-AKI）的现状和转归情况，分析影响重症患者发生VA-AKI和VA-AKI患者肾功能转归的独立危险因素，探究万古霉素用药疗程预测发生VA-AKI的效能，为该药的合理安全使用提供参考。方法回顾性收集2022年1月－2024年12月于复旦大学附属中山医院重症监护病房住院期间接受万古霉素治疗的重症患者资料，根据是否发生VA-AKI，将患者分为VA-AKI组和未发生AKI组。采用多因素Logistic回归分析筛选影响发生VA-AKI及VA-AKI患者肾功能转归的独立危险因素；采用受试者工作特征（ROC）曲线分析万古霉素用药疗程预测发生VA-AKI模型的区分能力。结果共纳入1484例患者，287例发生VA-AKI，发生率为19.3%，总体中位发生时间为用药后2.5d。合并高血压、心或肾功能不全、住院期间继发败血症/菌血症、多器官功能衰竭、住院期间接受机械通气、万古霉素用药疗程≥10d、联用碳青霉烯类药物、他克莫司是发生VA-AKI的独立危险因素（P＜0.05）；使用血管加压药是影响VA-AKI患者肾功能转归的独立危险因素（P＜0.05）。万古霉素用药疗程预测发生VA-AKI模型ROC的曲线下面积为0.624，最佳截断值（9.7d）下的灵敏度、特异度分别为47.4%、74.9%。结论重症患者VA-AKI发生率较高且多发生在用药早期；合并基础心肾疾病、严重感染、需机械通气、长疗程用药及联用碳青霉烯类药物、他克莫司的患者是发生VA-AKI的高危人群；使用血管加压药则会影响VA-AKI患者的肾功能恢复；万古霉素用药疗程≥10d时预测的急性肾损伤发生风险较高。 |
| 英文摘要： | OBJECTIVE To investigate the incidence and outcomes of vancomycin-associated acute kidney injury （VA-AKI） in critically ill patients， to analyze the independent risk factors for the development of VA-AKI and renal function outcomes in VA-AKI patients， and to evaluate the predictive performance of vancomycin treatment duration for VA-AKI occurrence， so as to provide reference for the rational and safe use of this drug.METHODS Clinical data of critically ill patients who received vancomycin during hospitalization in the intensive care unit of Zhongshan Hospital， Fudan University，from January 2022 to December 2024 were retrospectively collected. Patients were divided into the VA‑AKI group and the non‑AKI group according to the occurrence of VA‑AKI. Multivariate Logistic regression analysis was performed to screen for independent risk factors for VA‑AKI development and renal function outcomes in patients with VA‑AKI. The receiver operating characteristic （ROC） curve was used to analyze the predictive performance of vancomycin treatment duration for VA‑AKI.RESULTS A total of 1 484 patients were enrolled， among whom 287 developed VA‑AKI， with an incidence of 19.3%. The overall median time to onset was 2.5 days after vancomycin administration. Complicated hypertension， cardiac or renal insufficiency， hospital‑acquired sepsis/bacteremia， multiple organ failure， invasive mechanical ventilation during hospitalization， vancomycin treatment duration ≥10 days， and concomitant use of carbapenems or tacrolimus were independent risk factors for VA‑AKI （ P ＜0.05）. Concomitant use of vasopressors was an independent risk factor for renal function outcomes in patients with VA‑AKI （ P ＜0.05）. The area under the ROC curve （AUC） of the model using vancomycin treatment duration of predict the occurrence of VA-AKI was 0.624. At the optimal cut‑off value of 9.7 days， the sensitivity and specificity were 47.4% and 74.9%， respectively.CONCLUSIONS Critically ill patients have a relatively high incidence of VA-AKI， which mostly occurs in the early stage of vancomycin therapy. Patients with underlying cardiac-renal diseases， severe infection， requirement for mechanical ventilation， prolonged vancomycin therapy， and concomitant administration of carbapenems or tacrolimus are at high risk for VA-AKI. Concomitant vasopressor use affects renal function recovery in patients with VA-AKI. The predicted risk of acute kidney injury is higher when vancomycin treatment duration is ≥10 days. |
| 期刊： | 2026年第37卷第16期 |
| 作者： | 李洁；张颖；宋丹騑；潘坤明；李晓宇；吕迁洲 |
| 英文作者： | LI Jie，ZHANG Ying，SONG Danfei，PAN Kunming，LI Xiaoyu，LYU Qianzhou |
| 关键字： | 万古霉素；急性肾损伤；重症患者；危险因素；预后 |
| KEYWORDS： | Vancomycin;Acute kidney injury;critically ill patients;Risk factors;prognosis |
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