Blood concentration monitoring of tacrolimus in patients with nephrotic syndrome and establishment of MLP prediction model
- VernacularTitle:肾病综合征患者他克莫司血药浓度监测及MLP预测模型建立
- Author:
Xiaolu YAN
1
,
2
;
Hua OUYANG
1
,
2
,
3
;
Longsheng ZHU
4
;
Lingzhao ZHENG
2
;
Xiaoqing LIN
2
;
Xiaofeng LIN
3
;
Hongyuan LI
3
Author Information
1. School of Pharmacy，Fujian Medical University，Fuzhou 350122，China
2. Dept. of Pharmacy，Zhongshan Hospital Affiliated to Xiamen University，Fujian Xiamen 361004，China
3. Xiamen Pharmaceutical Association，Fujian Xiamen 361004，China
4. School of Advanced Technology，Xi’an Jiaotong- Liverpool University，Jiangsu Suzhou 215006，China
- Publication Type:Journal Article
- Keywords:
tacrolimus;
nephrotic syndrome;
blood concentration monitoring;
multilayer perceptron;
prediction model;
indivi-
- From:
China Pharmacy
2024;35(5):584-589
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To investigate the monitoring of tacrolimus blood concentration in patients with nephrotic syndrome （NS），and to establish a prediction model for tacrolimus blood concentration. METHODS Data from 509 concentration monitoring sessions of 166 NS patients using tacrolimus were collected from January 1， 2020 to August 31， 2023 in Zhongshan Hospital Affiliated to Xiamen University. The relationship of efficacy and adverse drug reaction（ADR） with blood concentration was analyzed. A multilayer perceptron （MLP） prediction model was established by using the blood concentration monitoring data of 302 times from 109 NS patients with genetic information， and then verified. RESULTS In terms of efficacy， the median blood concentration of tacrolimus in the non-remission group was 2.20 ng/mL， which was significantly lower than that in the partial remission group （4.00 ng/mL， P＜0.001） and the complete remission group （3.60 ng/mL， P＝0.002）. In terms of ADR， the median blood concentration of tacrolimus in the ADR group was 5.01 ng/mL， which was significantly higher than that in the non-ADR group （3.37 ng/mL） （P＝0.001）. According to the subgroup analysis of the receiver operating characteristic curve， when the blood concentration of tacrolimus was ≥6.65 ng/mL， patients were more likely to develop elevated blood creatinine [area under the curve （AUC） was 0.764， P＜0.001）； when the blood concentration of tacrolimus was ≥6.55 ng/mL， patients were more likely to develop blood glucose （AUC＝0.615， P＝ 0.005）. The established MLP prediction model has a loss function of 0.9， with an average absolute error of 0.279 5 ng/mL between the predicted and measured values. The determination coefficient of the validation scatter plot was 0.984， indicating an excellent predictive performance of the model. CONCLUSION Tacrolimus blood concentration has an impact on both efficacy and ADR in NS patients. The use of the MLP model for predicting blood concentration exhibits high accuracy with minimal error between predicted and measured values. The model can be used as an important tool in clinical individualized medication regimens.
