An area under curve-based nomogram to predicts vancomycin-associated nephrotoxicity in critically ill patients: a retrospective cohort study
10.3760/cma.j.cn112138-20211011-00688
- VernacularTitle:万古霉素曲线下面积的列线图预测重症患者万古霉素相关肾损伤的临床应用价值
- Author:
Jinlong WANG
1
;
Ming XUE
;
Haofei WANG
;
Lili HUANG
;
Qing LI
;
Jingyuan XU
;
Jianfeng XIE
;
Yingzi HUANG
Author Information
1. 东南大学附属中大医院重症医学科 江苏省重症医学重点实验室，南京210009
- Keywords:
Vancomycin;
Pharmacokinetics;
Nephrotoxicity;
Nomograms
- From:
Chinese Journal of Internal Medicine
2022;61(3):291-297
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To develop an area under curve (AUC)-based nomogram to predict vancomycin-associated nephrotoxicity in critically ill patients.Methods:This retrospective cohort study included adult patients treated with vancomycin in the intensive care unit at a tertiary teaching hospital from January 2015 to December 2017. Baseline clinical characteristics before vancomycin treatment and pharmacokinetic parameters were collected to establish a prediction model of nephrotoxicity. Univariate analysis was used to screen variables, and multivariate logistic regression analysis was used to establish the prediction model and nomogram.Results:A total of 159 patients met the inclusion criteria, sixty-four were included in the final analysis. Sixteen patients (25%, 16/64) developed vancomycin-associated nephrotoxicity. The following variables were incorporated into the prediction model: vancomycin AUC, estimated glomerular filtration rate (GFR), and combined nephrotoxic drugs. The following equation was established to calculate the probability of nephrotoxicity: logit (P)=-4.83+0.009×AUC-2.87×1 (if GFR>60 ml/min)+2.53×1 (if number of combined nephrotoxic drugs≥2). A nomogram was generated based on the equation. The receiver-operating characteristic curve demonstrated that the AUC of the prediction model was 0.927 (95% CI 0.851-1.000). The cut-off value of the probability of nephrotoxicity was 26.48%. The sensitivity and specificity were 87.5% and 87.5% respectively. Conclusion:The incidence of vancomycin-associated nephrotoxicity is high. The AUC-based nomogram can effectively predict vancomycin-associated nephrotoxicity in critically ill patients.
