Risk factors and predicting value analysis of early urinary tract infection in patients treated with tacrolimus after kidney transplantation
10.3760/cma.j.cn114015-20220214-00119
- VernacularTitle:肾移植术后患者他克莫司治疗早期泌尿系感染的危险因素及其预警价值分析
- Author:
Miao MIAO
1
;
Qian WANG
1
;
Xia WANG
1
;
Yuan ZHANG
1
;
Fang GUAN
1
;
Yuqi WANG
1
;
Meixia ZHANG
1
Author Information
1. 山东第一医科大学附属省立医院肾移植科，济南 250021
- Publication Type:Journal Article
- Keywords:
Kidney transplantation;
Graft rejection;
Urinary tract infections;
Immunosuppressive agents;
Tacrolimus
- From:
Adverse Drug Reactions Journal
2022;24(8):417-423
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the risk factors and the predicting value of early urinary tract infection in patients treated with tacrolimus (TAC)-containing immunosuppressive regimen after kidney transplantation.Methods:The medical records of patients who underwent allogeneic kidney transplantation in the Provincial Hospital Affiliated to Shandong First Medical University from January 1, 2015 to October 30, 2021 and received triple immunosuppressive regimen with TAC+mycophenolate mofetil+methylprednisolone were collected and analyzed retrospectively. Relevant clinical data of patients were extracted from the hospital information system. Patients were divided into infection group and non-infection group according to whether urinary tract infection occurred within 1 month after taking TAC and the clinical characteristics in patients between the 2 groups were compared. The risk factors of urinary tract infection were analyzed by binary logistic regression method, and the odds ratio ( OR) and its 95% confidence interval ( CI) were calculated. The receiver operating characteristic (ROC) curve was used to analyze the predicting value of risk factors on the risk of urinary tract infection. Results:A total of 256 patients were entered in the analysis, including 208 males and 48 females, aged 34 (29, 42) years with an range from 18 to 66 years, and the body mass index of these patients was 22.9 (20.4, 25.4) kg/m 2, ranging from 13.9 to 34.4 kg/m 2. There were 163 living donors from relatives and 93 cardiac dead organ donors (DCD). Among the 256 patients, 56 had urinary tract infection (asymptomatic bacteriuria in 32 patients and symptomatic urinary tract infection in 24 patients) after kidney transplantation with an incidence of 21.9%. The differences in gender, age, body weight, body mass index, primary disease, comorbidity disease, donor source, length of hospital stay after surgery, time of indwelling urinary tube and ureteral stent, postoperative complications, complicated infection in other parts of the body after surgery, laboratory test results and so on in patients between the 2 groups were not significant (all P>0.05). The trough plasma concentrations of TAC on the 7th, 14th, and 21st days after taking TAC in the infection group was higher than those in the non-infection group [9.7 (8.4, 13.5) μg/L vs. 8.0 (6.3, 9.8) μg/L, P<0.001; 9.4 (7.6, 11.0) μg/L vs. 8.0 (6.3, 9.8) μg/L, P=0.002; 9.2 (7.6, 11.1) μg/L vs. 8.2 (6.3, 9.8) μg/L, P=0.002]. The binary logistic regression analysis showed that the high trough plasma concentrations of TAC on the 7th day after taking TAC ( OR=1.815, 95 %CI: 1.332-2.474, P<0.001) was an independent risk factor for urinary tract infection in the early stage after kidney transplantation. The ROC curve analysis results showed that the area under the ROC curve of TAC trough plasma concentration on the 7th day was 0.704 (95 %CI: 0.626-0.782), with the cutoff value 8.35 μg/L, the sensitivity 76.8%, and the specificity 53.5%. The patients were divided into >8.35 μg/L group and ≤8.35 μg/L group according to this cutoff value, the incidences of urinary tract infection in the 2 groups were 31.4% (43/137) and 20.6% (13/119) respectively and the difference was statistically significant ( χ2=15.603, P<0.001). Conclusion:High trough plasma concentration of TAC on the 7th day after taking TAC is an independent risk factor for urinary tract infection after kidney transplantation and the predicting value is 8.35 μg/L, which has certain predicting value for early urinary tract infection after kidney transplantation.
