Occurrence and risk factors of acute kidney injury associated with polymyxin B in patients with severe infection
10.3760/cma.j.cn114015-20220512-00422
- VernacularTitle:重症感染患者多黏菌素B相关急性肾损伤的发生情况及危险因素分析
- Author:
Yunyan PAN
1
;
Jia LI
;
Qifeng CHEN
;
Meiling CHEN
;
Yanzhe XIA
;
Pan CHEN
;
Jie CHEN
Author Information
1. 中山大学附属第一医院药学部，广州 510080
- Publication Type:Journal Article
- Keywords:
Polymyxin B;
Acute kidney injury;
Risk factors;
Severe infection
- From:
Adverse Drug Reactions Journal
2023;25(2):95-100
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the occurrence and risk factors of intravenous polymyxin B-associated acute kidney injury (AKI) in patients with severe infection.Methods:Electronic medical records of patients with severe infection treated with intravenous polymyxin B during hospitalization in the First Affiliated Hospital, Sun Yat-sen University from October 2017 to October 2020 were collected and analyzed retrospectively. Patients with polymyxin B-induced acute kidney injury were screened out. The occurrence time, clinical stage, and outcome of AKI were statistically analyzed, and the incidence of polymyxin B-induced AKI and the cumulative incidence of AKI on the 3rd, 6th, 12th, and 15th days of administration were calculated. Patients were divided into AKI and non-AKI groups according to whether polymyxin B-associated AKI occurred. The clinical characteristics in patients of the 2 groups were compared. The risk factors of AKI were analyzed by multivariate logistic regression, and the odds ratio ( OR) and 95% confidence interval ( CI) were calculated. Results:A total of 311 patients were entered in the analysis, including 237 males (76.2%) and 74 (23.8%) females, with a median age of 58 (46, 70) years. Fifty-two patients (16.7%) developed polymyxin B-associated AKI, and the time from medication to onset of AKI was (4±2) days, ranging from 2 to 13 days. The cumulative incidence (%) of AKI and its 95 %CI on the 3rd, 6th, 12th, and 15th days of polymyxin B administration were 9.1(3.0-19.4), 15.4(7.9-25.2), 21.5(12.8-31.6), and 21.5(12.8-31.6), respectively. After developing AKI, polymyxin B was discontinued in 17 of 52 patients (32.7%), and 7 of them were given continuous renal replacement therapy (CRRT). The other 35 patients (53.8%) needed to continue medication because of the infection condition, and 25 of them were given CRRT and 10 received diuretics additionally. After the above treatments, 22 (42.3%) of 52 patients had Scr returning to normal, 6 patients (11.5%) were improved, 15 (28.9%) died due to primary diseases, and 9 (17.3%) were discharged under their own request. Multivariate logistic regression analysis showed that daily dose ≥150.0 mg ( OR=5.588, 95 %CI: 2.258-13.833, P<0.001) and high acute physiology and chronic health evaluation Ⅱ (APACHE-Ⅱ) score ( OR=1.063, 95 %CI: 1.021-1.106, P=0.003) were independent risk factors for polymyxin B-associated AKI. Conclusions:AKI may occur in a short time in patients with severe infection after intravenous administration of polymyxin B. The daily dose of polymyxin B ≥150.0 mg and high APACHE-Ⅱscore may increase the risk of AKI.
