Risk factors and prediction models for acute kidney injury caused by voriconazole for injection in patients with moderate to severe renal insufficiency
10.3760/cma.j.cn114015-20230714-00521
- VernacularTitle:注射用伏立康唑致中重度肾功能不全患者急性肾损伤的危险因素及其风险预测模型
- Author:
Shubo WANG
1
;
Tingting JIAO
;
Hongliang DONG
;
Youcai ZHANG
;
Bailing WANG
Author Information
1. 河南省焦作市人民医院临床药学室，焦作 454002
- Publication Type:Journal Article
- Keywords:
Injections, intravenous;
Acute kidney injury;
Risk factors;
Prediction model;
Voriconazole;
Antifungal drugs
- From:
Adverse Drug Reactions Journal
2024;26(3):150-156
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the risk factors of acute kidney injury (AKI) in patients with moderate and severe renal insufficiency after receiving voriconazole for injection and to establish a model for predicting the occurrence risk.Methods:The study was designed as a retrospective study. The subjects were selected from patients with moderate to severe renal insufficiency who were hospitalized in Jiaozuo People′s Hospital of Henan Province from January 1, 2020 to December 31, 2022 and received treatment with voriconazole for injection. Through the hospital information system, clinical data of patients were collected, including basic information, clinical diagnosis, laboratory test indexes, comorbid diseases, and co-medication. Patients were divided into AKI and non-AKI groups according to whether voriconazole-related AKI occurred. AKI risk factors were analyzed using multiple logistic regression, and prediction models were established accordingly. Calibration curves were plotted using R4.2.3 software, and the model was internally validated using the k-fold cross-validation method.Results:A total of 146 patients were enrolled in the study with an age of 72.4±13.8 years, including 84 males and 62 females; 61 patients (41.8%) of which developed voriconazole-related AKI. Compared with the non-AKI group, the white blood cell count, neutrophils percentage, proportion of patients with basic renal diseases, and proportion of patients with cardiovascular diseases were higher in the AKI group; the days of voriconazole injection treatment, proportion of patients with hematological diseases, and proportion of patients receiving glycopeptide drugs were lower in the AKI group. The results of multiple logistic regression showed that albumin [X 1, odds ratio( OR)=0.946, 95% confidence interval( CI): 0.915-0.977, P=0.001], neutrophil percentage (X 2, OR=1.013, 95 %CI: 1.000- 1.026, P=0.001), and complicated with underlying renal diseases (X 3, OR=2.230, 95 %CI: 1.110-4.483, P= 0.046) were independent influencing factors of AKI caused by voriconazole for injection in patients with moderate and severe renal insufficiency. The prediction model was established and the joint prediction factor Y=14.32X 1+0.23X 2-X 3. When the maximum value of Youden index was 0.382, the best tangent point of receiver operating characteristic curve was -11.33. The internal cross-validation results showed that the accuracy of the model was 0.70 and the Kappa coefficient (consistency) was 0.37. Conclusions:The incidence of AKI in patients with moderate and severe renal insufficiency after receiving voriconazole for injection was 41.8%. Albumin, neutrophil percentage and underlying renal diseases were the independent influencing factors. The calculation of joint predictors based on the above indicators was helpful to predict the risk of AKI and had a certain reference value for clinic.
