Vancomycin for Dialytic Therapy in Critically Ill Patients: Analysis of Its Reduction and the Factors Associated with Subtherapeutic Concentrations
Abstract
:1. Introduction
2. Methods
3. Statistical Analysis
4. Results
5. Discussion
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Pharmacokinetic | Formula |
---|---|
Distribution Volume (L) | VD = Vancomycin dose (mg)/concentration of vancomycin (mg/L) |
Dialytic Clearence of vancomycin (L/h) | Cl vanco = (Initial—final concentration)/Initial concentration × QD/t |
Half-life time | T½ life = 0.693 × VD/Cl |
% reduction in vancomycin | % red = (C pre HD—C final HD)/C pre HD) × 100 |
Variables | General (n = 55) | IHD (n = 27) | PHD 6 h (n = 17) | PHD 10 h (n = 11) | p |
---|---|---|---|---|---|
Age (Years) | 62.61 ± 13.12 | 63.30 ± 13.86 | 61.94 ± 14.15 | 62 ± 10.36 | 0.934 |
Male sex (%) | 37 (67.3) | 17 (62.86) | 13 (76.47) | 6 (54.54) | 0.457 |
Weight (kg) | 75.07 ± 24.20 | 71 (64–84.75) | 69 (57.32–77.75) | 62 (58.50–85.75) | 0.594 |
Comorbidities | |||||
Diabetes (%) | 28 (50.0) | 13 (48.15) | 10 (58.82) | 5 (45.45) | 0.726 |
Hypertension (%) | 40 (72.72) | 24 (88.89) a | 10 (58.82) b | 6 (54.54) b | 0.030 |
Cardiovascular disease (%) | 27 (49.09) | 18 (66.67) a | 5 (29.41) b | 4 (36.36) ab | 0.035 |
Obesity (%) | 9 (16.36) | 3 (11.11) | 2 (11.76) | 4 (36.36) | 0.134 |
Neoplasia (%) | 6 (10.90) | 2 (7.41) | 2 (11.76) | 2 (18.18) | 0.621 |
Smoking (%) | 25 (45.45) | 11 (40.74) | 8 (47.06) | 6 (54.54) | 0.731 |
Chronic Kidneyl Disease (%) | 4 (7.27) | 2 (7.40) | 1 (5.88) | 1 (9.09) | 0.950 |
Other (%) | 30 (54.54) | 13 (48.15) | 10 (58.82) | 7 (63.64) | 0.626 |
Hospitalization Diagnostic | |||||
Sepsis (%) | 35 (63.64) | 22 (81.48) a | 7 (41.18) b | 6 (54.54) b | 0.02 |
Acute abdomen (%) | 7 (12.73) | 3 (11.11) | 3 (17.65) | 1 (9.09) | 0.754 |
Acute Coronarary Syndrome (%) | 6 (10.90) | 5 (18.6) | 1 (5.88) | 0 | 0.183 |
Trauma (%) | 3 (5.45) | 1 (3.70) | 1 (5.88) | 1 (9.09) | 0.799 |
Elective Surgery (%) | 7 (12.73) | 2 (7.41) | 3 (17.65) | 2 (18.18) | 0.508 |
Other (%) | 3 (5.45) | 1 (3.70) | 0 | 2 (18.18) | 0.100 |
Arterial Thrombosis (%) | 7 (12.73) | 5 (18.52) | 2 (11.76) | 0 | 0.172 |
Infectious Focus | |||||
Lung (%) | 37 (67.27) | 21 (77.78) | 9 (52.94) | 7 (63.64) | 0.223 |
Urinary (%) | 3 (5.45) | 2 (7.41) | 1 (5.88) | 0 | 0.657 |
Abdominal (%) | 6 (10.90) | 1 (3.70) | 3 (17.65) | 2 (18.18) | 0.242 |
Cutaneous (%) | 5 (9.09) | 1 (3.70) | 1 (5.88) | 3 (27.27) | 0.062 |
Other (%) | 6 (10.90) | 3 (11.11) | 3 (17.65) | 0 | 0.343 |
APACHE II | 29.64 ± 7.56 | 27.16 ± 7.930 a | 33.06 ± 7.07 b | 30.00 ± 5.59 ab | 0.042 |
LIANO | 0.75 (0.6–0.87) | 0.72 (0.54–0.78) | 0.78 (0.71–0.84) | 0.89 (0.44–0.89) | 0.163 |
Death (%) | 41 (74.54) | 19 (70.37) | 15 (88.23) | 7 (63.63) | 0.27 |
Variables | General (n = 55) | IHD (n = 27) | PHD 6 h (n = 17) | PHD 10 h (n = 11) | p |
---|---|---|---|---|---|
Noradrenaline (mcg/kg/min) | 0.25 (0.05–0.5) | 0.05 (0.0–0.14) a | 0.5 (0.33–0.8) b | 0.45 (0.38–0.57) b | <0.001 |
Urinary Volume (mL/24 h) | 200 (50–650) | 300 (133–950) | 150 (27.5–800) | 100 (0.0–260) | 0.072 |
Hematocrit (%) | 27.85 ± 3.89 | 26.5 (23.8–28.9) | 27.9 (26.75–30.35) | 27.8 (26.8–29.9) | 0.062 |
PCR (mg/L) | 27.1 (7.3–33.7) | 25.8 (5.50–31.82) | 23.2 (8.12–35.3) | 27.8 (23.8–35.1) | 0.518 |
Albumin (g/dL) | 2.18 ± 0.49 | 2.21 ± 0.43 | 2.17 ± 0.51 | 2.11 ± 0.67 | 0.049 |
Ultrafiltration (mL) | 1901.82 ± 1148.19 | 2018.52 ± 1138.84 | 1564.71 ± 1225.22 | 2136.36 ± 1026.91 | 0.339 |
Kt/V | 0.89 ± 0.33 | 0.86 ± 0.28 | 0.82 ± 0.35 | 1.08 ± 0.36 | 0.093 |
Intradialitic hypotension | 9 (16.36) | 4 (14.81) | 4 (23.52) | 1 (9.09) | 0.574 |
Variables | General (n = 55) | IHD (n = 27) | PHD 6 h (n = 17) | PHD 10 h (n = 11) | p |
---|---|---|---|---|---|
Vancomycin days | 5 (2–10) | 7 (3–12) | 5 (2–6.5) | 4 (2–12) | 0.39 |
Vancomycin dose (mg/kg/dia) | 15.5 ± 7.3 | 13.9 (8.6–15.4) | 14.7 (13.5–18.0) | 18.7 (12.0–24.6) | 0.05 |
Vancomycin concentration before analysis (mg/L) | 19.6 (16–27.8) | 20.9 (17.8–31.5) | 20.2 (15.4–27.7) | 17.9 (14.1–23.0) | 0.61 |
Distribution volume (L/Kg) | 0.6 (0.4–0.85) | 0.40 (0.29–0.62) a | 0.8 (0.61–1.0) b | 0.7 (0.59–1.29) b | <0.001 |
Half-life time (h) | 17.4 (6.7–32.6) | 6.70 (4.2–11.9) a | 27.6 (19.5–74.4) b | 38.4 (30.62–74.78) b | <0.001 |
Vancomycin dialytic Clearence (L/h) | 1.9 (1.13–3.23) | 3.2 (2.54–3.68) a | 1.3 (0.93–1.72) b | 1.0 (0.75–1.15) b | <0.001 |
Vancomycin concentration (mg/L) at T0 | 26.0 (15.9–35.9) | 34.2 (22–44) a | 13.4 (10.7–18.4) b | 23.1 (13.6–31.0.6) ab | <0.001 |
Vancomycin concentration at T 2 h (mg/L) | 17.7 (11.39–28.2) | 22.8 (17.45–33.04) a | 11.1 (8.36–15.26) b | 16.6 (9.45–19.03) b | <0.001 |
Vancomycin concentration at T final (mg/L) | 14.2 (8.7–20.9) | 20.26 ± 9.91 a | 11.32 ± 5.71 b | 10.6 ± 5.96 b | <0.001 |
% of reduction in 2 h | 26.6 ± 12.6 | 25.5 ± 12.5 | 25.3 ± 13.3 | 31.5 ± 11.8 | 0.36 |
% Total reduction | 45.7 ± 12.79 | 43.1 (33.2–49.8) a | 44.7 (32.9–57.9) ab | 57.7 (40.5–64.3) b | 0.03 |
AUC/MIC 24 h | 411.37 (326.64–580.17) | 504.2 (409.8–840.1) a | 410.65 (336.34–565.39) ab | 328.53 (302.36–372.39) b | 0.04 |
AUC/MIC during analysis | 138.0 (99.6–215.2) | 169.8 (112.5–235.3) | 103.0 (94.8–178.1) | 124.7 (92.8–185.1) | 0.13 |
Variables | General Population (n = 41) | AUC/MIC 24 h <400 (n = 19) | AUC/MIC 24 h >400 (n = 22) | p |
---|---|---|---|---|
Age (years) | 65.00 (56.50–72.50) | 65.00 (57.00–74.00) | 65.00 (53.75–72.25) | 0.724 |
Male sex (%) | 15 (63.41) | 14 (73.68) | 12 (54.54) | 0.345 |
Weight (kg) | 70.00 (60.50–82.50) | 71.00 (62.00–86.00) | 70.00 (54.25–74.25) | 0.36 |
APACHE II | 32.00 (26.00–36.00) | 32.47 ± 6.04 | 28.91 ± 7.79 | 0.114 |
LIANO | 0.77 (0.61–0.89) | 0.83 ± 0.72 | 0.75 ± 0.51 | 0.123 |
Noradrenaline (mcg/kg/min) | 0.33 (0.06–0.53) | 0.38 (0.20–0.57) | 0.15 (0.00–0.52) | 0.11 |
Urinary volume (ml/24 h) | 200.00 (40.00–425.00) | 100.00 (25.00–450.00) | 200.00 (45.00–500.00) | 0.591 |
Hematocrite (%) | 28.10 ± 3.87 | 27.39 ± 3.75 | 28.71 ± 3.95 | 0.281 |
PCR (mg/L) | 24.80 (6.60–33.65) | 25.78 ± 14.67 | 19.12 ± 14.30 | 0.15 |
Albumin (g/dL) | 2.18 ± 0.49 | 2.14 ± 0.51 | 2.23 ± 0.48 | 0.587 |
Conventional hemodialysis (%) | 16 (39.02) | 3 (15.79) | 13 (59.10) | 0.012 |
Prolonged hemodialysis 6 and 10 h (%) | 25 (60.98) | 16 (84.21) | 9 (40.90) | 0.012 |
Kt/V | 0.89 ± 0.33 | 0.90 ± 0.35 | 0.88 ± 0.31 | 0.814 |
Dose of Vancomycin (mg/kg/day) | 14.71 (12.69–19.37) | 14.71 (10.71–20.00) | 14.60 (13.29–17.86) | 0.734 |
Volume of distribution (L/Kg) | 0.67 (0.45–0.87) | 0.73 (0.61–1.34) | 0.56 (0.34–0.83) | 0.018 |
Half-life time | 19.67 (9.36–38.14) | 28.38 (17.51–79.69) | 11.22 (5.99–26.28) | 0.004 |
Vancomycin dialytic clearance(L/h) | 1.69 (1.03–3.05) | 1.19 (0.95–1.70) | 2.39 (1.15–3.55) | 0.017 |
Vancomycin concentration (mg/L) at T0 | 23.59 (14.92–33.87) | 14.96 (13.19–24.20) | 32.83 (21.47–37.95) | 0.001 |
% of reduction in 2 h | 26.52 ± 13.29 | 27.18 ± 12.23 | 25.94 ± 14.41 | 0.771 |
% Total reduction | 46.98 ± 13.05 | 50.56 ± 14.62 | 43.90 ± 10.95 | 0.104 |
AUC/MIC during dialysis | 120.44 (94.85–211.45) | 103.07 (87.35–169.25) | 172.43 (108.01–252.98) | 0.016 |
Death (%) | 30 (73.17) | 16 (84.21) | 14 (63.64) | 0.259 |
Variables | Odds Ratio | Confidence Interval | p |
---|---|---|---|
Prolonged hemodialysis | 11.59 | 1.219–110.171 | 0.033 |
Distribution volume (L/Kg) | 0.197 | 0.0123–3.153 | 0.251 |
Dialytic clearance of vancomycin (L/h) | 1.614 | 0.391–6.672 | 0.508 |
Serum concentration of vancomycin (mg/L) at T0 | 0.791 | 0.664–0.942 | 0.009 |
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Freitas, F.M.d.; Zamoner, W.; Reis, P.F.d.; Balbi, A.L.; Ponce, D. Vancomycin for Dialytic Therapy in Critically Ill Patients: Analysis of Its Reduction and the Factors Associated with Subtherapeutic Concentrations. Int. J. Environ. Res. Public Health 2020, 17, 6861. https://doi.org/10.3390/ijerph17186861
Freitas FMd, Zamoner W, Reis PFd, Balbi AL, Ponce D. Vancomycin for Dialytic Therapy in Critically Ill Patients: Analysis of Its Reduction and the Factors Associated with Subtherapeutic Concentrations. International Journal of Environmental Research and Public Health. 2020; 17(18):6861. https://doi.org/10.3390/ijerph17186861
Chicago/Turabian StyleFreitas, Fernanda Moreira de, Welder Zamoner, Pamela Falbo dos Reis, André Luís Balbi, and Daniela Ponce. 2020. "Vancomycin for Dialytic Therapy in Critically Ill Patients: Analysis of Its Reduction and the Factors Associated with Subtherapeutic Concentrations" International Journal of Environmental Research and Public Health 17, no. 18: 6861. https://doi.org/10.3390/ijerph17186861