Analysis of influencing factors and prediction models of vancomycin AUC0-24 h in postoperative orthopedic patients

Published on Feb. 08, 2024Total Views: 806 times Total Downloads: 419 times Download Mobile

Author: YANG Hao ^1, ² XIONG Xiong ³ LIU Changjiang ^1, ²  JIN Xiaoyue ^1, ²

Affiliation: 1. Department of Pharmacy, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830001, China 2. Department of Pharmacy, The Sixth Clinical College of Xinjiang Medical University, Urumqi 830001, China 3. School of Pharmacy, Xinjiang Medical University, Urumqi 830017, China

Keywords: Postoperative orthopedic surgery Vancomycin Area under curve for 24 h Predictive modeling

DOI: 10.12173/j.issn.1008-049X.202311261

Reference: YANG Hao, XIONG Xiong, LIU Changjiang, JIN Xiaoyue.Analysis of influencing factors and prediction models of vancomycin AUC0-24 hin postoperative orthopedic patients[J].Zhongguo Yaoshi Zazhi,2024, 27(1):66-75.DOI: 10.12173/j.issn.1008-049X.202311261.[Article in Chinese]  Copied

Abstract
Full-text
References

Abstract

Objective To investigate the influencing factors of vancomycin in the area under curve for 24 h (AUC_{0-24 h}) in patients after orthopedic surgery, and to predictive and analyze a good pharmacokinetic model for AUC_{0-24 h}.

Methods Patients who underwent orthopedic surgery and used vancomycin in The Sixth Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2022 were included, and the basic information, the medication, the blood and biochemical indexes of the patients were collected to analyze the factors affecting postoperative vancomycin AUC_{0-24 h} in orthopedic surgery. The AUC_{0- 24 h} was calculated using the first-level pharmacokinetic formula, the JavaPK® for Desktop (JPKD) and the vancomycin daily dose elimination rate formula.

Results 91 patients were finally included, and the cystatin C (OR=189.168, P=0.005) and the single dose (OR=19.160, P<0.001) were independent protective factors for vancomycin AUC_{0-24 h} in postoperative orthopedic patients, and the retinol binding protein was an independent risk factor for vancomycin AUC_{0-24 h} (OR=0.910, P<0.05). By predicting and analyzing the model of vancomycin AUC_{0-24 h} in postoperative orthopedic patients, the absolute percentage error of both JPKD software and vancomycin daily dose elimination rate formula were lower than 30%. The intraclass correlation efficient between the AUC_{0-24 h} of the JPKD software and vancomycin daily dose elimination rate formula, and the AUC_{0-24 h} of the first-level pharmacokinetic formula were 0.781 and 0.524, respectively.

Conclusion Cystatin C is an important factor influencing vancomycin AUC_{0- 24 h} in postoperative orthopedic patients, and JPKD software is more suitable for predicting vancomycin AUC_{0-24 h} after orthopedic surgery than the vancomycin daily dose elimination rate formula method.

Full-text

Please download the PDF version to read the full text: download

References

1.Landersdorfer CB, Lee WL, Nation RL, et al. Penetration of vancomycin into noninfected bone in patients undergoing total joint arthroplasty evaluated by a minimal physiologically based population pharmacokinetic modeling approach[J]. Mol pharm, 2023, 20(3): 1509-1518. DOI: 10.1021/acs.molpharmaceut.2c00724.

2.Liu C, Yan S, Wang Y, et al. Drug-induced hospital-acquired acute kidney injury in China: a multicenter cross-sectional survey[J]. Kidney Dis, 2021, 7(2): 143-155. DOI: 10.1159/000510455.

3.Monteiro JF, Hahn SR, GonÇAlves J, et al. Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations[J]. Pharmacol Res perspect, 2018, 6(4): e00420. DOI: 10.1002/prp2.420.

4.Pham JT. Challenges of vancomycin dosing and therapeutic monitoring in neonates[J]. J Pediatr Pharmacol Ther, 2020, 25(6): 476-484. DOI: 10.5863/1551-6776-25.6.476.

5.He N, Su S, Ye Z, et al. Evidence-based guideline for therapeutic drug monitoring of vancomycin: 2020 update by the division of therapeutic drug monitoring, chinese pharmacological society[J]. Clin Infect Dis, 2020, 71(Suppl 4): S363-S371. DOI: 10.1093/cid/ciaa1536.

6.何娜, 苏珊, 翟所迪, 等. 《中国万古霉素治疗药物监测指南(2020更新版)》解读[J]. 临床药物治疗杂志, 2021, 19(1): 12-16. [He N, Su S, Zhai SD, et al. Evidence-based guideline for therapeutic drug monitoring of Vancomycin: 2020 update[J]. Clinical Medication Journal, 2021, 19(1): 12-16.] DOI: 10.3969/j.issn.1672-3384.2021.01.003.

7.Brown DL, Masselink AJ, Lalla CD. Functional range of creatinine clearance for renal drug dosing: a practical solution to the controversy of which weight to use in the Cockcroft-Gault equation[J]. Ann pharmacother, 2013, 47(7-8): 1039-1044. DOI: 10.1345/aph.1S176.

8.Winter MA, Guhr KN, Berg GM. Impact of various body weights and serum creatinine concentrations on the bias and accuracy of the Cockcroft-Gault equation[J]. Pharmacotherapy, 2012, 32(7): 604-612. DOI: 10.1002/j.1875-9114.2012.01098.x.

9.梁虹艺, 万宁, 叶嘉盛, 等. 基于PSM法的真实世界中国产与原研注射用盐酸万古霉素疗效和安全性一致性评价的队列研究[J]. 中国医院药学杂志, 2019, 39(17): 1751-1754. [Liang HY, Wan N, Ye JS, et al. Cohort study on the efficacy and safety of domestic and original vancomycin hydrochloride for injection in real-world based on PSM method[J]. Chin J Hosp Pharm, 2019, 39(17): 1751-1754.] DOI: 10.13286/j.cnki.chinhosppharmacyj.2019.17.08.

10.熊文艺. 万古霉素药代/药效动力学参数在儿童重症感染中的临床应用价值[D]. 重庆医科大学, 2021.

11.李燕, 王学彬, 陈礼治, 等. 万古霉素血药浓度与临床疗效及急性肾损伤的关系[J]. 第二军医大学学报, 2021, 42(3): 281-286. [LI Y, Wang XB, Chen LZ, ,et al. Association of blood vancomycin level with its clinical efficacy with acute kidney injury[J]. Former Academic Journal of Second Military Medical University, 2021, 42(3): 281-286.] DOI: 10.16781/j.0258-879x.2021.03.0281.

12.Pai MP, Neely M, Rodvold KA, et al. Innovative approaches to optimizing the delivery of vancomycin in individual patients[J]. Adv Drug Deliv Rev, 2014, 77: 50-57. DOI: 10.1016/j.addr.2014.05.016.

13.Moise-Broder PA, Forrest A, Birmingham MC, et al. Pharmacodynamics of vancomycin and other antimicrobials in patients with Staphylococcus aureus lower respiratory tract infections[J]. Clin Pharmacokinet, 2004, 43(13):925-942. DOI: 10.2165/00003088-200443130-00005.

14.Han L, Xu F, Zhang X, et al. Predictive performance of Smart Dose, PharmVan and JPKD on vancomycin plasma concentration[J]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2021, 33(3): 263-268. DOI: 10.3760/cma.j.cn121430-20201016-00674.

15.李学川, 杨惠忠, 冯晓敏, 等.万古霉素个体化给药辅助决策系统在烧伤患者中的应用[J]. 中国药师, 2022, 25(10): 1758-1762. [Li XC, Yang HZ, Feng XM, et al, Application of individualized dosage auxiliary system for vancomycin to burn patients[J]. China Pharmacist, 2022, 25(10): 1758-1762.] DOI: 10.19962/j.cnki.issn1008-049X.2022.10.012.

16.陈霁晖, 黄晓会, 李莉霞, 等. 回顾性比较药代动力学方程法和SmartDose软件估算重症感染患儿万古霉素浓度时间曲线下面积的差别[J]. 中国药师, 2022, 25(5): 856-860. [Chen JH, Huang XH, Li LX, et al. Comparison of the difference in estimating vancomycin area under curve in critically Ill cllildren between pharmacokinetic equation method and smart dose software：a retrospective study[J]. China Pharmacist, 2022, 25(5): 856-860.] DOI: 10.19962/j.cnki.issn1008-049X.2022.05.31.

17.谢松梅, 赵明, 杨进波, 等. 我国抗菌药物临床疗效评价标准的思考与确定[J]. 中国临床药理学杂志, 2008, (5): 466-468. [Xie SM, Zhao M, Yang JB, et al. Considerations and determination on the evaluation criterion for clinical efficacy of antibacterial agents in China[J]. Chin J Clin Pharmacol, 2008, (5): 466-468.] DOI: 10.3969/j.issn.1001-6821.2008.05.022.

18.Li DY, Li L, Li GZ, et al. Population pharmacokinetics modeling of vancomycin among Chinese infants with normal and augmented renal function[J]. Front pediatr, 2021, 9: 713588. DOI: 10.3389/fped.2021.713588.

19.Leroux S, Biran V, Van Den Anker J, et al. Serum creatinine and serum cystatin C are both relevant renal markers to estimate vancomycin clearance in critically Ill neonates[J]. Front pharmacol, 2021, 12: 634686. DOI: 10.3389/fphar.2021.634686.

20.Zhang R, Chen M, Liu TT, et al. Comparison of the predictive performance between cystatin C and serum creatinine by vancomycin via a population pharmacokinetic models: a prospective study in a Chinese population[J]. Eur J Drug Metab pharmacokinet, 2020, 45(1): 135-149. DOI: 10.1007/s13318-019-00578-4.

21.Chung JY, Jin SJ, Yoon JH, et al. Serum cystatin C is a major predictor of vancomycin clearance in a population pharmacokinetic analysis of patients with normal serum creatinine concentrations[J]. J Korean Med Sci, 2013, 28(1): 48-54. DOI: 10.3346/jkms.2013.28.1.48.

22.Yahav D, Abbas M, Nassar L, et al. Attention to age: similar dosing regimens lead to different vancomycin levels among older and younger patients[J]. Age Ageing, 2019, 49(1): 26-31. DOI: 10.1093/ageing/afz135.

23.Wang Y, Dai N, Wei W, et al. Outcomes and nephrotoxicity associated with vancomycin treatment in patients 80 years and older[J]. Clin Interv Aging, 2021, 16: 1023-1035. DOI: 10.2147/CIA.S308878.

24.Drennan PG, Begg EJ, Gardiner SJ, et al. The dosing and monitoring of vancomycin: What is the best way forward？ [J]. Int J Antimicrob Agents, 2019, 53(4): 401-407. DOI: 10.1016/j.ijantimicag.2018.12.014.