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

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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

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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.

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