PDF(Pubmed)
Abstract：
This study conducted a quantitative meta-analysis to investigate the association of vancomycin indicators, particularly area under the curve over 24 h (AUC24) and trough concentrations (Ctrough), and their relationship with both nephrotoxicity and efficacy. Literature research was performed in PubMed and Web of Science on vancomycin nephrotoxicity and efficacy in adult inpatients. Vancomycin Ctrough, AUC24, AUC24/minimum inhibitory concentration (MIC), nephrotoxicity evaluation and treatment outcomes were extracted. Logistic regression and Emax models were conducted, stratified by evaluation criterion for nephrotoxicity and primary outcomes for efficacy. Among 100 publications on nephrotoxicity, 29 focused on AUC24 and 97 on Ctrough, while of 74 publications on efficacy, 27 reported AUC24/MIC and 68 reported Ctrough. The logistic regression analysis indicated a significant association between nephrotoxicity and vancomycin Ctrough (odds ratio = 2.193; 95% CI 1.582-3.442, p < 0.001). The receiver operating characteristic curve had an area of 0.90, with a cut-off point of 14.55 mg/L. Additionally, 92.3% of the groups with a mean AUC24 within 400-600 mg·h/L showed a mean Ctrough of 10-20 mg/L. However, a subtle, non-statistically significant association was observed between the AUC24 and nephrotoxicity, as well as between AUC24/MIC and Ctrough concerning treatment outcomes. Our findings suggest that monitoring vancomycin Ctrough remains a beneficial and valuable approach to proactively identifying patients at risk of nephrotoxicity, particularly when Ctrough exceeds 15 mg/L. Ctrough can serve as a surrogate for AUC24 to some extent. However, no definitive cut-off values were identified for AUC24 concerning nephrotoxicity or for Ctrough and AUC24/MIC regarding efficacy.
摘要：
这项研究进行了定量荟萃分析，以探讨万古霉素指标的相关性，特别是24小时曲线下面积(AUC24)和谷浓度(Ctoor)，以及它们与肾毒性和疗效的关系。在PubMed和WebofScience中进行了关于成人住院患者万古霉素肾毒性和疗效的文献研究。万古霉素Ctrugh,AUC24，AUC24/最小抑制浓度（MIC），提取肾毒性评估和治疗结果.进行Logistic回归和Emax模型，根据肾毒性评估标准和疗效的主要结局进行分层。在100篇关于肾毒性的出版物中，29专注于AUC24和97专注于C槽，在74篇关于功效的出版物中，27报道了AUC24/MIC,68报道了Ctrough。logistic回归分析显示肾毒性与万古霉素Ctrugh之间存在显著关联(比值比=2.193;95%CI1.582-3.442,p<0.001)。受试者工作特性曲线的面积为0.90，截止点为14.55mg/L。此外,92.3％的平均AUC24在400-600mg·h/L内的组显示平均Ctugh为10-20mg/L。然而,一个微妙的，在AUC24和肾毒性之间观察到无统计学意义的关联，以及AUC24/MIC和Ctrugh之间关于治疗结果的关系。我们的研究结果表明，监测万古霉素Ctrugh仍然是一种有益且有价值的方法，可以主动识别有肾毒性风险的患者。特别是当Cfoot超过15mg/L时Ctoor在某种程度上可以作为AUC24的替代品。然而,对于与肾毒性有关的AUC24或与疗效有关的Cfootal和AUC24/MIC,未确定明确的临界值.
