A Risk Prediction Flowchart of Vancomycin-Induced Acute Kidney Injury to Use When Starting Vancomycin Administration: A Multicenter Retrospective Study
We previously constructed a risk prediction model of vancomycin (VCM)-associated nephrotoxicity for use when performing initial therapeutic drug monitoring (TDM), using decision tree analysis. However, we could not build a model to be used at the time of initial administration due to insufficient sa...
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| Veröffentlicht in: | Antibiotics (Basel) 2020-12, Vol.9 (12), p.920, Article 920 |
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| creator | Miyai, Takayuki Imai, Shungo Kashiwagi, Hitoshi Sato, Yuki Kadomura, Shota Yoshida, Kenji Yoshimura, Eri Teraya, Toshiaki Tsujimoto, Takashi Kawamoto, Yukari Itoh, Tatsuya Ueno, Hidefumi Goto, Yoshikazu Takekuma, Yoh Sugawara, Mitsuru |
| description | We previously constructed a risk prediction model of vancomycin (VCM)-associated nephrotoxicity for use when performing initial therapeutic drug monitoring (TDM), using decision tree analysis. However, we could not build a model to be used at the time of initial administration due to insufficient sample size. Therefore, we performed a multicenter study at four hospitals in Japan. We investigated patients who received VCM intravenously at a standard dose from the first day until the initial TDM from November 2011 to March 2019. Acute kidney injury (AKI) was defined according to the criteria established by the "Kidney disease: Improving global outcomes" group. We extracted potential risk factors that could be evaluated on the day of initial administration and constructed a flowchart using a chi-squared automatic interaction detection algorithm. Among 843 patients, 115 (13.6%) developed AKI. The flowchart comprised three splitting variables (concomitant drugs (vasopressor drugs and tazobactam/piperacillin) and body mass index >= 30) and four subgroups. The incidence rates of AKI ranged from 9.34 to 36.8%, and they were classified as low-, intermediate-, and high-risk groups. The accuracy of flowchart was judged appropriate (86.4%). We successfully constructed a simple flowchart predicting VCM-induced AKI to be used when starting VCM administration. |
| doi_str_mv | 10.3390/antibiotics9120920 |
| format | Article |
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However, we could not build a model to be used at the time of initial administration due to insufficient sample size. Therefore, we performed a multicenter study at four hospitals in Japan. We investigated patients who received VCM intravenously at a standard dose from the first day until the initial TDM from November 2011 to March 2019. Acute kidney injury (AKI) was defined according to the criteria established by the "Kidney disease: Improving global outcomes" group. We extracted potential risk factors that could be evaluated on the day of initial administration and constructed a flowchart using a chi-squared automatic interaction detection algorithm. Among 843 patients, 115 (13.6%) developed AKI. The flowchart comprised three splitting variables (concomitant drugs (vasopressor drugs and tazobactam/piperacillin) and body mass index >= 30) and four subgroups. The incidence rates of AKI ranged from 9.34 to 36.8%, and they were classified as low-, intermediate-, and high-risk groups. The accuracy of flowchart was judged appropriate (86.4%). We successfully constructed a simple flowchart predicting VCM-induced AKI to be used when starting VCM administration.</description><identifier>ISSN: 2079-6382</identifier><identifier>EISSN: 2079-6382</identifier><identifier>DOI: 10.3390/antibiotics9120920</identifier><identifier>PMID: 33352848</identifier><language>eng</language><publisher>BASEL: Mdpi</publisher><subject>acute kidney injury ; Algorithms ; Body mass ; Body mass index ; Body size ; Cardiovascular disease ; Creatinine ; Decision analysis ; decision tree analysis ; Decision trees ; Drug dosages ; Drugs ; Flow charts ; Infectious Diseases ; Kidney diseases ; Kidneys ; Life Sciences & Biomedicine ; Patients ; Pharmacists ; Pharmacology & Pharmacy ; Piperacillin ; Prediction models ; Regression analysis ; Risk analysis ; Risk factors ; Risk groups ; Science & Technology ; Staphylococcus infections ; Subgroups ; Tazobactam ; therapeutic drug monitoring ; Vancomycin ; Variables</subject><ispartof>Antibiotics (Basel), 2020-12, Vol.9 (12), p.920, Article 920</ispartof><rights>2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). 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The accuracy of flowchart was judged appropriate (86.4%). We successfully constructed a simple flowchart predicting VCM-induced AKI to be used when starting VCM administration.</description><subject>acute kidney injury</subject><subject>Algorithms</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Cardiovascular disease</subject><subject>Creatinine</subject><subject>Decision analysis</subject><subject>decision tree analysis</subject><subject>Decision trees</subject><subject>Drug dosages</subject><subject>Drugs</subject><subject>Flow charts</subject><subject>Infectious Diseases</subject><subject>Kidney diseases</subject><subject>Kidneys</subject><subject>Life Sciences & Biomedicine</subject><subject>Patients</subject><subject>Pharmacists</subject><subject>Pharmacology & Pharmacy</subject><subject>Piperacillin</subject><subject>Prediction models</subject><subject>Regression analysis</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Risk 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Multicenter Retrospective Study</atitle><jtitle>Antibiotics (Basel)</jtitle><stitle>ANTIBIOTICS-BASEL</stitle><addtitle>Antibiotics (Basel)</addtitle><date>2020-12-18</date><risdate>2020</risdate><volume>9</volume><issue>12</issue><spage>920</spage><pages>920-</pages><artnum>920</artnum><issn>2079-6382</issn><eissn>2079-6382</eissn><abstract>We previously constructed a risk prediction model of vancomycin (VCM)-associated nephrotoxicity for use when performing initial therapeutic drug monitoring (TDM), using decision tree analysis. However, we could not build a model to be used at the time of initial administration due to insufficient sample size. Therefore, we performed a multicenter study at four hospitals in Japan. We investigated patients who received VCM intravenously at a standard dose from the first day until the initial TDM from November 2011 to March 2019. Acute kidney injury (AKI) was defined according to the criteria established by the "Kidney disease: Improving global outcomes" group. We extracted potential risk factors that could be evaluated on the day of initial administration and constructed a flowchart using a chi-squared automatic interaction detection algorithm. Among 843 patients, 115 (13.6%) developed AKI. The flowchart comprised three splitting variables (concomitant drugs (vasopressor drugs and tazobactam/piperacillin) and body mass index >= 30) and four subgroups. The incidence rates of AKI ranged from 9.34 to 36.8%, and they were classified as low-, intermediate-, and high-risk groups. The accuracy of flowchart was judged appropriate (86.4%). We successfully constructed a simple flowchart predicting VCM-induced AKI to be used when starting VCM administration.</abstract><cop>BASEL</cop><pub>Mdpi</pub><pmid>33352848</pmid><doi>10.3390/antibiotics9120920</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0001-6385-9988</orcidid><orcidid>https://orcid.org/0000-0002-4325-0785</orcidid><orcidid>https://orcid.org/0000-0001-5706-613X</orcidid><orcidid>https://orcid.org/0000-0001-5350-2950</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | acute kidney injury Algorithms Body mass Body mass index Body size Cardiovascular disease Creatinine Decision analysis decision tree analysis Decision trees Drug dosages Drugs Flow charts Infectious Diseases Kidney diseases Kidneys Life Sciences & Biomedicine Patients Pharmacists Pharmacology & Pharmacy Piperacillin Prediction models Regression analysis Risk analysis Risk factors Risk groups Science & Technology Staphylococcus infections Subgroups Tazobactam therapeutic drug monitoring Vancomycin Variables |
| title | A Risk Prediction Flowchart of Vancomycin-Induced Acute Kidney Injury to Use When Starting Vancomycin Administration: A Multicenter Retrospective Study |
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