Analysis of Risk Factors Associated with Reduced Trough Concentrations of Vancomycin in Relation to Renal Function in a Tertiary Hospital in Japan

Figures & data

Figure 1 Flowchart of the study population.

Table 1 Background Characteristics of Patients with Normal Kidney Function, ie, with an eGFR of ≧60 mL/min/1.73 m²

	eGFR≧60mL/min/1.73m^2
	Lower Trough Group (n=47)	Appropriate Trough Group (n=54)	P value
Backgrounds
Gender (Male)	28	41	0.09^a
Age (years, Median)	78.0 (63–81)	70.0 (63–77)	0.047^b
Height (cm)	158.6 ± 10.4	163.3 ± 9.4	0.02^c
Weight (kg)	53.5 ± 12.7	55.9 ± 11.9	0.33^c
Body surface area (m^2)	1.53 ± 0.21	1.59 ± 0.18	0.11^c
BMI	20.6 (19.0–22.8)	20.5 (18.1–24.1)	0.88^b
Solid tumor	13	22	0.21^a
Hematological malignancy	8	2	0.04^a
Heart failure	8	15	0.24^a
Temperature (°C)	38.3 (37.2–39.0)	37.8 (36.9–38.6)	0.19^b
Laboratory data
BUN (mg/dL)	14.0 (11.0–18.5)	17.0 (13.3–19.0)	0.18^b
Scr (mg/dL)	0.63 ± 0.15	0.69 ± 0.18	0.07^c
eGFR (mL/min/1.73m^2)	82.0 (73.0–95.0)	76.9 (64.6–85.2)	0.42^b
eGFR (mL/min)	69.6 (62.7–88.6)	74.4 (64.6–85.7)	0.44^b
CLcr (mL/min)	69.9 (55.2–94.8)	76.5 (60.8–100.5)	0.30^b
WBC (/μL)	9700 (5400–13,550)	7850 (5450–10,625)	0.43^b
CRP (mg/dL)	9.88 (5.45–15.49)	6.25 (2.77–10.59)	0.02^b
Alb (g/dL)	2.69 ± 0.58	2.56 ± 0.60	0.27^c)
BNP (pg/mL)	61.6 (21.7–197.2)	134.1 (52.9–367.6)	0.07^b
Treatments
Loading use	18	13	0.14^a
VCM use until first measure (times)	5 (4.0–6.5)	5 (4.3–6.0)	0.54^b
Estimated trough value (μg/mL)	11.1 ± 4.4	13.4 ± 3.3	<0.01^c
Practical trough value (μg/mL)	7.2 ± 2.1	12.9 ± 2.3	<0.01^c
Transfusion (L)	3.5 (2.4–5.1)	2.9 (1.1–4.1)	0.056^b
Diuretic use	10	18	0.19^a
Catecholamine use	2	3	1^a
Operation within 48 hours	4	4	1^a
Within 14 days	9	8	0.60^a
Within 30 days	11	11	0.81^a

Notes: ^aFisher’s exact test, ^bMann–Whitney U-test, ^cStudent‘s t-test: mean ± SD.

Abbreviations: BMI, body mass index; BUN, blood urea nitrogen; Scr, serum creatinine; eGFR, estimated glomerular filtration rate; CLcr, creatinine clearance; WBC, white blood cell; CRP, C-reactive protein; Alb, albumin; BNP, brain natriuretic peptide; VCM, vancomycin, respectively.

Table 2 Background Characteristics of Patients with Decreased Renal Function, ie, an eGFR of <60 mL/min/1.73 m²

	eGFR<60mL/min/1.73m^2
	Lower Trough Group (n=20)	Appropriate Trough Group (n=25)	P value
Backgrounds
Gender (Female)	14	14	0.37^a
Age (years, Median)	75.3 ± 7.9	75.1 ± 10.3	0.95^c
Height (cm)	158.7 ± 9.2	157.1 ± 8.6	0.54^c
Weight (kg)	59.6 ± 13.8	57.4 ± 14.8	0.61^c
Body surface area (m^2)	1.60 ± 0.22	1.56 ± 0.20	0.51^c
BMI	23.4 ± 3.8	23.2 ± 5.5	0.87^c
Solid Tumor	7	5	0.32^a
Hematological malignancy	1	4	0.36^a
Heart failure	5	13	0.08^a
Temperature (°C)	37.7 (37.2–39.3)	37.6 (37.2–38.2)	0.41^b
Laboratory data
BUN (mg/dL)	22.5 (16.8–26.8)	25.0 (21.0–55.0)	0.16^b
Scr (mg/dL)	1.15 (0.97–1.28)	1.19 (1.03–1.59)	0.34^b
eGFR (mL/min/1.73m^2)	46.5 (39.3–50.3)	45.0 (30.0–50.0)	0.21^b
eGFR (mL/min)	41.8 ± 9.6	36.6 ± 12.0	0.13^c
CLcr (mL/min)	44.8 (38.1–48.8)	43.1 (25.4–46.4)	0.31^b
WBC (/μL)	10,150 (6325–11,525)	11,300 (5900–16,300)	0.88^b
CRP (mg/dL)	11.5 (5.1–22.3)	7.3 (2.2–14.0)	0.01^b
Alb (g/dL)	2.61 ± 0.63	2.62 ± 0.60	0.97^c
BNP (pg/mL)	76.7 (38.3–136.2)	198.2 (96.5–492.1)	0.02^b
Treatments
Loading use	5	13	0.07^a
VCM use until first measure (times)	4 (4.0–4.3)	4 (4.0–5.0)	0.46^b
Estimated trough value (μg/mL)	12.4 (11.4–13.3)	15.1 (13.2–17.1)	<0.01^b
Practical trough value (μg/mL)	6.34 ± 2.0	13.3 ± 2.4	<0.01^c
Transfusion (L)	3.36 ± 2.15	3.00 ± 1.80	0.49^c
Diuretic use	7	12	0.55^a
Catecholamine use	1	0	0.44^a
Operation within 48 hours	2	1	0.58^a
Within 14 days	7	6	0.52^a
Within 30 days	8	8	0.76^a

Notes: ^aFisher’s exact test, ^bMann–Whitney U-test, ^cStudent‘s t-test: mean ± SD.

Abbreviations: BMI, body mass index; BUN, blood urea nitrogen; Scr, serum creatinine; eGFR, estimated glomerular filtration rate; CLcr, creatinine clearance; WBC, white blood cell; CRP, C-reactive protein; Alb, albumin; BNP, brain natriuretic peptide; VCM, vancomycin, respectively.

Table 3 Multivariate Analysis of Factors Affecting Lower Trough Values of Vancomycin in Patients with eGFR ≧60 mL/min/1.73 m²

	Adjusted Odds Ratio	95% CI	P value
Age	0.99	0.963–1.030	0.75
eGFR (mL/min/1.73m^2)	0.99	0.987–1.010	0.88
CRP (mg/dL)	0.938	0.886–0.994	0.03
Total dose of VCM (mg/kg)	1.07	1.020–1.130	<0.02

Abbreviations: eGFR, estimated glomerular filtration rate; CRP, C-reactive protein; VCM, vancomycin, respectively.