Risk Factors for Acute Kidney Injury Induced by Intravenous Polymyxin B in Chinese Patients with Severe Infection

Figures & data

Table 1 The Baseline Characteristics of Patients and the Univariate Analysis of AKI- During Treatment Induced by Intravenous Polymyxin B

Related Indicators	Overall (n=321)	AKI (n=84)	Non-AKI (n=237)	P-value
Demographics
Age (years)	56.93 ± 15.33	59.79 ± 16.09	55.91 ± 14.96	0.046
Gender (male)	249 (77.6)	62 (73.8)	187 (78.9)	0.336
ICU admission	220 (68.5)	65 (77.4)	155 (65.4)	0.055
Hospitalization days	30 [18.0, 44.5]	27 [14.2, 44]	30 [19.5, 45.0]	0.320
Comorbidities
Diabetes	49 (15.3)	11 (13.1)	38 (16.0)	0.520
Hypertension	86 (26.8)	18 (21.4)	68 (28.7)	0.197
Transplantation history	24 (7.5)	8 (9.6)	16 (6.8)	0.390
Hypoproteinemia	130 (40.5)	38 (45.2)	92 (38.8)	0.303
Hematological malignant disease	35 (10.9)	11 (13.1)	24 (10.1)	0.453
Cancer	52 (16.2)	17 (20.2)	35 (14.8)	0.242
Surgery	163 (50.8)	40 (47.6)	123 (51.9)	0.500
Pulmonary diseases	179 (55.8)	53 (63.1)	126 (53.2)	0.115
Heart Diseases	112 (34.9)	24 (28.6)	88 (37.1)	0.157
Sepsis	122 (38.0)	34 (40.5)	88 (37.1)	0.587
Septic shock	123 (38.3)	41 (48.8)	82 (34.6)	0.021
Kidney injury before Polymyxin B	78 (24.3)	16 (19.0)	62 (26.2)	0.192
Concomitant fungal infection	134 (41.7)	43 (51.2)	91 (38.4)	0.041
Polymyxin B treatment
Duration days	7 [5,12]	7.5 [5.0, 13.75]	7.0 [5.0, 12.0]	0.964
Daily dose (WIU)	100 [100, 150]	100 [100, 150]	100 [100, 150]	0.664
Cumulative (Total) dose (WIU)	900 [600, 1512.5]	900 [600, 1537.5]	900 [600, 1512.5]	0.840
First loading dose	49 (15.3)	16 (19.0)	33 (13.9)	0.262
Concomitant drugs
Glucocorticoid	140 (43.6)	42 (50.0)	98 (41.4)	0.170
Tigecycline	162 (50.5)	48 (57.1)	114 (48.1)	0.154
β-lactam	145 (45.2)	36 (42.9)	109 (46.0)	0.620
Carbapenem	121 (37.7)	30 (35.7)	91 (38.4)	0.663
Fosfomycin	57 (17.8)	11 (13.1)	46 (19.4)	0.193
Vancomycin	35 (10.9)	15 (17.9)	20 (8.4)	0.017
Polymyxin B monotherapy	50 (15.6)	11 (13.1)	39 (16.5)	0.457
Aminoglycoside	35 (10.9)	9 (10.7)	26 (11.0)	0.004
Fluoroquinolone	55 (17.1)	15 (17.9)	40 (16.9)	0.042
Loop diuretics	96 (29.9)	32 (38.1)	64 (27.0)	0.056
Immunosuppressant	24 (7.5)	6 (7.1)	18 (7.6)	0.892
Iodine Contrast Agent	27 (8.4)	6 (7.1)	21 (8.9)	0.626
Outcome
Mortality	39 (12.1)	16 (19.0)	23 (9.7)	0.024

Note: Data are presented as n (%) mean ± SD, or median [IQR].

Table 2 Comparison Between AKI -During Treatment and AKI -End of Treatment by Intravenous Polymyxin B

Related Indicators	AKI -During Treatment (n=321)	AKI -End of Treatment (n=195)	P-value
Incidence of nephrotoxicity	84 (26.2)	49 (25.1)	0.793
Risk stage	33 (10.3)	16 (8.2)	0.444
Injury stage	41 (12.8)	23 (11.8)	0.835
Failure stage	10 (3.1)	10 (5.1)	0.186

Note: Data are presented as n (%).

Figure 1 Schematic diagram of the case-screening process.

Table 3 Multi-Factor Analysis of AKI- During Treatment Induced by Intravenous Polymyxin B

Risk Factor	Unadjusted OR (95% CI)	P-value	Adjusted OR (95% CI)	P-value
Septic shock	1.802 (1.088, 2.985)	0.022	1.972 (1.168, 3.330)	0.011
Concomitant Vancomycin	2.359 (1.146, 4.856)	0.020	2.585 (1.221, 5.471)	0.013
Concomitant Loop diuretics	1.633 (0.984, 2.813)	0.058	1.832 (1.055, 3.180)	0.031
Age (≥60 years)	1.655 (1.009, 2.748)	0.046	1.842 (1.091, 3.112)	0.022

Table 4 The Univariate Analysis of AKI- End of Treatment Induced by Intravenous Polymyxin B

Related Indicators	Overall (n=195)	AKI (n=49)	Nona-KI (n=146)	P-value
Demographics
Age (years)	57.22 ± 15.56	57.69 ± 18.00	57.05 ± 14.72	0.151
Gender (male)	155 (79.5)	42 (85.7)	113 (77.4)	0.212
ICU admission	121 (62.1)	35 (71.4)	86 (58.9)	0.118
Hospitalization days	35 [24, 51]	37 [23.5, 48.5]	34 [24, 51]	0.960
Comorbidities
Diabetes	37 (19.0)	7 (14.3)	30 (20.5)	0.333
Hypertension	52 (26.7)	10 (20.4)	42 (28.8)	0.252
Transplantation history	16 (8.2)	6 (12.2)	10 (6.8)	0.234
Hypoproteinemia	83 (42.6)	28 (57.1)	55 (37.7)	0.017
Hematological malignant disease	21 (10.8)	8 (16.3)	13 (8.9)	0.147
Cancer	32 (16.4)	11 (22.4)	21 (14.4)	0.187
Surgery	106 (54.4)	21 (42.9)	85 (58.2)	0.062
Pulmonary diseases	99 (50.8)	26 (53.1)	73 (50.0)	0.711
Heart Diseases	57 (29.2)	17 (34.7)	40 (27.4)	0.331
Sepsis	70 (35.9)	23 (46.9)	47 (32.2)	0.063
Septic shock	65 (33.3)	17 (34.7)	48 (32.9)	0.815
Kidney injury before Polymyxin B	41 (21.0)	9 (18.4)	32 (21.9)	0.598
Concomitant fungal infection	91 (46.7)	22 (44.9)	69 (47.3)	0.774
Polymyxin B treatment
Duration days	8 [5,12]	7 [6, 12.5]	8 [5, 12.25]	0.939
Daily dose (WIU)	100 [100, 150]	100 [100, 150]	100 [100, 150]	0.239
Cumulative (Total) dose (WIU)	900 [600, 1650]	800 [600, 1575]	900 [600, 1662.5]	0.532
First loading dose	171 (87.7)	41 (83.7)	130 (89.0)	0.322
Concomitant drugs
Glucocorticoid	77 (39.5)	22 (44.9)	55 (37.7)	0.371
Tigecycline	110 (56.4)	33 (67.3)	77 (52.7)	0.074
β-lactam	92 (47.2)	19 (38.8)	73 (50.0)	0.173
Carbapenem	81 (41.5)	18 (36.7)	63 (43.2)	0.430
Fosfomycin	38 (19.5)	7 (14.3)	31 (21.2)	0.288
Fluoroquinolone	23 (11.8)	5 (10.2)	18 (12.3)	0.690
Polymyxin B monotherapy	27 (13.8)	3 (6.1)	24 (16.4)	0.070
Aminoglycoside	26 (13.3)	5 (10.2)	21 (14.4)	0.456
Vancomycin	29 (14.9)	7 (14.3)	22 (15.1)	0.894
Loop diuretics	49 (25.1)	16 (32.7)	33 (22.6)	0.160
Immunosuppressant	13 (6.7)	5 (10.2)	8 (5.5)	0.251
Iodine Contrast Agent	18 (9.2)	4 (8.2)	14 (9.6)	0.765
AKI during treatment	44 (22.6)	32 (65.3)	12 (8.2)	<0.001
Outcome
Mortality	24(12.3)	13 (26.5)	11 (7.5)	<0.001

Table 5 Multi-Factor Analysis of AKI- End of Treatment Induced by Intravenous Polymyxin B

Risk Factor	Unadjusted OR (95% CI)	P-value	Adjusted OR (95% CI)	P-value
Hypoproteinemia	2.206 (1.143, 4.257)	0.018	1.774 (0.747, 4.214)	0.194
Sepsis	1.863 (0.963, 3.604)	0.064	1.705 (0.713, 4.077)	0.230
Concomitant Tigecycline	1.848 (0.937, 3.647)	0.077	1.345 (0.574, 3.150)	0.495
AKI during treatment	21.021 (9.133, 48.376)	<0.001	20.760 (8.791, 49.028)	<0.001