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      Derivation and Validation of a Risk Prediction Model for Vancomycin-Associated Acute Kidney Injury in Chinese Population

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          Vancomycin is the standard therapy for methicillin-resistant Staphylococcus aureus (MRSA) infection; however, nephrotoxicity happened with a high incidence of 15%~40%. Weighting the risk before receiving vancomycin treatment facilitates timely prevention of nephrotoxicity, but no standardized strategy exists for this purpose.


          A retrospective cohort study was performed. A total of 524 hospitalized patients treated with vancomycin were included in this study. They were divided into derivation cohort (n=341) and externally validation cohort (n=183) according to their admission time. Using univariate and multivariable logistic regression, we identified potential predictors of vancomycin-associated acute kidney injury (AKI) and developed a risk score by plotting nomogram. The predictive performance of this novel risk score was assessed and validated by discrimination and calibration. Besides, the risk score was also compared with existing prediction models according to integrated discrimination index (IDI) and net reclassification index (NRI).


          The incidence of AKI was 16.1% (55/341) in the derivation cohort and 16.4% (30/183) in the validation cohort. Three factors (vancomycin serum trough concentration, piperacillin/tazobactam and furosemide) were determined as predictors for vancomycin-associated AKI. The established three-item risk score showed a comparable discrimination in both derivation cohort (AUC=0.793, 95% CI: 0.732–0.855) and validation cohort (AUC=0.788, 95% CI: 0.698–0.877). The risk score also demonstrated a good calibration in the derivation cohort ( χ 2=6.079, P=0.638>0.05) and validation cohort (χ 2=5.665, P=0.686>0.05). Compared with prediction by C min alone, this risk score significantly improved reclassification accuracy (IDI=0.050, 95% CI: 0.024–0.076, P<0.001, NRI=0.166, 95% CI: 0.044–0.289, P=0.007).


          The established model in this study is a simplified three-item risk score, which provides a robust tool for the prediction of AKI after receiving vancomycin treatment.

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          Most cited references 22

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          Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials

          Dual antiplatelet therapy (DAPT) with aspirin plus a P2Y12 inhibitor prevents ischaemic events after coronary stenting, but increases bleeding. Guidelines support weighting bleeding risk before the selection of treatment duration, but no standardised tool exists for this purpose.
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            Vancomycin-induced nephrotoxicity: mechanism, incidence, risk factors and special populations. A literature review.

            Treatment failures following vancomycin therapy in patients with methicillin-resistant Staphylococcus aureus infections have led to the utilization of higher doses of this antibiotic to achieve the trough concentrations of 10-20 μg/mL recommended by the Infectious Diseases Society of America clinical practice guideline. However, many questions remain on the safety of such high doses of vancomycin, specifically their nephrotoxic effects. In this review, we have collected available evidence on the nephrotoxicity of vancomycin, particularly in terms of its mechanism, incidence, predisposing factors and special target populations. The data were collected by searching Scopus, PubMed, Medline, and Cochrane database systematic reviews. The key words used as search terms were "vancomycin", "nephrotoxicity", "renal failure", "renal damage", "risk factors", "infants", "children", "adult", "elderly" and "pregnancy". We have included all relevant animal and human studies up to the date of publication. Vancomycin-induced renal toxicity was reported in 10-20 % and 30-40 % of patients following conventional and high doses of vancomycin therapy, respectively .The most probable mechanism for its nephrotoxicity can be at least partially attributable to an increased production of reactive oxygen species and oxidative stress. There are a number of different risk factors which could accelerate or potentiate the occurrence of vancomycin-induced nephrotoxicity, with the most documented risk factors being high trough vancomycin level (especially >20 mg/L) or doses (>4 g/day), concomitant treatment with nephrotoxic agents, prolonged therapy (even more than 7 days), and admittance to an intensive care unit (especially prolonged stay). It is necessary to carry out more studies, especially those focused on the association between nephrotoxicity and high trough levels of vancomycin.
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              Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment

              Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most common complication in adult patients undergoing open heart surgery. In this Review, the authors discuss the definition, epidemiology, pathophysiology and risk factors of CSA-AKI. The authors also explore the use of novel biomarkers of AKI and their potential utility in preventing or treating CSA-AKI.

                Author and article information

                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                22 June 2020
                : 16
                : 539-550
                [1 ]Research Center of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine , Hangzhou, Zhejiang, People’s Republic of China
                [2 ]Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine , Hangzhou, Zhejiang, People’s Republic of China
                Author notes
                Correspondence: Yunliang Zheng The First Affiliated Hospital, Zhejiang University School of Medicine , 79# Qingchun Road, Hangzhou, Zhejiang310003, People’s Republic of China Email ylzheng1984@zju.edu.cn
                © 2020 Xu et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 5, Tables: 3, References: 29, Pages: 12
                Funded by: Medical Health Science and Technology Project of Zhejiang Provincial Health Commission
                Funded by: Zhejiang Provincial Natural Science Foundation of China
                Funded by: National Natural Science Foundation of China 10.13039/501100001809
                This study was supported by Medical Health Science and Technology Project of Zhejiang Provincial Health Commission [2019RC034], Zhejiang Provincial Natural Science Foundation of China [LY19H280011] and National Natural Science Foundation of China [81703615].
                Original Research


                prediction model, vancomycin, acute kidney injury


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