Incidence Evaluation of Acute Kidney Injury and Pharmacoeconomic Analysis Among Critically Ill Patients With Use of Antipseudomonal β-Lactams and Vancomycin

Abstract Background: Whether vancomycin (VAN) plus piperacillin-tazobactam (PTZ) could increase the risk of acute kidney injury (AKI) is still controversial in critically ill patients. The purpose of this study was to compare the risk of developing AKI and risk of developing AKI and treatment cost among this population receiving VAN/PTZ to a matched group receiving VAN/other antipseudomonal β-lactams. Methods: This multicenter, retrospective, matched study included 700 critically ill patients who received ≥48 hours of VAN/PTZ or VAN/other antipseudomonal β-lactams. The risk of developing AKI was compared between these two combination therapies using propensity-adjusted analysis. Furthermore, a pharmacoeconomic decision-analytic model was performed.Results: According to three AKI-defined criteria, VAN/PTZ was associated with significantly higher incidence of than VAN/other antipseudomonal β-lactams (all P < 0.001). In multivariate analysis, regardless of any VAN/other antipseudomonal β-lactams, VAN/PTZ was an independent predictor for stage 2 or 3 AKI. In the empiric treatment, the incremental cost-effectiveness ratios per additional nephrotoxic episode of 1147.35$, 1845.11$, and 3989.95$ were found for VAN/PTZ relative to, vancomycin plus imipenem-cilastatin, vancomycin plus meropenem, and vancomycin plus cefoperazone-sulbactam, respectively. Conclusion: In critically ill patients, VAN/PTZ was associated with both higher AKI risk and treatment cost when considering AKI occurence compared to VAN/other antipseudomonal β-lactams.Trial registration: retrospectively registered, ClinicalTrials.gov number: NCT03776409.

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Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin-Tazobactam, Cefepime, or Meropenem

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02658-18 ◽

2019 ◽

Vol 63 (5) ◽

Cited By ~ 16

Author(s):

Adam M. Blevins ◽

Jennifer N. Lashinsky ◽

Craig McCammon ◽

Marin Kollef ◽

Scott Micek ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Primary Outcome ◽

Independent Predictor ◽

Kidney Injury ◽

University Hospital ◽

Increased Risk ◽

Kdigo Guidelines

ABSTRACT Critically ill patients are frequently treated with empirical antibiotic therapy, including vancomycin and β-lactams. Recent evidence suggests an increased risk of acute kidney injury (AKI) in patients who received a combination of vancomycin and piperacillin-tazobactam (VPT) compared with patients who received vancomycin alone or vancomycin in combination with cefepime (VC) or meropenem (VM), but most studies were conducted predominately in the non-critically ill population. A retrospective cohort study that included 2,492 patients was conducted in the intensive care units of a large university hospital with the primary outcome being the development of any AKI. The rates of any AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, were 39.3% for VPT patients, 24.2% for VC patients, and 23.5% for VM patients (P < 0.0001 for both comparisons). Similarly, the incidences of stage 2 and stage 3 AKI were also significantly higher for VPT patients than for the patients in the other groups. The rates of stage 2 and stage 3 AKI, respectively, were 15% and 6.6% for VPT patients, 5.8% and 1.8% for VC patients, and 6.6% and 1.3% for VM patients (P < 0.0001 for both comparisons). In multivariate analysis, the use of vancomycin in combination with piperacillin-tazobactam was found to be an independent predictor of AKI (odds ratio [OR], 2.161; 95% confidence interval [CI], 1.620 to 2.883). In conclusion, critically ill patients receiving the combination of VPT had the highest incidence of AKI compared to critically ill patients receiving either VC or VM.

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Association between Obstructive Sleep Apnea and Acute Kidney Injury in Critically Ill Patients: A Propensity-Matched Study

Nephron ◽

10.1159/000453367 ◽

2016 ◽

Vol 135 (2) ◽

pp. 137-146 ◽

Cited By ~ 7

Author(s):

Lin Dou ◽

Haitao Lan ◽

Daniel J. Reynolds ◽

Tina M. Gunderson ◽

Rahul Kashyap ◽

...

Keyword(s):

Acute Kidney Injury ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Obstructive Sleep ◽

Matched Study

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Hyperglycemia is an independent predictor of in-hospital mortality in critically ill patients with acute kidney injury-a cohort study

Journal of Epidemiological Research ◽

10.5430/jer.v2n1p102 ◽

2015 ◽

Vol 2 (1) ◽

pp. 102

Author(s):

Maristela Bohlke ◽

Laura Madeira ◽

Tulio Reichert ◽

Ana Carolina Brochado Geist ◽

Pedro Funari Pereira ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Roc Analysis ◽

Independent Predictor ◽

Multivariate Logistic Regression Analysis ◽

Kidney Injury ◽

Threshold Level ◽

Operating Characteristics

Introduction: The association of hyperglycemia with poor outcomes has been described in several settings, including in generalintensive care unit (ICU) patients. However, it is not clear whether this relationship is consistent for all critically ill patients. Ourstudy assessed the association of blood glucose (BG) with in-hospital mortality in critically ill patients with acute kidney injury(AKI).Methods: A cohort of critical care patients with AKI was followed up until death or hospital discharge. The associationof BG level with in-hospital mortality was analyzed with multivariate logistic regression analysis adjusted for demographic,socioeconomic, laboratory and clinical variables. Receiver-operating characteristics (ROC) analysis was used to assess the abilityof various levels of BG to predict in-hospital mortality.Results: One hundred patients were followed, with a mean age of 62.2 years, 49 male, 41 surgical, 34 diabetics and 63 withsepsis. Nineteen patients needed renal replacement therapy and 67 died during hospital stay. In the final multivariate model, age,glucose level and sepsis had an independent association with the outcome death. The threshold level of BG that maximized thecombined sensitivity and specificity for the prediction of in-hospital mortality by ROC analysis was 109 mg/dl. In the stratifiedanalysis, BG was an independent predictor of death only among non-diabetic patients.Conclusions: To the best of our knowledge, this is the first study to describe an association between hyperglycemia and in-hospitalmortality in critically ill patients with AKI. Further studies are needed to confirm this finding and to assess the potential impact oftighter glucose control in this subpopulation.

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Independent Predictive Ability of Procalcitonin of Acute Kidney Injury among Critically Ill Patients

Journal of Clinical Medicine ◽

10.3390/jcm9061939 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1939 ◽

Cited By ~ 1

Author(s):

Ya-Ting Huang ◽

Min-Yu Lai ◽

Wei-Chih Kan ◽

Chih-Chung Shiao

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Generalized Linear Model ◽

Independent Predictor ◽

Additive Model ◽

Kidney Injury ◽

Predictive Ability ◽

Icu Admission ◽

Logistic Regression Method

It is unclear whether serum procalcitonin (PCT) levels rise in patients with acute kidney injury (AKI), and it is also unclear whether the elevation of PCT levels in this setting is independent of the existence of infection and impaired renal clearance. We conducted a retrospective study in a regional teaching hospital in Taiwan to evaluate the AKI-predictive ability of serum PCT among critically ill patients. We enrolled 330 patients (mean age, 70.5 ± 16.4 years; 57.0% men) who were admitted to the intensive care unit (ICU) from 1 July 2016, to 31 December 2016, and who had serum PCT measurement performed within 24 h after ICU admission. We used the generalized additive model and generalized linear model to evaluate the association of serum PCT levels and renal function variables. In addition, we used the multivariate logistic regression method to demonstrate serum PCT level as an independent predictor of AKI in both the non-infected patients (odds ratio (OR) = 1.38, 95% confidence interval (CI) = 1.12–1.71, p = 0.003) and the infected patients (OR = 1.23, 95% CI = 1.03–1.46, p = 0.020). In conclusion, serum PCT level at ICU admission is an independent predictor of developing AKI irrespective of infection among critically ill patients.

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