中国药房2026，Vol.37Issue(16)：2144-2149,6.DOI:10.6039/j.issn.1001-0408.2026.16.11
重症患者万古霉素相关急性肾损伤发生现状及相关因素分析
Investigation of the current status and related factors of vancomycin-associated acute kidney injury in critically ill patients
摘要
Abstract
OBJECTIVE To investigate the incidence and outcomes of vancomycin-associated acute kidney injury(VA-AKI)in critically ill patients,to analyze the independent risk factors for the development of VA-AKI and renal function outcomes in VA-AKI patients,and to evaluate the predictive performance of vancomycin treatment duration for VA-AKI occurrence,so as to provide reference for the rational and safe use of this drug.METHODS Clinical data of critically ill patients who received vancomycin during hospitalization in the intensive care unit of Zhongshan Hospital,Fudan University,from January 2022 to December 2024 were retrospectively collected.Patients were divided into the VA-AKI group and the non-AKI group according to the occurrence of VA-AKI.Multivariate Logistic regression analysis was performed to screen for independent risk factors for VA-AKI development and renal function outcomes in patients with VA-AKI.The receiver operating characteristic(ROC)curve was used to analyze the predictive performance of vancomycin treatment duration for VA-AKI.RESULTS A total of 1 484 patients were enrolled,among whom 287 developed VA-AKI,with an incidence of 19.3%.The overall median time to onset was 2.5 days after vancomycin administration.Complicated hypertension,cardiac or renal insufficiency,hospital-acquired sepsis/bacteremia,multiple organ failure,invasive mechanical ventilation during hospitalization,vancomycin treatment duration≥10 days,and concomitant use of carbapenems or tacrolimus were independent risk factors for VA-AKI(P＜0.05).Concomitant use of vasopressors was an independent risk factor for renal function outcomes in patients with VA-AKI(P＜0.05).The area under the ROC curve(AUC)of the model using vancomycin treatment duration of predict the occurrence of VA-AKI was 0.624.At the optimal cut-off value of 9.7 days,the sensitivity and specificity were 47.4%and 74.9%,respectively.CONCLUSIONS Critically ill patients have a relatively high incidence of VA-AKI,which mostly occurs in the early stage of vancomycin therapy.Patients with underlying cardiac-renal diseases,severe infection,requirement for mechanical ventilation,prolonged vancomycin therapy,and concomitant administration of carbapenems or tacrolimus are at high risk for VA-AKI.Concomitant vasopressor use affects renal function recovery in patients with VA-AKI.The predicted risk of acute kidney injury is higher when vancomycin treatment duration is≥10 days.关键词
万古霉素/急性肾损伤/重症患者/危险因素/预后Key words
vancomycin/acute kidney injury/critically ill patients/risk factors/prognosis分类
医药卫生引用本文复制引用
李洁,张颖,宋丹騑,潘坤明,李晓宇,吕迁洲..重症患者万古霉素相关急性肾损伤发生现状及相关因素分析[J].中国药房,2026,37(16):2144-2149,6.基金项目
国家自然科学基金项目(No.82204520) （No.82204520）
上海市卫生健康委员会科研项目(No.20244Y0101) （No.20244Y0101）
上海市"医苑新星"青年医学人才培养资助计划项目(No.沪卫人事[2024]70号) （No.沪卫人事[2024]70号）
吴阶平医学基金项目(No.320.6750.2024-18-12) （No.320.6750.2024-18-12）
中国医药教育协会"聚火优才"全国药学服务科研项目(No.CMEAPC2024016) （No.CMEAPC2024016）
上海市医师协会抗菌药物科学化标杆管理项目(No.2023LCYS001_S14) （No.2023LCYS001_S14）
