低蛋白血症和显著低蛋白血症对万古霉素血药谷浓度影响的临床研究OA

Objective To investigate the effect of hypoproteinemia and significant hypoalbuminemia on vancomycin trough concentration.Methods Patients who had vancomycin trough concentration checked in our hospital were categorized into two classification systems based on albumin(ALB):one dividing patients into hypoalbuminemia group(ALB＜35 g·L-1)and non-hypoalbuminemia group(ALB≥35 g·L-1);and the other into significant hypoalbuminemia group(ALB＜30 g·L-1)and non-significant hypoalbuminemia group(ALB≥30 g·L-1).Propensity score matching(PSM)was conducted for the patients' gender,age,body surface area,body mass index(BMI),laboratory test indicators,comorbidities,and concomitant medications such as cefazolin and ceftriaxone,to make the baseline conditions of the patients comparable.Differences in vancomycin trough concentrations,microbiological outcomes,and therapeutic outcomes were compared between the hypoalbuminemia and non-hypoalbuminemia groups,as well as between the significant and non-significant hypoalbuminemia groups.Results This study included 584 patients.After matching hypoalbuminemia group with non-hypoalbuminemia group,there were 69 patients in each group.The vancomycin trough concentrations were 14.10(7.25,18.84)and 12.10(8.15,17.75)μg·mL-1,respectively;microbiological clearance rates were 79.70％(59 cases/69 cases)and 84.10％(58 cases/69 cases),respectively;and clinical effective rates were 82.60％(57 cases/69 cases)and 84.10％(58 cases/69 cases),respectively;compared between 2 groups,the differences of the above indicators were not statistically significant(all P＞0.05).Additionally,after matching significant hypoalbuminemia group with non-significant hypoalbuminemia group,there were 82 patients in each group.The vancomycin trough concentrations were 17.15(12.23,21.55)and 14.40(9.38,19.20)μg·mL-1,and the difference was statistically significant(P＜0.05).The microbial eradication rates were 93.90％(77 cases/82 cases)and 87.80％(72 cases/82 cases),respectively;and clinical effective rates were 91.50％(75 cases/82 cases)and 87.80％(72 cases/82 cases),respectively;but no statistically signifcant differences were found in microbial eradication rates and clinical effective rates(all P＞0.05).Conclusion Hypoproteinemia has a relatively minor impact on vancomycin trough concentration,however,significant hypoproteinemia may increase vancomycin trough concentration.In clinical practice,it is necessary to monitor vancomycin trough concentration in patients with significant hypoproteinemia.