Augmented renal clearance is a common finding with worse clinical outcome in critically ill patients receiving antimicrobial therapy

作者：Claus Barbara O M^*; Hoste Eric A; Colpaert Kirsten; Robays Hugo; Decruyenaere Johan; De Waele Jan J

来源：Journal of Critical Care, 2013, 28(5): 695-700.

DOI：10.1016/j.jcrc.2013.03.003

• Augmented renal clearance
• 24-hour creatinine clearance
• Antibiotic underdosing
• Glomerular hyperfiltration

Introduction: We describe incidence and patient factors associated with augmented renal clearance (ARC) in adult intensive care unit (ICU) patients. %26lt;br%26gt;Materials and Methods: A prospective observational study in a mixed cohort of surgical and medical ICU patients receiving antimicrobial therapy at the Ghent University Hospital, Belgium. Kidney function was assessed by the 24-hour creatinine clearance (Ccr); ARC defined as at least one Ccr of %26gt;130 mL/min per 1.73 m(2). Multivariate logistic regression analysis: to assess variables associated with ARC occurrence. Therapeutic failure (TF): an impaired clinical response and need for alternate antimicrobial therapy. %26lt;br%26gt;Results: Of the 128 patients and 599 studied treatment days, ARC was present in 51.6% of the patients. Twelve percent permanently expressed ARC. ARC patients had a median Ccr of 144 mL/min per 1.73 m2 (IQR 98-196). Median serum creatinine concentration on the first day of ARC was 0.54 mg/dL (IQR 0.48-0.69). Patients with ARC were significantly younger (P %26lt; .001). Age and male gender were independently associated with ARC whereas the APACHE II score was not. ARC patients had more TF (18 (27.3%) vs. 8 (12.9%); P = .04). %26lt;br%26gt;Conclusion: ARC was documented in approximately 52% of a mixed ICU patient population receiving antibiotic treatment with worse clinical outcome. Young age and male gender were independently associated with ARC presence.

• 出版日期2013-10