Jun Wan, Shiteng Lin, Wei Zhuang, Weida Chen, Yanting Huang, Zhiyi Huang, Wanlong Lin, Yao Chen
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引用次数: 0
Abstract
Background: Maintaining optimal potassium levels is critical in neonates. Piperacillin/tazobactam (TZP) is associated with hypokalemia in adults, but neonatal data are limited.
Objectives: This study aimed to investigate the incidence, severity, and determinants of TZP-associated hypokalemia (TAH) in neonates and develop a predictive model for early detection.
Design: Retrospective cohort study.
Methods: Neonates treated with TZP between January 2019 and December 2024 at Xiamen Women and Children's Hospital were included. Demographic, laboratory, and medication data were extracted. Naranjo probability scores assessed TAH causality. Multivariate logistic regression identified predictors, and a nomogram predicted TAH occurrence. Nomogram performance was evaluated.
Results: Among 1027 neonates initially screened, 358 met the inclusion criteria and were ultimately included in the analysis. The incidence of TAH in this cohort was 20.4% (73/358). Independent predictors included higher baseline serum creatinine (p = 0.012, OR 1.02, 95% CI 1.00-1.03), dopamine use (p = 0.002, OR 3.37, 95% CI 1.54-7.36), and lower serum calcium (p = 0.049, OR 0.31, 95% CI 0.10-0.99) was a protective factor. The nomogram showed good predictive accuracy (AUC = 0.771) and net benefit. High-risk neonates had a higher hypokalemia incidence (log-rank test p < 0.001).
Conclusion: Higher baseline serum creatinine, dopamine use, and lower serum calcium are independent predictors of neonatal TAH. The nomogram offers a user-friendly tool for TAH prediction, facilitating early detection and management in clinical practice. This study supports early detection, diagnosis, and intervention for neonatal TAH.
背景：维持最佳钾水平对新生儿至关重要。哌拉西林/他唑巴坦（TZP）与成人低钾血症相关，但新生儿数据有限。目的：本研究旨在探讨新生儿tzp相关性低钾血症（TAH）的发生率、严重程度和决定因素，并建立早期发现的预测模型。设计：回顾性队列研究。方法：纳入2019年1月至2024年12月在厦门市妇幼医院接受TZP治疗的新生儿。提取了人口统计学、实验室和用药数据。Naranjo概率分数评估了TAH的因果关系。多元逻辑回归确定了预测因子，并采用nomogram预测TAH的发生。评估Nomogram表现。结果：在最初筛选的1027名新生儿中，358名符合纳入标准，最终纳入分析。该队列中TAH的发生率为20.4%（73/358）。独立预测因素包括较高的基线血清肌酐（p = 0.012, OR 1.02, 95% CI 1.00-1.03），多巴胺使用（p = 0.002, OR 3.37, 95% CI 1.54-7.36）和较低的血清钙（p = 0.049, OR 0.31, 95% CI 0.10-0.99）是保护因素。nomogram显示出较好的预测准确度（AUC = 0.771）和净效益。结论：较高的基线血清肌酐、多巴胺使用和较低的血清钙是新生儿TAH的独立预测因素。nomogram为TAH预测提供了一种用户友好的工具，有助于临床实践中的早期发现和管理。本研究支持新生儿TAH的早期发现、诊断和干预。
期刊介绍：
Therapeutic Advances in Drug Safety delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies pertaining to the safe use of drugs in patients.
The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in drug safety, providing a forum in print and online for publishing the highest quality articles in this area. The editors welcome articles of current interest on research across all areas of drug safety, including therapeutic drug monitoring, pharmacoepidemiology, adverse drug reactions, drug interactions, pharmacokinetics, pharmacovigilance, medication/prescribing errors, risk management, ethics and regulation.
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