Lin Hu, Yuan Su, Xi Tang, Yanfei Li, Jinhui Feng, Gefei He
{"title":"肝功能异常患者的治疗药物监测和伏立康唑的安全性。","authors":"Lin Hu, Yuan Su, Xi Tang, Yanfei Li, Jinhui Feng, Gefei He","doi":"10.1128/aac.01126-24","DOIUrl":null,"url":null,"abstract":"<p><p>This study aims to describe the distribution characteristics of voriconazole (VRC) plasma trough concentrations (<i>C</i><sub>trough</sub>) in patients with liver dysfunction, identify factors influencing VRC <i>C</i><sub>trough</sub>, and provide recommendations for the use of VRC in this population. We retrospectively collected medical records of hospitalized patients with liver dysfunction who used VRC and underwent therapeutic drug monitoring (TDM) at the First Hospital of Changsha. The severity of liver dysfunction was assessed by the Child-Pugh (CP) score. Multiple linear regression was employed to explore factors affecting VRC <i>C</i><sub>trough</sub> in these patients. A total of 147 <i>C</i><sub>trough</sub> from 102 patients with liver dysfunction were analyzed. Patients were categorized into a control group (<i>n</i> = 40), CP-A (<i>n</i> = 39), CP-B (<i>n</i> = 11), and CP-C group (<i>n</i> = 12). The initial probability of target attainment of <i>C</i><sub>trough</sub> was 70.6%, with 6.9% of patients obtaining subtherapeutic <i>C</i><sub>trough</sub> and 22.5% obtaining supertherapeutic <i>C</i><sub>trough</sub>. The initial <i>C</i><sub>trough</sub> in CP-A and B were 5.05 (0.64-9.57) mg/L and 5.37 (0.26-10.01) mg/L, respectively, significantly higher than the control group (<i>P</i> = 0.021 and <i>P</i> = 0.010). The proportion of VRC <i>C</i><sub>trough</sub> of >5.5 mg/L in CP-A and B was 33.3% and 45.5%, respectively. Multiple linear regression analysis revealed that factors such as age ≥70 years, CP class, C-reactive protein (CRP), and direct bilirubin were significantly related to the initial VRC <i>C</i><sub>trough</sub>. Among all measurements, patients with severe inflammation (CRP >100 mg/L), aged ≥70 years, and albumin levels of <30 or <25 g/L had significantly higher VRC <i>C</i><sub>trough</sub>. The treatment success rate of VRC was 69.6% (71 of 102), and the rate of VRC-related adverse drug reactions was 29.4% (30 of 102). The recommended half-maintenance dose may lead to elevated VRC <i>C</i><sub>trough</sub> in patients with CP-A and CP-B. TDM is essential for patients with advanced age, severe infections, or hypoalbuminemia to prevent excessive VRC trough levels.</p>","PeriodicalId":8152,"journal":{"name":"Antimicrobial Agents and Chemotherapy","volume":" ","pages":"e0112624"},"PeriodicalIF":4.1000,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539214/pdf/","citationCount":"0","resultStr":"{\"title\":\"Therapeutic drug monitoring and safety of voriconazole in patients with liver dysfunction.\",\"authors\":\"Lin Hu, Yuan Su, Xi Tang, Yanfei Li, Jinhui Feng, Gefei He\",\"doi\":\"10.1128/aac.01126-24\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>This study aims to describe the distribution characteristics of voriconazole (VRC) plasma trough concentrations (<i>C</i><sub>trough</sub>) in patients with liver dysfunction, identify factors influencing VRC <i>C</i><sub>trough</sub>, and provide recommendations for the use of VRC in this population. We retrospectively collected medical records of hospitalized patients with liver dysfunction who used VRC and underwent therapeutic drug monitoring (TDM) at the First Hospital of Changsha. The severity of liver dysfunction was assessed by the Child-Pugh (CP) score. Multiple linear regression was employed to explore factors affecting VRC <i>C</i><sub>trough</sub> in these patients. A total of 147 <i>C</i><sub>trough</sub> from 102 patients with liver dysfunction were analyzed. Patients were categorized into a control group (<i>n</i> = 40), CP-A (<i>n</i> = 39), CP-B (<i>n</i> = 11), and CP-C group (<i>n</i> = 12). The initial probability of target attainment of <i>C</i><sub>trough</sub> was 70.6%, with 6.9% of patients obtaining subtherapeutic <i>C</i><sub>trough</sub> and 22.5% obtaining supertherapeutic <i>C</i><sub>trough</sub>. The initial <i>C</i><sub>trough</sub> in CP-A and B were 5.05 (0.64-9.57) mg/L and 5.37 (0.26-10.01) mg/L, respectively, significantly higher than the control group (<i>P</i> = 0.021 and <i>P</i> = 0.010). The proportion of VRC <i>C</i><sub>trough</sub> of >5.5 mg/L in CP-A and B was 33.3% and 45.5%, respectively. Multiple linear regression analysis revealed that factors such as age ≥70 years, CP class, C-reactive protein (CRP), and direct bilirubin were significantly related to the initial VRC <i>C</i><sub>trough</sub>. Among all measurements, patients with severe inflammation (CRP >100 mg/L), aged ≥70 years, and albumin levels of <30 or <25 g/L had significantly higher VRC <i>C</i><sub>trough</sub>. The treatment success rate of VRC was 69.6% (71 of 102), and the rate of VRC-related adverse drug reactions was 29.4% (30 of 102). The recommended half-maintenance dose may lead to elevated VRC <i>C</i><sub>trough</sub> in patients with CP-A and CP-B. TDM is essential for patients with advanced age, severe infections, or hypoalbuminemia to prevent excessive VRC trough levels.</p>\",\"PeriodicalId\":8152,\"journal\":{\"name\":\"Antimicrobial Agents and Chemotherapy\",\"volume\":\" \",\"pages\":\"e0112624\"},\"PeriodicalIF\":4.1000,\"publicationDate\":\"2024-11-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539214/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Antimicrobial Agents and Chemotherapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1128/aac.01126-24\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"MICROBIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Antimicrobial Agents and Chemotherapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1128/aac.01126-24","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/21 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"MICROBIOLOGY","Score":null,"Total":0}
Therapeutic drug monitoring and safety of voriconazole in patients with liver dysfunction.
This study aims to describe the distribution characteristics of voriconazole (VRC) plasma trough concentrations (Ctrough) in patients with liver dysfunction, identify factors influencing VRC Ctrough, and provide recommendations for the use of VRC in this population. We retrospectively collected medical records of hospitalized patients with liver dysfunction who used VRC and underwent therapeutic drug monitoring (TDM) at the First Hospital of Changsha. The severity of liver dysfunction was assessed by the Child-Pugh (CP) score. Multiple linear regression was employed to explore factors affecting VRC Ctrough in these patients. A total of 147 Ctrough from 102 patients with liver dysfunction were analyzed. Patients were categorized into a control group (n = 40), CP-A (n = 39), CP-B (n = 11), and CP-C group (n = 12). The initial probability of target attainment of Ctrough was 70.6%, with 6.9% of patients obtaining subtherapeutic Ctrough and 22.5% obtaining supertherapeutic Ctrough. The initial Ctrough in CP-A and B were 5.05 (0.64-9.57) mg/L and 5.37 (0.26-10.01) mg/L, respectively, significantly higher than the control group (P = 0.021 and P = 0.010). The proportion of VRC Ctrough of >5.5 mg/L in CP-A and B was 33.3% and 45.5%, respectively. Multiple linear regression analysis revealed that factors such as age ≥70 years, CP class, C-reactive protein (CRP), and direct bilirubin were significantly related to the initial VRC Ctrough. Among all measurements, patients with severe inflammation (CRP >100 mg/L), aged ≥70 years, and albumin levels of <30 or <25 g/L had significantly higher VRC Ctrough. The treatment success rate of VRC was 69.6% (71 of 102), and the rate of VRC-related adverse drug reactions was 29.4% (30 of 102). The recommended half-maintenance dose may lead to elevated VRC Ctrough in patients with CP-A and CP-B. TDM is essential for patients with advanced age, severe infections, or hypoalbuminemia to prevent excessive VRC trough levels.
期刊介绍：
Antimicrobial Agents and Chemotherapy (AAC) features interdisciplinary studies that build our understanding of the underlying mechanisms and therapeutic applications of antimicrobial and antiparasitic agents and chemotherapy.
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