Cuiyao He, Yuhua Deng, Tingsong Li, Dongmei Deng, Fengjun Lv, Yuan Qu, Li Jiang, Siqi Hong, Xiaogang Hu, Yuanyuan Luo
{"title":"社区获得性细菌性脑膜炎儿童患者接受万古霉素治疗后肾小球滤过率升高与临床预后差的关系：一项10年回顾性队列研究。","authors":"Cuiyao He, Yuhua Deng, Tingsong Li, Dongmei Deng, Fengjun Lv, Yuan Qu, Li Jiang, Siqi Hong, Xiaogang Hu, Yuanyuan Luo","doi":"10.1007/s40121-025-01196-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to explore the association between elevated estimated glomerular filtration rate (eGFR) and poor prognosis in pediatric patients with community-acquired bacterial meningitis (BM) receiving vancomycin.</p><p><strong>Methods: </strong>This retrospective cohort study included children aged 1 month to 18 years with community-acquired BM admitted to the Department of Neurology, Children's Hospital of Chongqing Medical University (CHCMU) from 2013 to 2023. Relevant information for all patients was collected, and clinical outcomes were assessed using the Glasgow Outcome Scale (GOS) at the time of discharge. Logistic regression analysis, receiver operating characteristic (ROC) curve analysis, integrated discrimination improvement (IDI), net reclassification improvement (NRI) indices, and survival curve analysis were employed to investigate the associations between elevated eGFR and poor clinical outcomes in pediatric patients with community-acquired BM.</p><p><strong>Results: </strong>A total of 119 patients were included. Significant differences in the eGFR were observed among pediatric patients with different prognoses (P < 0.05). The initial vancomycin trough concentration in the elevated eGFR group was significantly lower than that in the normal eGFR group [5.600 (4.590; 8.060) mg/L vs. 9.205 (7.500; 12.070) mg/L]. At discharge, the GOS scores of the two groups also significantly differed (P < 0.05). In the analysis of factors influencing poor prognosis in pediatric patients with BM, an eGFR ≥ 169.21 mL/min/1.73 m<sup>2</sup> was identified as an important factor associated with poor clinical outcomes in both univariate and multivariate analyses. Incorporating the elevated eGFR factor into the predictive model significantly improved its diagnostic performance (NRI 0.624, P = 0.00297; IDI 0.1057, P = 0.00414). Kaplan‒Meier survival analysis also revealed that an eGFR ≥ 169.21 mL/min/1.73 m<sup>2</sup> was associated with a greater likelihood of poor outcomes (P = 0.0092).</p><p><strong>Conclusion: </strong>Elevated eGFR is associated with an increased risk of poor clinical outcomes in community-acquired BM in children.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"1899-1916"},"PeriodicalIF":5.3000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339840/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Association Between Elevated Estimated Glomerular Filtration Rate and Poor Clinical Outcomes of Pediatric Patients with Community-Acquired Bacterial Meningitis Receiving Vancomycin: A Ten-Year Retrospective Cohort Study.\",\"authors\":\"Cuiyao He, Yuhua Deng, Tingsong Li, Dongmei Deng, Fengjun Lv, Yuan Qu, Li Jiang, Siqi Hong, Xiaogang Hu, Yuanyuan Luo\",\"doi\":\"10.1007/s40121-025-01196-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>This study aimed to explore the association between elevated estimated glomerular filtration rate (eGFR) and poor prognosis in pediatric patients with community-acquired bacterial meningitis (BM) receiving vancomycin.</p><p><strong>Methods: </strong>This retrospective cohort study included children aged 1 month to 18 years with community-acquired BM admitted to the Department of Neurology, Children's Hospital of Chongqing Medical University (CHCMU) from 2013 to 2023. Relevant information for all patients was collected, and clinical outcomes were assessed using the Glasgow Outcome Scale (GOS) at the time of discharge. Logistic regression analysis, receiver operating characteristic (ROC) curve analysis, integrated discrimination improvement (IDI), net reclassification improvement (NRI) indices, and survival curve analysis were employed to investigate the associations between elevated eGFR and poor clinical outcomes in pediatric patients with community-acquired BM.</p><p><strong>Results: </strong>A total of 119 patients were included. Significant differences in the eGFR were observed among pediatric patients with different prognoses (P < 0.05). The initial vancomycin trough concentration in the elevated eGFR group was significantly lower than that in the normal eGFR group [5.600 (4.590; 8.060) mg/L vs. 9.205 (7.500; 12.070) mg/L]. At discharge, the GOS scores of the two groups also significantly differed (P < 0.05). In the analysis of factors influencing poor prognosis in pediatric patients with BM, an eGFR ≥ 169.21 mL/min/1.73 m<sup>2</sup> was identified as an important factor associated with poor clinical outcomes in both univariate and multivariate analyses. Incorporating the elevated eGFR factor into the predictive model significantly improved its diagnostic performance (NRI 0.624, P = 0.00297; IDI 0.1057, P = 0.00414). 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引用次数: 0
摘要
本研究旨在探讨接受万古霉素治疗的社区获得性细菌性脑膜炎（BM）患儿肾小球滤过率（eGFR）升高与预后不良的关系。方法：本回顾性队列研究纳入2013 - 2023年重庆医科大学儿童医院神经内科收治的1个月~ 18岁社区获得性BM患儿。收集所有患者的相关信息，并在出院时使用格拉斯哥结果量表（GOS）评估临床结果。采用Logistic回归分析、受试者工作特征（ROC）曲线分析、综合判别改善（IDI）、净重分类改善（NRI）指数和生存曲线分析，探讨社区获得性脑转移患儿eGFR升高与不良临床结局的关系。结果：共纳入119例患者。在不同预后的儿童患者中观察到eGFR的显著差异（在单因素和多因素分析中，p2被认为是与不良临床结果相关的重要因素）。将升高的eGFR因子纳入预测模型可显著提高其诊断效能(NRI 0.624, P = 0.00297；Idi = 0.1057, p = 0.00414)。Kaplan-Meier生存分析还显示，eGFR≥169.21 mL/min/1.73 m2与不良预后的可能性较大相关（P = 0.0092）。结论：eGFR升高与社区获得性脑脊髓炎儿童临床预后不良风险增加相关。
The Association Between Elevated Estimated Glomerular Filtration Rate and Poor Clinical Outcomes of Pediatric Patients with Community-Acquired Bacterial Meningitis Receiving Vancomycin: A Ten-Year Retrospective Cohort Study.
Introduction: This study aimed to explore the association between elevated estimated glomerular filtration rate (eGFR) and poor prognosis in pediatric patients with community-acquired bacterial meningitis (BM) receiving vancomycin.
Methods: This retrospective cohort study included children aged 1 month to 18 years with community-acquired BM admitted to the Department of Neurology, Children's Hospital of Chongqing Medical University (CHCMU) from 2013 to 2023. Relevant information for all patients was collected, and clinical outcomes were assessed using the Glasgow Outcome Scale (GOS) at the time of discharge. Logistic regression analysis, receiver operating characteristic (ROC) curve analysis, integrated discrimination improvement (IDI), net reclassification improvement (NRI) indices, and survival curve analysis were employed to investigate the associations between elevated eGFR and poor clinical outcomes in pediatric patients with community-acquired BM.
Results: A total of 119 patients were included. Significant differences in the eGFR were observed among pediatric patients with different prognoses (P < 0.05). The initial vancomycin trough concentration in the elevated eGFR group was significantly lower than that in the normal eGFR group [5.600 (4.590; 8.060) mg/L vs. 9.205 (7.500; 12.070) mg/L]. At discharge, the GOS scores of the two groups also significantly differed (P < 0.05). In the analysis of factors influencing poor prognosis in pediatric patients with BM, an eGFR ≥ 169.21 mL/min/1.73 m2 was identified as an important factor associated with poor clinical outcomes in both univariate and multivariate analyses. Incorporating the elevated eGFR factor into the predictive model significantly improved its diagnostic performance (NRI 0.624, P = 0.00297; IDI 0.1057, P = 0.00414). Kaplan‒Meier survival analysis also revealed that an eGFR ≥ 169.21 mL/min/1.73 m2 was associated with a greater likelihood of poor outcomes (P = 0.0092).
Conclusion: Elevated eGFR is associated with an increased risk of poor clinical outcomes in community-acquired BM in children.
期刊介绍：
Infectious Diseases and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of infectious disease therapies and interventions, including vaccines and devices. Studies relating to diagnostic products and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged.
Areas of focus include, but are not limited to, bacterial and fungal infections, viral infections (including HIV/AIDS and hepatitis), parasitological diseases, tuberculosis and other mycobacterial diseases, vaccinations and other interventions, and drug-resistance, chronic infections, epidemiology and tropical, emergent, pediatric, dermal and sexually-transmitted diseases.
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