Association Between Trough Serum Vancomycin Concentration and Vancomycin-Associated Acute Kidney Injury and 30-Day Mortality in Critically Ill Elderly Adults

Abstract

Abstract Background: Vancomycin-associated acute kidney injury (VA-AKI) is the most clinically relevant side effect of vancomycin. Method: Elderly patients with trough serum vancomycin concentration records(VTC) in the Medical Information Mart-IV (MIMIC-IV) and eICU databases were retrospectively studied. Results: A total of 3,146 critically ill elderly adults were finally enrolled. The incidence of VA-AKI in the elderly population was 76.5%. Logistic regression analysis revealed significant relationships between VA-AKI and various factors, including VTC, comorbidities, and laboratory indicators, and SOFA, and GCS score. For each mg/L increase, the OR for VA-AKI increased by 2.5%. The association between VTC and 30-day mortality was found to be statistically significant (odds ratio (OR): 1.021, 95% CI: 1.010-1.031), P < 0.001). The Restricted cubic splines (RCS) curves revealed that VTCranged of 19.67 to 35.72mg/l for AKI and 19.17 to 42.86mg/l for 30-day mortality exhibit OR with 95% CIabove 1, indicating statistically significant associations with an increased risk of AKI and 30-day mortality, respectively. In the subgroup analysis, VTC was identified as a risk factor for VA-AKI in specific patient groups, including white individuals, female patients, those with shock, patients with SOFA >6, patients with baseline creatinine >1.2 mg/dl and patients with or without exposed to other nephrotoxic medications. Conclusion: This study found the significant association between VTC and the incidence of VA-AKI and 30-day mortality in critically ill elderly adults. The RCS curves indicated concentration ranges for AKI (19.67-35.72 mg/L) and 30-day mortality (19.17-42.86 mg/L), signifying increased risk.