Pre-Treatment Serum C-Reactive Protein Level Is An Independent Risk Factor for Development of Nephrotoxicity in Patients Receiving High-Dose Vancomycin

Abstract

High-dose vancomycin treatment increases the likelihood of vancomycin-related nephrotoxicity. C-reactive protein (CRP) is a sensitive marker of systemic inflammation. In this study, we evaluated the pre-treatment serum CRP level as a risk factor of the development of nephrotoxicity in patients receiving high total daily doses (>2.5 g) of vancomycin. Data extracted from medical records for 174 patients who received total daily doses of >2.5 g of intravenous vancomycin for a minimum of 48 h and had their serum CRP level and erythrocyte sedimentation rate tested within 24 h before vancomycin treatment were subject to final analyses. Univariate analyses showed that patients who developed nephrotoxicity during vancomycin treatment had significantly higher median vancomycin serum concentration, duration of vancomycin treatment, and the serum CRP level within 24 h before vancomycin treatment than the non-nephrotoxicity group. Multivariate logistic regression analysis showed that after adjustment for potential confounders, median vancomycin serum concentration, duration of treatment, serum CRP level within 24 h before vancomycin treatment, and nephrotoxic medication were found significantly associated with the development of nephrotoxicity. This was confirmed by multivariate hazard ratio analysis after adjustment for potential confounders. In conclusion, this study provides the first evidence supporting the fact that the serum CRP level within 24 h before vancomycin treatment is an independent risk factor for the development of nephrotoxicity in patients receiving total daily doses of >2.5 g of vancomycin. Therefore, the serum CRP level within 24 h before vancomycin treatment could be a potential biomarker or prognostic factor for the development of vancomycin nephrotoxicity.

Risk factors for vancomycin‐associated acute kidney injury: A systematic review and meta‐analysis

“…Among these, 261 studies were excluded for the following reasons: evaluating antibiotics other than vancomycin ( n = 104), evaluating outcomes other than AKI ( n = 45), not assessing risk factors ( n = 68), not original articles ( n = 4), involving paediatric patients ( n = 8), involving nonhuman subjects ( n = 12), overlapping study population ( n = 3), not a patient‐level analysis ( n = 1), involving patients who underwent renal replacement therapy ( n = 4), and data extraction not possible or feasible ( n = 12). Finally, 53 studies were included in the meta‐analysis 6–8,10–12,21–67 . A flow diagram summarizing the study selection process is shown in Figure 1.…”

Area-Under-Curve–Guided Versus Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-Analysis

“…Forty-eight studies 9,18–22,25,26,31–34 with 36–61 scores 63–67 of 69–73 ≥7 on the Newcastle–Ottawa scale were considered for the meta-analysis. Of these, 10 included patients aged <18 years (neonates–adolescents).…”

“…Among the 57 included studies (Table 2), 4 made direct comparisons between AUC-guided and trough-guided cohorts 9,18–20 ; 10 reported both AUC-guided and trough-guided monitoring 21–28,64,65 ; 2 reported only AUC-guided monitoring 29,30 ; and 41 reported only trough-guided monitoring. 31–63,66–73 Four studies had vancomycin doses adjusted based on both AUC-guided and trough-guided monitoring; 48 had vancomycin doses adjusted based solely on trough-guided monitoring; and 5 had vancomycin doses titrated based solely on AUC-guided monitoring. Most studies were from the United States (n = 34) and Asia-Pacific region (n = 18).…”

Effect Of Calcium Acetate And QuercetinOn Gentamicin‐Induced Nephrotoxicity In Rat

“…Degenerative changes in renal glomeruli and tubules were also reported in the gentamicin-treated group. Med J 20:2 (2019) 20-27 The nephrotoxic effect of gentamicin administration was clearly described in many previous studies, manifested by elevation of serum BUN and creatinine levels (Lopez-Novoa et al, 2011;Boroushaki and Sadeghnia, 2015;Balakumar et al, 2017;, elevation of serum inflammation marker (CRP) (Balakumar et al, 2010;El-Ashker et al, 2015;and He et al, 2016), and alteration in oxidative/antioxidative status biomarkers in form of increased MDA and decreased superoxide dismutase (SOD), glutathione (GSH), and catalase (CAT) activities (Abdel-Raheem et al, 2009;Patil et al, 2014;and Casanova et al, 2017). The histopathological alterations reported in this study are consistent with the former studies.…”