Risk Scoring System for Vancomycin-Associated Acute Kidney Injury

Abstract

Vancomycin-associated acute kidney injury (AKI) remains a major challenge for patients and clinicians. This study aimed to construct a risk scoring system for vancomycin-associated AKI. We retrospectively reviewed medical records of patients who underwent therapeutic drug monitoring for vancomycin from June 2018 to July 2019. We selected possible risk factors for AKI by univariate and multivariable logistic regression analyses and developed a scoring system for vancomycin-associated AKI. Machine learning methods were utilized to predict risk factors for the occurrence of AKI. The incidence of vancomycin-associated AKI was 31.7% among 104 patients included in this study. A bodyweight ≤60 kg (two points), a Charlson comorbidity index ≥3 (two points), a vancomycin trough serum level >15 μg/ml (one point), and concomitant use of ≥6 nephrotoxic agents (two points) were included to construct a risk scoring system based on the coefficient from the logistic regression model. The area under the receiver operating characteristic curve (AUROC) (mean, 95% confidence interval (CI)) across 10 random iterations using five-fold cross-validated multivariate logistic regression, elastic net, random forest, support vector machine (SVM)-linear kernel, and SVM-radial kernel models was 0.735 (0.638–0.833), 0.737 (0.638–0.835), 0.721 (0.610–0.833), 0.739 (0.648–0.829), and 0.733 (0.640–0.826), respectively. For total scores of 0–1, 2–3, 4–5, 6–7, the risk of vancomycin-associated AKI was 5, 25, 45, and 65%, respectively. Our scoring system can be applied to clinical settings in which several nephrotoxic agents are used along with vancomycin therapy.

Pharmacokinetic assessment of vancomycin in critically ill patients and nephrotoxicity prediction using individualized pharmacokinetic parameters

“…The most significant adverse reactions related to vancomycin are nephrotoxicity and ototoxicity that are related to the trough (C min ) and peak (C max ) concentration values, respectively ( Sacristan and Soto, 1992 ). Risk scoring systems can be recruited to predict vancomycin-associated nephrotoxicity ( Kim et al, 2022 ). Recent guideline regarding the TDM of vancomycin in severe MRSA infections has been reported that trough-only monitoring approach with a target trough concentration of 15–20 μg/ml is no longer recommended in patients with severe MRSA infection due to the lack of efficacy and higher nephrotoxicity occurrence ( Rybak et al, 2020 ).…”

Analysis of a machine learning–based risk stratification scheme for acute kidney injury in vancomycin

“…In previous studies, machine learning was used to predict AKI after cardiac surgery, in pediatric intensive care and cancer patients ( Tseng et al, 2020 ; Dong et al, 2021 ; Scanlon et al, 2021 ). In addition, Kim et al have developed a single-center vancomycin-associated AKI risk scoring system ( Kim et al, 2022 ), which estimated of vancomycin area under the curve after vancomycin administration based on machine learning ( Bououda et al, 2022 ). However, despite these advancements, all of these models were globally, which could not analyse and evaluate vancomycin-associated AKI in different underlying diseases specifically.…”