Infection and drug resistance · 2026
Risk Stratification for Vancomycin-Associated Acute Kidney Injury in Chinese Adult Inpatients: A Multicenter Retrospective Cohort Study.
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Chen Shu, Zhang Ying, Hou Xingyun, Wang Yuzhu, Zuo Chengchun, Huang Chengwei, Xia Xiaotong, Cao Chang, Lv Qianzhou, Li Xiaoyu, Pan Kunming
Аннотация
PURPOSE: Vancomycin-associated acute kidney injury (VA-AKI) remains a major safety concern during treatment of serious infections. We aimed to identify a clinically relevant vancomycin trough threshold associated with VA-AKI and to define factors associated with renal injury in Chinese adult inpatients.
PATIENTS AND METHODS: We conducted a multicenter retrospective cohort study of 2230 Chinese adult inpatients treated with intravenous vancomycin between 2016 and 2025. VA-AKI was defined according to Kidney Disease: Improving Global Outcomes criteria. Receiver operating characteristic analysis was used to identify the trough threshold associated with VA-AKI, and multivariable logistic regression was performed to assess factors independently associated with VA-AKI.
RESULTS: VA-AKI occurred in 493/2230 patients (22.1%). The trough concentration most closely associated with VA-AKI was 15.9 mg/L (AUC 0.64). Compared with troughs <10 mg/L, concentrations of 10-20 mg/L and >20 mg/L were associated with progressively higher AKI risk. Factors independently associated with VA-AKI included contrast exposure, concomitant piperacillin-tazobactam or cephalosporin therapy, critical illness, treatment duration ≥14 days, cardiac dysfunction, and baseline renal impairment. VA-AKI was also associated with worse outcomes, including higher 60-day mortality (16% vs 4%) and greater dialysis requirement (6% vs 2%).
CONCLUSION: In this large multicenter cohort, VA-AKI occurred in approximately one in five Chinese adult inpatients receiving vancomycin. A vancomycin trough concentration of approximately 15.9 mg/L may serve as a practical threshold for early AKI risk stratification, particularly in clinical settings where AUC-guided monitoring is not routinely available. Closer renal surveillance may be warranted in patients with additional treatment-related or clinical risk factors.
PATIENTS AND METHODS: We conducted a multicenter retrospective cohort study of 2230 Chinese adult inpatients treated with intravenous vancomycin between 2016 and 2025. VA-AKI was defined according to Kidney Disease: Improving Global Outcomes criteria. Receiver operating characteristic analysis was used to identify the trough threshold associated with VA-AKI, and multivariable logistic regression was performed to assess factors independently associated with VA-AKI.
RESULTS: VA-AKI occurred in 493/2230 patients (22.1%). The trough concentration most closely associated with VA-AKI was 15.9 mg/L (AUC 0.64). Compared with troughs <10 mg/L, concentrations of 10-20 mg/L and >20 mg/L were associated with progressively higher AKI risk. Factors independently associated with VA-AKI included contrast exposure, concomitant piperacillin-tazobactam or cephalosporin therapy, critical illness, treatment duration ≥14 days, cardiac dysfunction, and baseline renal impairment. VA-AKI was also associated with worse outcomes, including higher 60-day mortality (16% vs 4%) and greater dialysis requirement (6% vs 2%).
CONCLUSION: In this large multicenter cohort, VA-AKI occurred in approximately one in five Chinese adult inpatients receiving vancomycin. A vancomycin trough concentration of approximately 15.9 mg/L may serve as a practical threshold for early AKI risk stratification, particularly in clinical settings where AUC-guided monitoring is not routinely available. Closer renal surveillance may be warranted in patients with additional treatment-related or clinical risk factors.