Publication: Internal and Emergency Medicine
Abstract
Long-stay critically ill patients with persistent inflammation, immunosuppression, and catabolism syndrome (PICS) often have unreliable creatinine-based renal function estimates due to muscle wasting, complicating vancomycin dosing. This study compared cystatin C- and creatinine-based glomerular filtration rate estimates for predicting vancomycin clearance in patients with and without PICS, building a population pharmacokinetic model using Phoenix NLME with separate modeling and validation cohorts. PICS was associated with supratherapeutic vancomycin trough concentrations when dosed using creatinine-based estimates, and combining cystatin C and creatinine-based renal function estimates substantially reduced unexplained variability in vancomycin clearance (from 75.6% to 28.5%). The validated combined-marker model can help optimize vancomycin dosing in critically ill patients with PICS, where standard creatinine-based estimates may be unreliable.
Author(s): Huang J, Wang X, Hao C, Yang W, Zhang W, Liu J, Qu H
Published: 2021 年 3 月 16 日
Phoenix NLME：Combining Renal Markers for Better Accuracy
Phoenix NLME's population model showed combining two renal function markers sharply reduced unexplained variability in vancomycin clearance in this critically ill patient study. Within a Phoenix platform that centralizes data, analyses, and templates with built-in collaboration, Phoenix NLME is also available through RsNLME, bringing population PK/PD modeling into R for teams who prefer that environment.
