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The following is a summary of “Association between trough serum vancomycin concentration and vancomycin-associated acute kidney injury and 30-day mortality in critically ill elderly adults,” published in the March 2024 issue of Infectious Diseases by Chen et al. 

Previous studies found that 5%–43% of non-elderly patients exposed to vancomycin developed Vancomycin-associated acute kidney injury (VA-AKI), which sometimes further leads to chronic kidney disease.

Researchers conducted a retrospective study to investigate the association between Vancomycin concentration records (VTC) and VA-AKI, as well as 30-day mortality in adult patients who were critically ill. 

They introduced elderly patients with trough serum VTC in Medical Information Mart-IV (MIMIC-IV) and studied eICU databases to investigate trends and outcomes related to vancomycin therapy.

The results showed 3,146 elderly adults who were critically ill, out of which 76.5% were the incidence of VA-AKI. Logistic regression analysis revealed significant relationships between VA-AKI and various factors. The OR for VA-AKI increased by 2.5% for every mg/L increase, and the association between VTC and 30-day mortality was significant (OR: 1.021, 95% CI: 1.010-1.031, P<0.001). Restricted cubic splines (RCS) curves showed VTC ranges of 19.67 to 35.72 mg/L for AKI and 19.17 to 42.86 mg/L for 30-day mortality, ORs with 95% CI above 1 indicate significant associations with increased risk. Subgroup analysis identified VTC as a risk factor for VA-AKI in specific patient groups.

Investigators concluded that a major correlation was observed in ill elderly adults between VTC levels and VA-AKI incidence along with 30-day mortality. The RCS curves also highlighted specific concentration ranges indicative of heightened risk. 

Source: bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09227-x