Clearance of vancomycin during continuous infusion in Intensive Care Unit patients: Correlation with measured and estimated creatinine clearance and serum cystatin C

摘要

Vancomycin (VAN) dosing requires adjustment to renal function, which is often estimated using the Cockcroft-Gault formula; however, its precision is poor in Intensive Care Unit (ICU) patients. VAN clearance (CL_(Van)) during continuous infusion was prospectively determined in 25 ICU patients [14 male, 11 female; age range 31-82 years; body mass index (BMI) 16.5-41.5kg/m~2; Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission 8-36; creatinine clearance 25-195mL/min] and its correlation with measured creatinine clearance (CL_(Crea)), estimated creatinine clearance using the Cockcroft-Gault formula (CL_(CG)) and estimated glomerular filtration rate according to Hoek's formula based on serum cystatin C (GFR_(Hoek)) was investigated. The correlation between CL_(Van) and CL_(Crea) was very good (r~2=0.88), but it was rather poor with CL_(CG) (r~2=0.37) and was acceptable with GFR_(Hoek) (r~2=0.70). For VAN dose adjustments in ICU patients, determination of cystatin C may be an interesting and practical alternative to measured CL_(Crea), whereas the Cockcroft-Gault formula should be used with caution.