Comparison between area under the concentration-time curve and trough concentration in guiding the vancomycin treatment for critically ill patients by randomized controlled clinical trials

Wang Rui; He Nannan; Xi Zhenchuang; Luo Yannian; Gao Xuehua; Li Meiling; Cao Wen

doi:10.3969/j.issn.1002-1949.2024.11.014

Abstract：Objective To compare the clinical safety and efficacy of two therapeutic drug monitoring methods including area under the concentration-time curve and trough concentration in critically ill patients receiving vancomycin treatment.Methods The patients of Gram-positive bacterial infection with vancomycin treatment admitted to the Intensive Care Unit of the Second Hospital of Lanzhou University from January 2021 to December 2023 were enrolled and divided into two groups by random number table method for prospective,randomized,single-blind,controlled trial.The vancomycin trough concentration of 10-20 mg/L was regarded as the target value in the control group,and the area under the concentration-time curve of vancomycin(400-600 mg·h/L)was regarded as the target value in the observation group.After therapeutic drug monitoring,77 cases in the control group and 79 cases in the observation group finally met the target value range,the relevant statistical analysis and comparison were conducted.Results The incidence of vancomycin-associated acute kidney injury(AKI)in the observation group was significantly lower than that in the control group(P=0.002).There was no significant difference in clinical efficacy and total treatment time between the two groups.Multivariate Logistic regression analysis showed that trough concentration(OR=1.021,95％CI 1.019-1.577,P=0.033)and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score(OR=1.189,95％CI 1.055-1.339,P=0.004)were independent risk factors for vancomycin-associated AKI.Total sampling number(OR=0.476,95％CI 0.247-0.917,P=0.000)was an independent risk factor for clinical outcomes.Receiver operating characteristic(ROC)curve analysis showed that the critical value of trough concentration for predicting vancomycin-associated AKI was 15.65 mg/L,with a sensitivity of 0.786,a specificity of 0.697 and area under ROC curve of 0.727.Conclusions The drug monitoring method based on area under the concentration-time curve as the target value can decrease the incidence of vancomycin-associated AKI,and the clinical efficacy is not different.