Analysis on correlation between plasma polymyxin B concentration and risk of acute kidney injury

LI Boren; WEI Ruhua; CHEN Xiaoyu; LI Yan; ZHANG Li; WEI Shuilin; TAN Sitao; GUO Qiuyan

doi:10.3969/j.issn.1674-3806.2026.01.13

Abstract：Objective To analyze the correlation between plasma polymyxin B concentration and risk of acute kidney injury(AKI).Methods A retrospective analysis was conducted on the clinical data of 53 patients who were hospitalized and treated with polymyxin B in the People's Hospital of Guangxi Zhuang Autonomous Region from April 1 2024 to August 8,2024.After 3 doses of polymyxin B were administered for the patients to reach steady state,2-3 mL of their venous blood was collected 30 minutes before the next dose was administered.A mass spectrometer YS EXACT 9900MD was used to detect plasma polymyxin B concentration.The effect of polymyxin B combined with nephrotoxic antibiotics on the serum creatinine levels of the patients was analyzed.The effect of the use of polymyxin B on the renal function indicators of the patients was analyzed.Multivariate logistic regression was used to analyze the influencing factors for the occurrence of AKI after the administration of polymyxin B.Results Compared with the use of polymyxin B in no combination with nephrotoxic antibiotics,the combination of polymyxin B and nephrotoxic antibiotics did not significantly affect the serum creatinine levels of the patients(P＞0.05).Compared with those of the patients before the administration of polymyxin B,the serum creatinine and urea levels of the patients increased,while the creatinine clearance rate decreased after the administration of polymyxin B,and the differences were statistically significant(P＜0.05).The results of multivariate logistic regression analysis showed that a higher level of plasma polymyxin B concentration was an independent risk factor for the occurrence of AKI after the administration of polymyxin B[OR(95%CI)=1.874(1.220-2.879),P=0.004].The results of receiver operating characteristic(ROC)curve analysis showed that plasma polymyxin B concentration could effectively predict the occurrence of AKI[AUC(95%CI)=0.734(0.599-0.868),P=0.004],with an optimal cut-off value of 3.18 mg/L,a corresponding sensitivity of 65.4%,and a specificity of 77.8%.Conclusion After receiving polymyxin B treatment,the patients' serum creatinine and urea levels increase.The occurrence of AKI is closely related to plasma polymyxin B concentration.Clinicians should conduct monitoring of plasma polymyxin B concentration during the treatment process to precisely adjust the medication regimen.