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: March 16, 2021
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.
