Prevalence of polymyxin-induced nephrotoxicity and its predictors in critically ill adult patients:A meta-analysis  

作　　者：Jiang-Lin Wang Bi-Xiao Xiang Xiao-Li Song Rui-Man Que Xiao-Cong Zuo Yue-Liang Xie 

机构地区：[1]Department of Pharmacy,The Third Xiangya Hospital of Central South University,Changsha 410013,Hunan Province,China [2]Department of Pharmacy,Sanya Central Hospital,Sanya 572000,Hainan Province,China

出　　处：《World Journal of Clinical Cases》2022年第31期11466-11485,共20页世界临床病例杂志

基　　金：Supported by The Hunan Province Natural Science Foundation,No.2022JJ80043;Nature Science Foundation of Changsha,No.kq2014268;Hunan Engineering Research Center of Intelligent Prevention and Control for Drug Induced Organ Injury,No.40;Scientific Research Fund Project of Hunan Pharmaceutical Society,No.2020YXH010.

摘　　要：BACKGROUND Polymyxin-induced nephrotoxicity is a major safety concern in clinical practice due to long-term adverse outcomes and high mortality.AIM To conducted a systematic review and meta-analysis of the prevalence and potential predictors of polymyxin-induced nephrotoxicity in adult intensive care unit(ICU)patients.METHODS PubMed,EMBASE,the Cochrane Library and Reference Citation Analysis database were searched for relevant studies from inception through May 30,2022.The pooled prevalence of polymyxin-induced nephrotoxicity and pooled risk ratios of associated factors were analysed using a random-effects or fixed-effects model by Stata SE ver.12.1.Additionally,subgroup analyses and meta-regression were conducted to assess heterogeneity.RESULTS A total of 89 studies involving 12234 critically ill adult patients were included in the meta-analysis.The overall pooled incidence of polymyxin-induced nephrotoxicity was 34.8%.The pooled prevalence of colistin-induced nephrotoxicity was not higher than that of polymyxin B(PMB)-induced nephrotoxicity.The subgroup analyses showed that nephrotoxicity was significantly associated with dosing interval,nephrotoxicity criteria,age,publication year,study quality and sample size,which were confirmed in the univariable meta-regression analysis.Nephrotoxicity was significantly increased when the total daily dose was divided into 2 doses but not 3 or 4 doses.Furthermore,older age,the presence of sepsis or septic shock,hypoalbuminemia,and concomitant vancomycin or vasopressor use were independent risk factors for polymyxin-induced nephrotoxicity,while an elevated baseline glomerular filtration rate was a protective factor against colistin-induced nephrotoxicity.CONCLUSION Our findings indicated that the incidence of polymyxin-induced nephrotoxicity among ICU patients was high.It emphasizes the importance of additional efforts to manage ICU patients receiving polymyxins to decrease the risk of adverse outcomes.

关 键 词：Polymyxins NEPHROTOXICITY Critically ill adult patients Risk factors META-ANALYSIS 

分 类 号：R692[医药卫生—泌尿科学]