Relationship Between Mean Vancomycin Trough Concentration and Mortality in Critically Ill Patients: A Multicenter...

Area of Science:

• Pharmacology
• Critical Care Medicine
• Clinical Pharmacy

Background:

• The clinical significance of mean vancomycin trough concentration (VTC) for critically ill patients remains uncertain.
• This study investigated the association between mean VTC and mortality in intensive care unit (ICU) patients.

Purpose of the Study:

• To determine if mean VTC, calculated from the entire vancomycin therapy course, impacts mortality in critically ill patients.
• To explore the relationship between different VTC ranges and patient outcomes in the ICU.

Main Methods:

• A retrospective cohort study of 3,603 adult ICU patients with at least two VTC measurements.
• Mean VTC was analyzed as both a continuous and categorical variable (<10, 10-15, 15-20, >20 mg/L).
• Multivariable logistic regression and subgroup analyses were used to assess mortality associations.

Main Results:

• Mean VTC, as a continuous variable, showed a positive correlation with both ICU and hospital mortality.
• VTC levels of 10-15 mg/L and 15-20 mg/L were not associated with reduced mortality.
• VTC levels of 15-20 mg/L and >20 mg/L were linked to significantly higher ICU mortality, and >20 mg/L to higher hospital mortality.

Conclusions:

• Mean VTC was not associated with decreased ICU or hospital mortality in critically ill patients.
• The findings suggest that routine VTC monitoring may not guarantee vancomycin efficacy in the ICU setting.
• Higher mean VTC levels appear to be associated with increased mortality risk.