赛斯塔丁C在预测Cefepime清除中优于肌素 在儿童干细胞移植接受者中
H Rhodes Hambrick1, Lin Fei2, Kathryn Pavia3
1Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Translational and Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Transplantation and cellular therapy
|March 24, 2024
概括
囊素C (CysC) 估计的淋巴球过率 (eGFR) 比血清肌素 (SCr) 更好地预测儿科血型干细胞移植 (HSCT) 患者的塞费皮姆清除率. 在eGFR计算中包括CysC可确保足够的塞费皮姆剂量,优化抗菌疗效.
科学领域:
- 药理动力学和药理动力学
- 儿科血液学/瘤学
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 儿童造血干细胞移植 (HSCT) 患者面临败血症和功能改变的风险.
- 在HSCT后使用的抗生素Cefepime需要根据功能进行剂量调整,以获得最佳的疗效.
- 血清肌素 (SCr) 是一个不可靠的生物标志物,用于估计由于肌肉质量变化的原因,HSCT患者的淋巴膜过率 (eGFR).
研究的目的:
- 为了评估eGFR如何影响cefepime在儿科HSCT患者中达到药理动力学/药理动力学 (PK/PD) 目标.
- 确定估计GFR (SCr,Cystatin C [CysC]或组合) 的最佳方法,以预测cefepime清除率.
- 在这个人群中确定cefepime清除的额外预测因子.
主要方法:
- 对接受至少两剂cefepime的儿科HSCT患者的潜在招募.
- 测量塞费皮姆度,SCr和CysC的测量.
- 使用儿科专用方程和贝叶斯估计的cefepime清除率计算eGFR.
主要成果:
- 基于CysC的EGFR (单独或与SCr结合) 预测了Cefepime清除比SCr-eGFR更准确.
- 较低的SCr-和CysC-eGFR与实现cefepime的PK/PD目标 (例如,%fT>1xMIC) 有关.
- 诸如血红蛋白病变,移植前状态和氨尿素抑制剂使用等因素影响了塞费皮姆的清除.
结论:
- 基于cystatin C的eGFR估计对于优化儿科HSCT患者的cefepime剂量至关重要.
- 较高的CysC-eGFR值与达到治疗性塞费皮姆度的可能性降低相关.
- 使用CysC进行准确的功能评估对于防止Cefepime剂量不足和确保治疗有效性至关重要.
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