Serum cystatin C predicts vancomycin trough levels better than serum creatinine in hospitalized patients: a cohort study

Frazee, Erin N; Rule, Andrew D; Herrmann, Sandra M; Kashani, Kianoush B; Leung, Nelson; Virk, Abinash; Voskoboev, Nikolay; Lieske, John C

doi:10.1186/cc13899

Critical Care

Table 3 Predictive models for vancomycin trough level, mg/L

From: Serum cystatin C predicts vancomycin trough levels better than serum creatinine in hospitalized patients: a cohort study

Model variable^a	Beta	P value	Model fit (R²)	Target trough achievement (95% CI)
Model 1: log creatinine			0.306	35% (28%-42%)
Intercept	9.10	0.002
Age, years	0.0886	0.002
Male	−2.30	0.02
Weight, kg	−0.0136	0.004
Vancomycin total dose, g	3.28	<0.001
Every 8-hour interval	3.18	0.1
Every 12-hour interval	REF	-
Every 24-hour interval	−6.61	<0.001
Log baseline creatinine	8.80	<0.001
Model 2: log cystatin C			0.559	52% (45%-59%)
Intercept	10.2	<0.001
Age, years	−0.00578	0.8
Male	−2.32	0.004
Weight, kg	−0.0708	0.05
Vancomycin total dose, g	2.50	<0.001
Every 8-hour interval	4.25	0.009
Every 12-hour interval	REF	-
Every 24-hour interval	−6.66	<0.001
Log baseline cystatin C	12.6	<0.001
Model 3: log creatinine and log cystatin C			0.575	53% (45%-60%)
Intercept	11.5	<0.001
Age, years	0.00582	0.8
Male	−2.64	0.001
Weight, kg	−0.0931	0.01
Vancomycin total dose, g	2.70	<0.001
Every 8-hour interval	4.15	0.009
Every 12-hour interval	REF	-
Every 24-hour interval	−7.90	<0.001
Log baseline creatinine	2.89	0.01
Log baseline cystatin C	11.3	<0.001
Model 4: eGFR with Cockcroft-Gault			0.269	33% (26% - 40%)
Intercept	10.3	<0.001
Vancomycin total dose, g	2.66	<0.001
Every 8-hour interval	3.20	0.1
Every 12-hour interval	REF	-
Every 24-hour interval	−4.11	0.008
eGFR with Cockcroft-Gault, mL/min	−0.0704	<0.001
Model 5: eGFR with CKD-EPI _creatinine			0.394	38% (31%-46%)
Intercept	16.4	<0.001
Vancomycin total dose, g	3.35	<0.001
Every 8-hour interval	3.47	0.06
Every 12-hour interval	REF	-
Every 24-hour interval	−7.58	<0.001
eGFR with CKD-EPI_creatinine, mL/min^b	−0.163	<0.001
Model 6: eGFR with CKD-EPI _{cystatin C}			0.538	51% (44%-59%)
Intercept	14.3	<0.001
Vancomycin total dose, g	2.61	<0.001
Every 8-hour interval	4.91	<0.001
Every 12-hour interval	REF	-
Every 24-hour interval	−5.94	<0.001
eGFR with CKD-EPI_{cystatin C}, mL/min^b	−0.134	<0.001
Model 7: eGFR with CKD-EPI _{creatinine-cystatin C}			0.580	54% (45%-61%)
Intercept	16.7	<0.001
Vancomycin total dose, g	2.95	<0.001
Every 8-hour interval	4.84	0.002
Every 12-hour interval	REF	-
Every 24-hour interval	−7.70	<0.001
eGFR with CKD-EPI_{creatinine-cystatin C}, mL/min^b	−0.163	<0.001

^aVancomycin total dose represents the cumulative grams of vancomycin given prior to trough level being drawn. Per the study definition, this represents three doses of vancomycin therapy. ^bTo convert from milliliters per minute per 1.73², multiply by [(0.007184*height (cm)^0.725*weight (kg)^0.425)/1.73] [37]. CI, confidence interval; CKD-EPI, Chronic Kidney Disease Epidemiology Collaborative; eGFR, estimated glomerular filtration rate; REF, reference.

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