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Increased glomerular filtration in the critically ill patient receiving anti-infective treatment
Critical Care volume 14, Article number: P509 (2010)
Little is known about the occurrence of increased glomerular filtration rates (GFR) in critically ill patients. Increased GFR may in theory lead to subtherapeutic concentrations of life-saving drugs. The aim of this study was to evaluate the occurrence rate and pattern of increased GFR in critically ill patients receiving anti-infective treatment (AIT).
Prospective evaluation of consecutive ICU patients during a 6-week period, treated with anti-infective drugs, either therapeutically or prophylactically; dialysed patients were excluded. Patient characteristics: retrieved from the computerized Intensive Care Information System. Surrogate measure for GFR: the 24-hour urinary creatinine clearance (Ccr) calculated per day of AIT. Increased GFR: Ccr >120 ml/minute. Statistical analysis with SPSS 17.0: Student's t test, chi-square or Fisher's exact test. Data expression: median and interquartile range (IQR). Multivariate analysis: logistic regression analysis with increased GFR as dependent variable.
One hundred and forty-one (94 male) patients were included; median age was 59.9 (50.3 to 70.1); 80 (56.7%) were surgical ICU (SICU) patients. Most common infection types were pneumonia (59.2%) and intra-abdominal infection (9.9%). Prophylactic use was 17.6% of all AIT. Median length of stay 4.6 days; ICU mortality 5.7%. Median Ccr in the whole patient group was 97.0 ml/minute (57.5 to 164.5). In total, 753 AIT days were available for analysis in which 302 days of increased GFR were present (40.1%). Seventy-six patients (53.9%) had an episode of increased GFR at some time during AIT. In 31 patients (22.0%) GFR was increased throughout the whole episode of AIT. Patients with increased GFR were significantly younger (54.2 vs 65.6, P < 0.001) and there was a trend towards a higher incidence of increased GFR in patients treated for infections, in male and in SICU patients. Multivariate analysis showed that age (OR 0.93 per year), therapeutic administration of AIT (OR 5.49), and SICU admission (OR 2.27) were independently associated with increased GFR.
Increased GFR were a frequent finding in critically ill patients receiving AIT, and was associated with younger age and SICU admission.
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Claus, B., Colpaert, K., Hoste, E. et al. Increased glomerular filtration in the critically ill patient receiving anti-infective treatment. Crit Care 14, P509 (2010). https://doi.org/10.1186/cc8741
- Glomerular Filtration Rate
- Urinary Creatinine
- Infection Type
- Theory Lead
- Therapeutic Administration