Risk factors for acute kidney injury associated with intravenous vancomycin in neurosurgical inpatients: a retrospective study.

PURPOSE: Vancomycin (VAN) is widely used in neurosurgical patients for intracranial infections. We aimed to assess the incidence and risk factors for VAN-associated acute kidney injury (VA-AKI) in this population. METHODS: A case-control study of patients who treated with vancomycin in neurosurgery from January 2020 to December 2022 was conducted. Demographics and potential risk factors were collected. Multivariate logistic regression analyses were performed to identify risk factors for VA-AKI. AKI was defined according to the Kidney Disease Improving Global Outcomes Guidelines (KDIGO). RESULTS: A total of 345 patients participated with a VA-AKI incidence of 17.1% (59 cases). Among them, 15 patients had renal impairment (Stage 2 or higher), and 2 required dialysis. With univariate analysis and binary logistic regression analysis, we found that the use of mannitol (OR: 4.164; 95% CI: 1.606-10.792; P = 0.003), loop diuretics (OR: 3.371; 95% CI: 1.633-6.958; P = 0.001), three or more antimicrobial applications (OR: 3.623; 95% CI: 1.600-8.206; P = 0.002), diastolic blood pressure 80-89 mm Hg (OR: 5.532; 95% CI: 1.677-18.250; P = 0.005) and diastolic blood pressure ≥ 90 mm Hg (OR: 6.845; 95% CI: 1.518-30.866; P = 0.012) were independent risk factors for VA-AKI. In addition, according to the Youden Index, the trough concentration of vancomycin should not exceed 15.845 mg/L. CONCLUSION: The incidence of VA-AKI in neurosurgical patients was 17.1%. The concomitant use of mannitol and loop diuretics, along with higher diastolic blood pressure and the combined use of more than three antimicrobial agents, were associated with an increased risk of neurosurgical VA-AKI.

[Pre-operation application of recombinant human growth hormone for liver cirrhosis with portal hypertension and hypoproteinemia].

OBJECTIVE: To evaluate the effectiveness of pre-operation use of recombinant human growth Sixty patients with hormone (rhGH) for liver cirrhosis with portal hypertension and hypoproteinemia. METHODS: Sixty patients with liver cirrhosis and portal hypertension and hypoproteinemia (child's class B) were randomly divided into control group (n = 30) and rhGH group (n = 30). The patients in the rhGH group were given subcutaneously growth hormone at a dose of 4 i.u. per day for five days before operation. All patients were given the same parenteral nutrition before operation. The levels of albumin, globulin, prealbumin, and blood sugar were measured before and 3, 4, and 5 days after given the hormone. Results The prealbumin increased 3 days after given the hormone (P < 0.05), while the albumin increased 5 days after given the hormone (P < 0.05). The general condition and the quality of life of the patients receiving the hormone improved. No side effects had been found. The blood sugar and globulin did not change over time in both groups. CONCLUSION: The pre-operation use of the recombinant human growth hormone may benefit to the alleviation of hypoproteinemia and to the improvement of the quality of life of the patients with liver cirrhosis and portal hypertension and hypoproteinemia when combined with the use of parenteral nutrition.