High creatinine clearance in critically ill patients with community-acquired acute infectious meningitis

BMC Nephrology

Bertrand Souweine²  Anne-Elisabeth Heng²  Vincent Tixier³  Ali AitHssain³  Lemlih Ouchchane¹  Thuy-Nga Phan³  Alexandre Lautrette² 

[1] Departments of Biostatistics, University hospital of Clermont-Ferrand, Clermont-Ferrand, France;Univ Clermont 1, UFR Médecine, Clermont-Ferrand, F-63001, France;Departments of Intensive Care Unit and Nephrology, University hospital of Clermont-Ferrand, Clermont-Ferrand, France

关键词: Meningitis;    High creatinine clearance;    Glomerular filtration rate;    Critically ill;   

Others  :  1083087
DOI  :  10.1186/1471-2369-13-124

 received in 2012-05-29, accepted in 2012-09-22,  发布年份 2012

【 摘 要 】

Background

A high dose of anti-infective agents is recommended when treating infectious meningitis. High creatinine clearance (CrCl) may affect the pharmacokinetic / pharmacodynamic relationships of anti-infective drugs eliminated by the kidneys. We recorded the incidence of high CrCl in intensive care unit (ICU) patients admitted with meningitis and assessed the diagnostic accuracy of two common methods used to identify high CrCl.

Methods

Observational study performed in consecutive patients admitted with community-acquired acute infectious meningitis (defined by >7 white blood cells/mm³ in cerebral spinal fluid) between January 2006 and December 2009 to one medical ICU. During the first 7 days following ICU admission, CrCl was measured from 24-hr urine samples (24-hr-UV/P creatinine) and estimated according to Cockcroft-Gault formula and the simplified Modification of Diet in Renal Disease (MDRD) equation. High CrCl was defined as CrCl >140 ml/min/1.73 m² by 24-hr-UV/P creatinine. Diagnostic accuracy was performed with ROC curves analysis.

Results

Thirty two patients were included. High CrCl was present in 8 patients (25%) on ICU admission and in 15 patients (47%) during the first 7 ICU days for a median duration of 3 (1-4) days. For the Cockcroft-Gault formula, the best threshold to predict high CrCl was 101 ml/min/1.73 m² (sensitivity: 0.96, specificity: 0.75, AUC = 0.90 ± 0.03) with a negative likelihood ratio of 0.06. For the simplified MDRD equation, the best threshold to predict high CrCl was 108 ml/min/1.73 m² (sensitivity: 0.91, specificity: 0.80, AUC = 0.88 ± 0.03) with a negative likelihood ratio of 0.11. There was no difference between the estimated methods in the diagnostic accuracy of identifying high CrCl (p = 0.30).

Conclusions

High CrCl is frequently observed in ICU patients admitted with community-acquired acute infectious meningitis. The estimated methods of CrCl could be used as a screening tool to identify high CrCl.

【 授权许可】

   
2012 Lautrette et al.; licensee BioMed Central Ltd.

【 图 表 】

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