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Gillespie SL, Hanrahan TP, Rockey DC, Majumdar A, Hayes PC. Review article: controversies surrounding the use of carvedilol and other beta blockers in the management of portal hypertension and cirrhosis. Aliment Pharmacol Ther 2023; 57:454-463. [PMID: 36691947 DOI: 10.1111/apt.17380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/03/2022] [Accepted: 12/18/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Advanced chronic liver disease is an increasing cause of premature morbidity and mortality in the UK. Portal hypertension is the primary driver of decompensation, including the development of ascites, hepatic encephalopathy and variceal haemorrhage. Non-selective beta blockers (NSBB) reduce portal pressure and are well established in the prevention of variceal haemorrhage. Carvedilol, a newer NSBB, is more effective at reducing portal pressure due to additional α-adrenergic blockade and has additional anti-oxidant, anti-inflammatory and anti-fibrotic effects. AIM To summarise the available evidence on the use of beta blockers, specifically carvedilol, in cirrhosis, focussing on when and why to start METHODS: We performed a comprehensive literature search of PubMed for relevant publications. RESULTS International guidelines advise the use of NSBB in primary prophylaxis against variceal haemorrhage in those with high-risk varices, with substantial evidence of efficacy comparable with endoscopic band ligation (EBL). NSBB are also well established in secondary prophylaxis, in combination with EBL. More controversial is their use in patients without large varices, but with clinically significant portal hypertension. However, there is gathering evidence that NSBB, particularly carvedilol, reduce the risk of decompensation and improve survival. While caution is advised in patients with advanced cirrhosis and refractory ascites, recent evidence suggests that NSBB can continue to be used safely, and that premature discontinuation may be detrimental. CONCLUSIONS With increasing evidence of benefit independent of variceal bleeding, namely retardation of decompensation and improvement in survival, it is time to consider whether carvedilol should be offered to all patients with advanced chronic liver disease.
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Affiliation(s)
| | - Timothy P Hanrahan
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Australia
| | - Don C Rockey
- Digestive Disease Research Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Avik Majumdar
- Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Peter C Hayes
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK.,College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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2
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Hey P, Hoermann R, Gow P, Hanrahan TP, Testro AG, Apostolov R, Sinclair M. Reduced upper limb lean mass on dual energy X-ray absorptiometry predicts adverse outcomes in male liver transplant recipients. World J Transplant 2022; 12:120-130. [PMID: 35979539 PMCID: PMC9258268 DOI: 10.5500/wjt.v12.i6.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/24/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pre-transplant muscle wasting measured by computed tomography has been associated with adverse clinical outcomes after liver transplantation including increased rates of sepsis and hospitalisation days. Upper limb lean mass (LM) measured by dual-energy X-ray absorptiometry (DEXA) was recently identified as a novel predictor of sarcopenia-associated mortality in men waitlisted for transplantation.
AIM To investigate the use of DEXA LM in predicting gender-stratified early post-transplant outcomes.
METHODS Liver transplant recipients who underwent pre-transplant DEXA body composition imaging between 2002 and 2017 were included. Endpoints included post-transplant mortality and graft failure, bacterial infections, acute cellular rejection (ACR) and intensive care and total hospital length of stay.
RESULTS Four hundred and sixty-nine patients met inclusion criteria of which 338 were male (72%). Median age was 55.0 years (interquartile range 47.4, 59.7) and model for end-stage liver disease (MELD) score 16. Median time from assessment to transplantation was 7 mo (3.5, 12). Upper limb LM was inversely associated with bacterial infections at 180 d post-transplant (hazard ratio = 0.42; 95% confidence interval: 0.20-0.89; P = 0.024) in males only. There was a negative correlation between upper limb LM and intensive care (τb = -0.090, P = 0.015) and total hospital length of stay (τb = -0.10, P = 0.0078) in men. In women, neither MELD nor body composition parameters were associated with post-transplant adverse outcomes or increased length of stay. Body composition parameters, MELD and age were not associated with 90-d mortality or graft failure in either gender. There were no significant predictors of early ACR.
CONCLUSION Sarcopenia is an independent and potentially modifiable predictor of increased post-transplant bacterial infections and hospital length of stay in men with cirrhosis. DEXA upper limb LM provides a novel measure of muscle wasting that has prognostic value in this cohort. The lack of association in women requires further investigation.
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Affiliation(s)
- Penelope Hey
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- Department of Medicine, University of Melbourne, Melbourne 3052, Australia
| | - Rudolf Hoermann
- Department of Medicine, University of Melbourne, Melbourne 3052, Australia
| | - Paul Gow
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- Department of Medicine, University of Melbourne, Melbourne 3052, Australia
| | | | - Adam G Testro
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- Department of Medicine, University of Melbourne, Melbourne 3052, Australia
| | - Ross Apostolov
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- Department of Medicine, University of Melbourne, Melbourne 3052, Australia
| | - Marie Sinclair
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- Department of Medicine, University of Melbourne, Melbourne 3052, Australia
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3
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Hamblin PS, Wong R, Ekinci EI, Sztal-Mazer S, Balachandran S, Frydman A, Hanrahan TP, Hu R, Ket SN, Moss A, Ng M, Ragunathan S, Bach LA. Body mass index is inversely associated with capillary ketones at the time of colonoscopy: Implications for SGLT2i use. Clin Endocrinol (Oxf) 2022; 96:549-557. [PMID: 34697809 DOI: 10.1111/cen.14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/18/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been associated with diabetic ketoacidosis at the time of colonoscopy. This study aimed to identify factors associated with ketone concentrations in SGLT2i-treated type 2 diabetes compared with non-SGLT2i-treated diabetes, and those with impaired fasting glycaemia (IFG) and normoglycaemia. DESIGN Cross-sectional, multicentre, observational study June-December 2020 in four Australian tertiary hospitals. PARTICIPANTS Capillary glucose and ketones were measured in people undergoing colonoscopy: 37 SGLT2i-treated and 105 non-SGLT2i-treated type 2 diabetes, 65 IFG and 151 normoglycaemia. MEASUREMENTS Body mass index (BMI), age, glucose, fasting duration and where relevant, HbA1c and time since last SGLT2i dose. RESULTS In SGLT2i-treated diabetes, BMI (ρ = -0.43 [95% confidence interval: -0.67, -0.11]) and duration since last SGLT2i dose (ρ = -0.33 [-0.60, 0.00]) correlated negatively with increasing ketones, but there was no correlation with fasting duration. In non-SGLT2i-treated diabetes, BMI correlated negatively (ρ = -0.24 [-0.42, -0.05]) and fasting duration positively (ρ = 0.26 [0.07, 0.43]) with ketones. In IFG participants, only fasting duration correlated with ketones (ρ = 0.28 [0.03, 0.49]). In normoglycaemic participants, there were negative correlations with BMI (ρ = -0.20 [-0.35, -0.04]) and fasting glucose (ρ = -0.31 [-0.45, -0.15]) and positive correlations with fasting duration (ρ = 0.20 [0.04, 0.35]) and age (ρ = 0.19 [0.03, 0.34]). Multiple regression analysis of the entire cohort showed BMI, age and fasting glucose remained independently associated with ketones, but in SGLT2i-treated participants only BMI remained independently associated. CONCLUSIONS In SGLT2i-treated diabetes, lower BMI was a novel risk factor for higher ketones precolonoscopy. Pending larger confirmatory studies, extra vigilance for ketoacidosis is warranted in these people.
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Affiliation(s)
- Peter S Hamblin
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rosemary Wong
- Department of Endocrinology and Diabetes, Eastern Health, Melbourne, Victoria, Australia
- Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Elif I Ekinci
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shoshana Sztal-Mazer
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | | | - Aviva Frydman
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Victoria, Australia
| | - Timothy P Hanrahan
- Department of Gastroenterology and Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Raymond Hu
- Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Shara N Ket
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
| | - Alan Moss
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endoscopic Services, Western Health, Melbourne, Victoria, Australia
| | - Mark Ng
- Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Anaesthesia, Pain and Perioperative Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Sashikala Ragunathan
- Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia
- Gastroenterological Nurses College of Australia, Melbourne, Victoria, Australia
| | - Leon A Bach
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine (Alfred), Monash University, Melbourne, Victoria, Australia
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4
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Hamblin PS, Wong R, Ekinci EI, Sztal-Mazer S, Balachandran S, Frydman A, Hanrahan TP, Hu R, Ket SN, Moss A, Ng M, Ragunathan S, Bach LA. Response to Comment on Hamblin et al. Capillary Ketone Concentrations at the Time of Colonoscopy: A Cross-Sectional Study With Implications for SGLT2 Inhibitor-Treated Type 2 Diabetes. Diabetes Care 2021;44:e124-e126. Diabetes Care 2022; 45:e17-e18. [PMID: 34986256 DOI: 10.2337/dci21-0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Peter S Hamblin
- 1Department of Endocrinology & Diabetes, Western Health, Melbourne, Australia.,2Department of Medicine, Western Health, The University of Melbourne, Australia
| | - Rosemary Wong
- 3Department of Endocrinology and Diabetes, Eastern Health, Melbourne, Australia.,4Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Elif I Ekinci
- 5Department of Endocrinology, Austin Health, Melbourne, Australia.,6Melbourne Medical School, The University of Melbourne, Australia
| | - Shoshana Sztal-Mazer
- 7Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia.,8School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,9Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | | | - Aviva Frydman
- 1Department of Endocrinology & Diabetes, Western Health, Melbourne, Australia
| | - Timothy P Hanrahan
- 10Department of Gastroenterology and Liver Transplant Unit, Austin Health, Melbourne, Australia
| | - Raymond Hu
- 6Melbourne Medical School, The University of Melbourne, Australia.,11Department of Anaesthesia, Austin Health, Melbourne, Australia
| | - Shara N Ket
- 12Department of Gastroenterology, Alfred Health, Melbourne, Australia
| | - Alan Moss
- 2Department of Medicine, Western Health, The University of Melbourne, Australia.,13Department of Endoscopic Services, Western Health, Melbourne, Australia
| | - Mark Ng
- 4Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,14Department of Anaesthesia, Pain and Perioperative Medicine, Eastern Health, Melbourne, Australia
| | - Sashikala Ragunathan
- 15Department of Gastroenterology, Austin Health, Melbourne, Australia.,16Gastroenterological Nurses College of Australia, Melbourne, Australia
| | - Leon A Bach
- 7Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia.,17Department of Medicine, Central Clinical School Monash University, Victoria, Australia
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5
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Hamblin PS, Wong R, Ekinci EI, Sztal-Mazer S, Balachandran S, Frydman A, Hanrahan TP, Hu R, Ket SN, Moss A, Ng M, Ragunathan S, Bach LA. Capillary Ketone Concentrations at the Time of Colonoscopy: A Cross-Sectional Study With Implications for SGLT2 Inhibitor-Treated Type 2 Diabetes. Diabetes Care 2021; 44:e124-e126. [PMID: 33896795 PMCID: PMC8247528 DOI: 10.2337/dc21-0256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/06/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Peter S Hamblin
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Australia .,Department of Medicine, Western Health, The University of Melbourne, Melbourne, Australia
| | - Rosemary Wong
- Department of Endocrinology and Diabetes, Eastern Health, Melbourne, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Elif I Ekinci
- Department of Endocrinology, Austin Health, Melbourne, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Shoshana Sztal-Mazer
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | | | - Aviva Frydman
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Australia
| | - Timothy P Hanrahan
- Department of Gastroenterology and Liver Transplant Unit, Austin Health, Melbourne, Australia
| | - Raymond Hu
- Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Department of Anaesthesia, Austin Health, Melbourne, Australia
| | - Shara N Ket
- Department of Gastroenterology, Alfred Health, Melbourne, Australia
| | - Alan Moss
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, Australia.,Department of Endoscopic Services, Western Health, Melbourne, Australia
| | - Mark Ng
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Department of Anaesthesia, Pain and Perioperative Medicine, Eastern Health, Melbourne, Australia
| | - Sashikala Ragunathan
- Department of Gastroenterology, Austin Health, Melbourne, Australia.,Gastroenterological Nurses College of Australia, Melbourne, Australia
| | - Leon A Bach
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia.,Department of Medicine (Alfred), Monash University, Victoria, Australia
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6
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Hanrahan TP, Goodwin M, Testro A. An Extraordinary Cause of Dyspnea and Weight Loss. Gastroenterology 2021; 160:e19-e20. [PMID: 32673693 DOI: 10.1053/j.gastro.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Timothy P Hanrahan
- Liver and Intestinal Transplant Unit, Austin Health, Melbourne, Victoria, Australia.
| | - Mark Goodwin
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Adam Testro
- Liver and Intestinal Transplant Unit, Austin Health, Melbourne, Victoria, Australia
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7
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Hanrahan TP, Lubel JS, Garg M. Lessons From COVID-19, ACE2, and Intestinal Inflammation: Could a Virus Trigger Chronic Intestinal Inflammation? Clin Gastroenterol Hepatol 2021; 19:206. [PMID: 32712394 PMCID: PMC7376351 DOI: 10.1016/j.cgh.2020.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Timothy P Hanrahan
- Department of Gastroenterology, Northern Hospital, Melbourne, Victoria, Australia
| | - John S Lubel
- Department of Gastroenterology, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Mayur Garg
- Department of Gastroenterology, Northern Hospital, Department of Gastroenterology, Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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8
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Hey P, Hanrahan TP, Sinclair M, Testro AG, Angus PW, Peterson A, Warrillow S, Bellomo R, Perini MV, Starkey G, Jones RM, Fink M, McClure T, Gow P. Epidemiology and outcomes of acute liver failure in Australia. World J Hepatol 2019; 11:586-595. [PMID: 31388400 PMCID: PMC6669190 DOI: 10.4254/wjh.v11.i7.586] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/19/2019] [Accepted: 07/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute liver failure (ALF) is a life-threatening syndrome with varying aetiologies requiring complex care and multidisciplinary management. Its changing incidence, aetiology and outcomes over the last 16 years in the Australian context remain uncertain.
AIM To describe the changing incidence, aetiology and outcomes of ALF in South Eastern Australia.
METHODS The database of the Victorian Liver Transplant Unit was interrogated to identify all cases of ALF in adults (> 16 years) in adults hospitalised between January 2002 and December 2017. Overall, 169 patients meeting criteria for ALF were identified. Demographics, aetiology of ALF, rates of transplantation and outcomes were collected for all patients. Transplant free survival and overall survival (OS) were assessed based on survival to discharge from hospital. Results were compared to data from a historical cohort from the same unit from 1988-2001.
RESULTS Paracetamol was the most common aetiology of acute liver failure, accounting for 50% of cases, with an increased incidence compared with the historical cohort (P = 0.046). Viral hepatitis and non-paracetamol drug or toxin induced liver injury accounted for 15% and 10% of cases respectively. Transplant free survival (TFS) improved significantly compared to the historical cohort (52% vs 38%, P = 0.032). TFS was highest in paracetamol toxicity with spontaneous recovery in 72% of cases compared to 31% of non-paracetamol ALF (P < 0.001). Fifty-nine patients were waitlisted for emergency liver transplantation. Nine of these died while waiting for an organ to become available. Forty-two patients (25%) underwent emergency liver transplantation with a 1, 3 and 5 year survival of 81%, 78% and 72% respectively.
CONCLUSION Paracetamol toxicity is the most common aetiology of ALF in South-Eastern Australia with a rising incidence over 30 years. TFS has improved, however it remains low in non-paracetamol ALF.
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Affiliation(s)
- Penelope Hey
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | | | - Marie Sinclair
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Adam G Testro
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Peter W Angus
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Adam Peterson
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
| | - Stephen Warrillow
- Department of Intensive Care, Austin Heath, Melbourne 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Heath, Melbourne 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Marcos V Perini
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Graham Starkey
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Robert M Jones
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Michael Fink
- Department of Surgery, Austin Health, Melbourne 3084, Australia
| | - Tess McClure
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Paul Gow
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
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9
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Affiliation(s)
- Timothy P Hanrahan
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jeffrey Lipman
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia. .,Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Jason A Roberts
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Pharmacy Department, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
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10
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Hanrahan TP, Kotapati C, Roberts MJ, Rowland J, Lipman J, Roberts JA, Udy A. Factors associated with vancomycin nephrotoxicity in the critically ill. Anaesth Intensive Care 2015; 43:594-9. [PMID: 26310409 DOI: 10.1177/0310057x1504300507] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Vancomycin is a glycopeptide antibiotic commonly used in the management of methicillin-resistant Staphylococcus aureus infection. The recent increase in prevalence of methicillin-resistant Staphylococcus aureus with reduced susceptibility to vancomycin has prompted experts to advocate for higher target trough serum concentrations. This study aimed to evaluate the potential consequences of more aggressive vancomycin therapy, by examining the association between higher serum concentrations and acute kidney injury (AKI) in a population of critically ill patients. We collected data for all patients who received vancomycin over a five-year period and evaluated the prevalence of new-onset AKI using the Risk, Injury, Failure, Loss and End-stage (RIFLE) kidney disease criteria. One-hundred and fifty-nine patients provided complete data, with 8.8% manifesting new onset AKI while receiving vancomycin. The median age was 57 (44 to 68) years, while the median trough serum concentration was 16 (10 to 19) mg/l. Multivariate logistic regression analysis identified mean trough concentration (OR=1.174, P=0.024), APACHE II score (OR=1.141, P=0.012) and simultaneous aminoglycoside prescription (OR=18.896, P=0.002) as significant predictors of AKI. These data suggest higher trough vancomycin serum concentrations are associated with greater odds of AKI in the critically ill.
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Affiliation(s)
- T P Hanrahan
- Co-First Author, Resident Medical Officer, Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital and Burns Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland
| | - C Kotapati
- Co-First Author, Registrar, Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Queensland
| | - M J Roberts
- Resident Medical Officer, Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital and Burns Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland
| | - J Rowland
- Medical Student, Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Queensland
| | - J Lipman
- Director and Consultant Intensivist, Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital and Burns Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland
| | - J A Roberts
- Consultant Pharmacist, Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital and Burns Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland
| | - A Udy
- Consultant Intensivist, Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria
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