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Indocyanine green clearance test as a predictor of linezolid overexposure in septic patients

Ying Xu,Chen Qu, Ming Yan,Qin Gu, Ning Liu

INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS(2023)

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摘要
Objectives: Hepatic impairment increases the risk of drug overexposure in septic patients. However, there is a lack of effective indicators to predict overexposure risk. The indocyanine green (ICG) clearance test is a helpful method for dynamically assessing hepatic function and perfusion. This study aimed to investigate whether the ICG test could serve as a potential predictor of linezolid trough concentration (C-min) and to compare its efficacy with that of conventional liver function markers.Methods: A total of 35 consecutive septic patients treated with linezolid were grouped into either linezolid C-min of <= 7 mu g/mL or >7 mu g/mL. Correlations between linezolid C-min and ICG-PDR (plasma disappearance rate), ICG-R15 (retention ratio after 15 min) and other traditional indicators were analysed by Spearman's rank test. A multivariable regression model was employed to discern factors contributing independently to overexposure.Results: Statistical differences were observed between groups for APACHE II score ( P = 0.031), SOFA score ( P = 0.018), creatinine clearance (CLCr) ( P = 0.003), thrombocytes ( P = 0.039), lactate ( P = 0.003), ICG-PDR ( P < 0.001) and ICG-R15 ( P < 0.001). Moreover, linezolid C-min was correlated with ICG-PDR (rho = -0.628, P < 0.001), ICG-R15 (rho = 0.676, P < 0.001) and CLCr (rho = -0.503, P = 0.002). ICG-PDR was identified as an independent predictor of linezolid overexposure, with an optimal cut-off value of 17.70%/min (93.3% sensitivity, 85.0% specificity; P < 0.001).Conclusions: This pilot clinical trial represents the first investigation of potential of the ICG test to predict linezolid overexposure in septic patients.(c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )
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关键词
Indocyanine green clearance,Liver function,Linezolid,Trough concentration,Sepsis
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