Cargando…

Association between voriconazole exposure and Sequential Organ Failure Assessment (SOFA) score in critically ill patients

Therapeutic drug monitoring (TDM) is essential for voriconazole to ensure optimal drug exposure, mainly in critically ill patients for whom voriconazole demonstrated a large variability. The study aimed at describing factors associated with trough voriconazole concentrations in critically ill patien...

Descripción completa

Detalles Bibliográficos
Autores principales: Bienvenu, Anne-Lise, Pradat, Pierre, Plesa, Alexandra, Leclerc, Vincent, Piriou, Vincent, Fellahi, Jean-Luc, Argaud, Laurent, Rimmelé, Thomas, Menotti, Jean, Aubrun, Frédéric, Richard, Jean-Christophe, Gagnieu, Marie-Claude, Parant, François, Chidiac, Christian, Leboucher, Gilles, Tod, Michel, Goutelle, Sylvain
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8612507/
https://www.ncbi.nlm.nih.gov/pubmed/34818379
http://dx.doi.org/10.1371/journal.pone.0260656
_version_ 1784603460586438656
author Bienvenu, Anne-Lise
Pradat, Pierre
Plesa, Alexandra
Leclerc, Vincent
Piriou, Vincent
Fellahi, Jean-Luc
Argaud, Laurent
Rimmelé, Thomas
Menotti, Jean
Aubrun, Frédéric
Richard, Jean-Christophe
Gagnieu, Marie-Claude
Parant, François
Chidiac, Christian
Leboucher, Gilles
Tod, Michel
Goutelle, Sylvain
author_facet Bienvenu, Anne-Lise
Pradat, Pierre
Plesa, Alexandra
Leclerc, Vincent
Piriou, Vincent
Fellahi, Jean-Luc
Argaud, Laurent
Rimmelé, Thomas
Menotti, Jean
Aubrun, Frédéric
Richard, Jean-Christophe
Gagnieu, Marie-Claude
Parant, François
Chidiac, Christian
Leboucher, Gilles
Tod, Michel
Goutelle, Sylvain
author_sort Bienvenu, Anne-Lise
collection PubMed
description Therapeutic drug monitoring (TDM) is essential for voriconazole to ensure optimal drug exposure, mainly in critically ill patients for whom voriconazole demonstrated a large variability. The study aimed at describing factors associated with trough voriconazole concentrations in critically ill patients and evaluating the impact of voriconazole concentrations on adverse effects. A 2-year retrospective multicenter cohort study (NCT04502771) was conducted in six intensive care units. Adult patients who had at least one voriconazole TDM were included. Univariable and multivariable linear regression analyses were performed to identify predictors of voriconazole concentrations, and univariable logistic regression analysis, to study the relationship between voriconazole concentrations and adverse effects. During the 2-year study period, 70 patients were included. Optimal trough voriconazole concentrations were reported in 37 patients (52.8%), subtherapeutic in 20 (28.6%), and supratherapeutic in 13 (18.6%). Adverse effects were reported in six (8.6%) patients. SOFA score was identified as a factor associated with an increase in voriconazole concentration (p = 0.025), mainly in the group of patients who had SOFA score ≥ 10. Moreover, an increase in voriconazole concentration was shown to be a risk factor for occurrence of adverse effects (p = 0.011). In that respect, critically ill patients who received voriconazole treatment must benefit from a TDM, particularly if they have a SOFA score ≥ 10. Indeed, identifying patients who are overdosed will help to prevent voriconazole related adverse effects. This result is of utmost importance given the recognized COVID-19-associated pulmonary aspergillosis in ICU patients for whom voriconazole is among the recommended first-line treatment.
format Online
Article
Text
id pubmed-8612507
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-86125072021-11-25 Association between voriconazole exposure and Sequential Organ Failure Assessment (SOFA) score in critically ill patients Bienvenu, Anne-Lise Pradat, Pierre Plesa, Alexandra Leclerc, Vincent Piriou, Vincent Fellahi, Jean-Luc Argaud, Laurent Rimmelé, Thomas Menotti, Jean Aubrun, Frédéric Richard, Jean-Christophe Gagnieu, Marie-Claude Parant, François Chidiac, Christian Leboucher, Gilles Tod, Michel Goutelle, Sylvain PLoS One Research Article Therapeutic drug monitoring (TDM) is essential for voriconazole to ensure optimal drug exposure, mainly in critically ill patients for whom voriconazole demonstrated a large variability. The study aimed at describing factors associated with trough voriconazole concentrations in critically ill patients and evaluating the impact of voriconazole concentrations on adverse effects. A 2-year retrospective multicenter cohort study (NCT04502771) was conducted in six intensive care units. Adult patients who had at least one voriconazole TDM were included. Univariable and multivariable linear regression analyses were performed to identify predictors of voriconazole concentrations, and univariable logistic regression analysis, to study the relationship between voriconazole concentrations and adverse effects. During the 2-year study period, 70 patients were included. Optimal trough voriconazole concentrations were reported in 37 patients (52.8%), subtherapeutic in 20 (28.6%), and supratherapeutic in 13 (18.6%). Adverse effects were reported in six (8.6%) patients. SOFA score was identified as a factor associated with an increase in voriconazole concentration (p = 0.025), mainly in the group of patients who had SOFA score ≥ 10. Moreover, an increase in voriconazole concentration was shown to be a risk factor for occurrence of adverse effects (p = 0.011). In that respect, critically ill patients who received voriconazole treatment must benefit from a TDM, particularly if they have a SOFA score ≥ 10. Indeed, identifying patients who are overdosed will help to prevent voriconazole related adverse effects. This result is of utmost importance given the recognized COVID-19-associated pulmonary aspergillosis in ICU patients for whom voriconazole is among the recommended first-line treatment. Public Library of Science 2021-11-24 /pmc/articles/PMC8612507/ /pubmed/34818379 http://dx.doi.org/10.1371/journal.pone.0260656 Text en © 2021 Bienvenu et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Bienvenu, Anne-Lise
Pradat, Pierre
Plesa, Alexandra
Leclerc, Vincent
Piriou, Vincent
Fellahi, Jean-Luc
Argaud, Laurent
Rimmelé, Thomas
Menotti, Jean
Aubrun, Frédéric
Richard, Jean-Christophe
Gagnieu, Marie-Claude
Parant, François
Chidiac, Christian
Leboucher, Gilles
Tod, Michel
Goutelle, Sylvain
Association between voriconazole exposure and Sequential Organ Failure Assessment (SOFA) score in critically ill patients
title Association between voriconazole exposure and Sequential Organ Failure Assessment (SOFA) score in critically ill patients
title_full Association between voriconazole exposure and Sequential Organ Failure Assessment (SOFA) score in critically ill patients
title_fullStr Association between voriconazole exposure and Sequential Organ Failure Assessment (SOFA) score in critically ill patients
title_full_unstemmed Association between voriconazole exposure and Sequential Organ Failure Assessment (SOFA) score in critically ill patients
title_short Association between voriconazole exposure and Sequential Organ Failure Assessment (SOFA) score in critically ill patients
title_sort association between voriconazole exposure and sequential organ failure assessment (sofa) score in critically ill patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8612507/
https://www.ncbi.nlm.nih.gov/pubmed/34818379
http://dx.doi.org/10.1371/journal.pone.0260656
work_keys_str_mv AT bienvenuannelise associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT pradatpierre associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT plesaalexandra associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT leclercvincent associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT piriouvincent associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT fellahijeanluc associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT argaudlaurent associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT rimmelethomas associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT menottijean associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT aubrunfrederic associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT richardjeanchristophe associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT gagnieumarieclaude associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT parantfrancois associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT chidiacchristian associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT lebouchergilles associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT todmichel associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients
AT goutellesylvain associationbetweenvoriconazoleexposureandsequentialorganfailureassessmentsofascoreincriticallyillpatients