An evaluation on the association of vancomycin trough concentration with mortality in critically ill patients: A multicenter retrospective study

To determine the impact of initial vancomycin trough concentration (VTC) on mortality in adult patients in the intensive care unit (ICU) undergoing vancomycin therapy. During their first ICU stay, patients with initial VTC records after vancomycin treatment were recruited from the eICU Collaborative Research Database to this multicenter retrospective cohort study, and classified into four groups according to VTC: less than 10, 10-15, 15-20, and greater than 20 mg/L. Multivariable logistic regression and sensitivity analyses were performed to explore the association of VTC, as a continuous and categorical variable, with mortality. This study enrolled 7220 patients from 335 different ICUs at 208 hospitals. Multivariable logistic regression models indicated that VTC was positively correlated with ICU (odds ratio [OR], 1.028, 95% confidence interval [CI], 1.019-1.037) and hospital (OR 1.028, 95% CI, 1.020-1.036) mortalities. Moreover, compared with VTC less than 10 mg/L, VTCs of 10-15, 15-20, and greater than 20 mg/L were associated with a higher risk of ICU mortality (OR, 1.330, 95% CI, 1.070-1.653; OR, 1.596, 95% CI, 1.265-2.015; abd OR, 1.875, 95% CI, 1.491-2.357, respectively), and VTCs of 15-20 and greater than 20 mg/L were also correlated with increased hospital mortality (OR, 1.482, 95% CI, 1.225-1.793; and OR, 1.831, 95% CI, 1.517-2.210, respectively). Similar results persisted in patients with different Acute Physiology and Chronic Health Evaluation scores, creatinine clearance levels, ages, and body mass indexes. Our findings indicated a potential relationship of initial VTC with ICU and hospital mortalities in patients in the ICU. However, due to the retrospective nature of this study, future prospective studies or randomized controlled trials are needed to validate those results.