TABLE 1.
Comparison between patients who developed neurotoxicity for which piperacillin causality was suggestive and patients who did not show piperacillin neurotoxicitya
| Parameterb | Result forc: |
P valued | |
|---|---|---|---|
| Piperacillin neurotoxicity group (n = 23) | Rest of cohort (n = 30) | ||
| Demographic data and medical history at admission | |||
| Women, % | 39.1 | 23.3 | 0.2423 |
| Age, median yr | 65 (61.5–71.5) | 71.5 (64.3–79.5) | 0.0502 |
| Wt, median kg | 87 (68–99) | 87.5 (78.3–99) | 0.1778 |
| BMI, median kg/m2 | 29.6 (23.3–32.8) | 28.4 (25–32.7) | 0.6416 |
| History of brain injury (stroke or trauma), % | 13.0 | 0 | 0.0760 |
| History of epilepsy, % | 8.7 | 3.3 | 0.5730 |
| History of alcoholism, % | 17.4 | 13.3 | 0.7150 |
| History of drug abuse, % | 0 | 0 | |
| History of cardiovascular disease, % | 82.6 | 76.7 | 0.7379 |
| History of cancer, % | 43.4 | 60 | 0.2756 |
| SAPS II, median | 58 (46–76) | 54 (42–73) | 0.4454 |
| Clinical data from day of piperacillin serum measurement | |||
| Fever, % | 30.4 | 20 | 0.5220 |
| Sepsis, % | 65.2 | 26.7 | 0.0006* |
| Mechanical ventilation, % | 60.9 | 53.3 | 0.7800 |
| Renal replacement therapy, % | 26.1 | 26.7 | 1 |
| Vasopressive comedications, % | 82.6 | 46.7 | 0.0100* |
| Potentially neurotoxic comedications, % | 73.9 | 80 | 0.7430 |
| Hepatic impairment, % | 30.4 | 13.3 | 0.1770 |
| Biological data from day of piperacillin serum measurement | |||
| Creatininemia, median μM | 261 (170–349.5) | 122 (54–242) | 0.0169* |
| eGFR, median ml/min/1.73 m2 | 18 (15–37) | 50 (12–83) | 0.0142* |
| Proteinemia, median g/liter | 55 (51–60) | 55 (42–64) | 0.7060 |
| Natremia, median mM | 139 (137–144) | 138 (130–141) | 0.3726 |
| Calcemia, median mM | 1.9 (1.8–2) | 2 (1.8–2.2) | 0.1368 |
| Lactatemia, median mM | 1.6 (1.1–2.4) | 1.5 (1.1–1.9) | 0.3528 |
| CRP, median mg/liter | 149.6 (103–281.2) | 144.3 (89.9–190.1) | 0.1537 |
| PCT, median μg/liter | 25 (1.9–35.6) | 2.48 (2.5–9.45) | 0.0072* |
| pH, median | 7.39 (7.35–7.47) | 7.44 (7.39–7.47) | 0.3173 |
| Piperacillin treatment at initiation time | |||
| Dose, median g/24 h | 12 (12–12) | 12 (12–12) | 0.4866 |
| Dose normalized to eGFR, median g/24 h/100 ml/min/1.73 m2 | 36.4 (16–58.6) | 28.6 (12.8–52.5) | 0.5634 |
| Piperacillin treatment on day of piperacillin serum measurement | |||
| Dose, median g/24 h | 12 (8–12) | 12 (9–12) | 0.9207 |
| Dose normalized to eGFR, median g/24 h/100 ml/min/1.73 m2 | 48 (35.3–69.7) | 22 (14.3–54) | 0.0111* |
| Serum concn, median mg/liter | 156.9 (95.4–236) | 91.3 (68.6–126.8) | 0.0016* |
| Time from treatment initiation, median days | 3 (2–5) | 3 (2–5) | 0.7819 |
| fC/MIC, median | 9.72 (5.35–15.06) | 5.4 (3.6–7.9) | 0.0174* |
a
Patients who developed neurotoxicity for which the piperacillin causality was suggestive are represented by the piperacillin neurotoxicity group, and those who did not show piperacillin neurotoxicity are indicated as the rest of the cohort.
b
Abbreviations: BMI, body mass index; CRP, C-reactive protein; eGFR, estimated glomerular filtration rate; fC/MIC, free concentration of piperacillin over the MIC of the infective pathogen; PCT, procalcitonin; SAPS II, simplified acute physiology score.
c
Interquartile ranges are shown in parentheses.
d
*, significant at P <0.05.