The use of the kidney function
biomarker cystatin C (cysC) can improve the accuracy of
vancomycin dosing for target trough attainment in nonobese patients. It is unknown whether cysC can also improve
vancomycin target trough attainment in
overweight and obese patients. We conducted a retrospective observational study of
overweight or obese hospitalized adults with stable renal function administered intravenous
vancomycin between January 2011 and July 2019. Linear regression models were used to predict initial steady-state
vancomycin troughs using several factors, including various cysC- and serum
creatinine (SCr)-based estimates of kidney function. We compared the predicted proportion of patients within the target trough range (10 to 20 mg/liter) using the derived models to that observed from usual care. Of the 200 included patients, the mean trough level was 15 ± 6.3 mg/liter. The optimal model to predict the initial trough included both cysC and SCr (R2 = 0.48) rather than either
biomarker alone. This model predicted that 79% (95% confidence interval [CI], 73% to 85%) of troughs could be between 10 and 20 mg/liter compared to the 62% observed in clinical practice (P < 0.001), a 1.3-fold increase. This study is the first to examine the role of cysC in predicting
vancomycin levels in an exclusively
overweight or obese population. While dosing models based on cysC appear promising in this setting, prospective validation is needed.