哌拉西林/他唑巴坦相关性新生儿低钾血症的发生率、危险因素和预测模型
Incidence, risk factors, and prediction model of piperacillin/tazobactam-associated hypokalemia in neonates.
摘要(中文译文)
维持最佳钾水平对新生儿至关重要。哌拉西林/他唑巴坦（TZP）在成人中与低钾血症相关，但新生儿数据有限。本研究旨在探讨新生儿中TZP相关低钾血症（TAH）的发生率、严重程度及决定因素，并构建预测模型以实现早期发现。回顾性队列研究。纳入2019年1月至2024年12月在厦门市妇幼保健院接受TZP治疗的新生儿。提取人口学、实验室及用药数据。采用Naranjo概率评分评估TAH的因果关系。多因素logistic回归识别预测因素，并构建列线图预测TAH的发生。评估列线图的性能。在最初筛查的1027名新生儿中，358名符合纳入标准并最终纳入分析。该队列中TAH的发生率为20.4%（73/358）。独立预测因素包括较高的基线血清肌酐（= 0.012，OR 1.02，95% CI 1.00-1.03）、使用多巴胺（= 0.002，OR 3.37，95% CI 1.54-7.36），而较低的血清钙（= 0.049，OR 0.31，95% CI 0.10-0.99）为保护因素。列线图显示出良好的预测准确性（AUC = 0.771）和净获益。高风险新生儿的低钾血症发生率更高（log-rank检验 < 0.001）。较高的基线血清肌酐、使用多巴胺及较低的血清钙是新生儿TAH的独立预测因素。该列线图提供了一种用户友好的TAH预测工具，有助于临床实践中的早期发现和管理。本研究支持新生儿TAH的早期发现、诊断和干预。
Abstract
Maintaining optimal potassium levels is critical in neonates. Piperacillin/tazobactam (TZP) is associated with hypokalemia in adults, but neonatal data are limited. This study aimed to investigate the incidence, severity, and determinants of TZP-associated hypokalemia (TAH) in neonates and develop a predictive model for early detection. Retrospective cohort study. Neonates treated with TZP between January 2019 and December 2024 at Xiamen Women and Children's Hospital were included. Demographic, laboratory, and medication data were extracted. Naranjo probability scores assessed TAH causality. Multivariate logistic regression identified predictors, and a nomogram predicted TAH occurrence. Nomogram performance was evaluated. Among 1027 neonates initially screened, 358 met the inclusion criteria and were ultimately included in the analysis. The incidence of TAH in this cohort was 20.4% (73/358). Independent predictors included higher baseline serum creatinine ( = 0.012, OR 1.02, 95% CI 1.00-1.03), dopamine use ( = 0.002, OR 3.37, 95% CI 1.54-7.36), and lower serum calcium ( = 0.049, OR 0.31, 95% CI 0.10-0.99) was a protective factor. The nomogram showed good predictive accuracy (AUC = 0.771) and net benefit. High-risk neonates had a higher hypokalemia incidence (log-rank test < 0.001). Higher baseline serum creatinine, dopamine use, and lower serum calcium are independent predictors of neonatal TAH. The nomogram offers a user-friendly tool for TAH prediction, facilitating early detection and management in clinical practice. This study supports early detection, diagnosis, and intervention for neonatal TAH.
如何引用
AMA
Jun Wan, Shiteng Lin, Wei Zhuang, Weida Chen, Yanting Huang, Zhiyi Huang, et al. Incidence, risk factors, and prediction model of piperacillin/tazobactam-associated hypokalemia in neonates.. Therapeutic advances in drug safety. 2026; doi:10.1177/20420986261434697.
APA
Jun Wan, Shiteng Lin, Wei Zhuang, Weida Chen, Yanting Huang, Zhiyi Huang, et al (2026). Incidence, risk factors, and prediction model of piperacillin/tazobactam-associated hypokalemia in neonates.. Therapeutic advances in drug safety. https://doi.org/10.1177/20420986261434697
GB/T 7714
Jun Wan, Shiteng Lin, Wei Zhuang, Weida Chen, Yanting Huang, Zhiyi Huang, et al. Incidence, risk factors, and prediction model of piperacillin/tazobactam-associated hypokalemia in neonates.[J]. Therapeutic advances in drug safety, 2026 doi:10.1177/20420986261434697.
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