G. Lugo et G. Castanedahernandez, AMIKACIN BAYESIAN FORECASTING IN CRITICALLY ILL PATIENTS WITH SEPSIS AND CIRRHOSIS, Therapeutic drug monitoring, 19(3), 1997, pp. 271-276
This study was designed to determine the population pharmacokinetic pa
rameters of amikacin in two subpopulations of intensive care unit pati
ents with sepsis and cirrhosis and sepsis without cirrhosis, The autho
rs evaluated the usefulness of the obtained parameters to forecast the
serum amikacin concentrations in a validation group of patients with
sepsis and cirrhosis when used as a priori distribution in a Bayesian
forecaster. The population parameters were estimated by a nonparametri
c expectation maximization algorithm (NPEM), and the accuracy of the p
redictions were evaluated through a prediction error analysis. Signifi
cant differences (p < 0.05) were found in Vd (0.668 versus 0.470 l/kg)
and K (0.0701 versus 0.161 h(-1)) between subpopulations of patients
with and without cirrhosis. The model derived for patients with cirrho
sis used as a priori distribution, with and without feedback, was supe
rior to the model derived for patients with sepsis in forecasting amik
acin serum concentrations. The results show the relevance of using the
specific model for the subgroup with cirrhosis as a priori distributi
on in a Bayesian forecaster to obtain a nonbiased prediction with an a
cceptable precision.