The effect of inflammation on voriconazole plasma trough concentrations in Chinese children and adolescent patients

AIMS The aim of this study was to explore whether inflammation, reflected by the C-reactive protein (CRP) concentrations affected the VRC plasma concentration in hospitalized Chinese children and adolescent patients. METHODS Medical records of inpatients were reviewed retrospectively. A linear regression analysis was performed to assess the relationship between CRP values and VRC plasma trough concentration. RESULTS Fifth-nine patients aged 1-18 years were included. A total of 90 VRC trough concentrations were included in the linear regression. The plasma trough concentration of VRC increased with the CRP concentration (n=90, r=0.377, P<0.001). VRC trough concentrations in patients with the group of moderate inflammation (3.09 (0.12~8.58); n=30) were significantly (P=0.011) higher than the group of mild inflammation (1.53 (0.01~9.35); n=60). There were no significant difference (P=0.865) in VRC trough concentration between patients with the group of mild inflammation (≤40 mg/L, n=30) and moderate inflammation (41-200 mg/L, n=6) in patients aged<12 years. VRC trough concentrations were significantly higher (P=0.032) in patients with the group of moderate inflammation (41-200 mg/L, n=24) compared to the group of mild inflammation (≤40 mg/L, n=30) in patients aged ≥12 years. When CRP concentration increased 1 mg/L, the VRC trough concentration increased by 0.010 mg/L and 0.009 mg/L in the unadjusted (95% confidence interval (CI), 0.005 to 0.016 mg/L) and adjusted (95% CI, 0.001 to 0.016 mg/L) linear regression analyses, respectively. CONCLUSIONS Inflammation response appears to provide an explanation for some of the variability in VRC exposure.