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Hypokalemia and hyponatremia are common but easily ignored adverse events in treatment with voriconazole (VCZ) that can lead to serious consequences. We intend to investigate the incidence of VCZ‐induced hypokalemia and hyponatremia and their risk factors based on real‐world data. A prospective study was conducted. A total of 272 patients with 414 VCZ plasma trough concentrations (C0) and VCZ N‐oxide concentrations (CN) were included. The incidence of hypokalemia was 18.0% (48/266). A total of 81.2% (39/48) of patients developed hypokalemia within 14 days, whereas 56.2% (27/48) of patients developed hypokalemia within 1 week. The proportion of female patients in the hypokalemia group was higher than that in the nonhypokalemia group, as was the proportion of patients receiving intravenous VCZ. In the multivariate analysis, the independent risk factors for hypokalemia were sex, combined use of antibiotics, and VCZ CN/C0. The incidence of hyponatremia was 7.9% (21/266). The proportion of patients over 47 years of age in the hyponatremia group was 71.4% (15/21). The number of days of VCZ use in the hyponatremia group was greater than that in the nonhyponatremia group. A total of 47.6% (10/21) of patients in the hyponatremia group had supratherapeutic VCZ C0 (>5.0 µg/mL). In conclusion, hypokalemia is more likely to occur in females, in patients receiving intravenous VCZ, and in patients with the combined use of antibiotics. Hyponatremia is more likely to occur in patients older than 47 years who have been using VCZ for a long time and have higher VCZ C0 values. [ABSTRACT FROM AUTHOR]

Recent publications regarding the role of mesencephalic astrocyte‐derived neurotrophic factor (MANF) in various metabolic and degenerative disorders suggest that MANF is both a marker of disease and a possible therapeutic agent. We investigate the role of plasma MANF levels in patients in intensive care units (ICUs) receiving voriconazole (VCZ) therapy while also comparing MANF levels in healthy individuals. A single‐center prospective study was conducted. The plasma MANF level in patients in ICU was found to have high interindividual variability and was significantly higher than that in healthy controls (P <.01). Compared with patients using VCZ only, patients using both VCZ and amikacin had 3‐fold lower MANF concentrations (P <.05). The MANF concentrations also decreased when alkaline phosphatase (ALP) and serum creatinine levels were above the upper limits of the normal range (P <.05) and the estimated glomerular filtration rate (eGFR) was below the lower limit of the normal range (P <.01). Receiver operating characteristic curve analysis indicated that low MANF levels were associated with high ALP levels, high creatinine levels, and low eGFR. The cut‐off value of MANF for ALP levels higher than 126 U/L was 0.35 ng/mL (area under curve, AUC = 0.62, 95%CI = 0.50–0.74, P =.044); for serum creatinine levels higher than 104 μmol/L, the cut‐off value was 0.41 ng/mL (AUC = 0.74, 95%CI = 0.62–0.87, P =.001); and for eGFR below 80 mL/min, the cut‐off value was 0.75 ng/mL (AUC = 0.70, 95%CI = 0.59–0.81, P =.002). Monitoring plasma MANF levels may be of value for clinical decision‐making regarding the choice of antibiotics and the prediction of impaired liver function and renal function in patients admitted to an ICU. [ABSTRACT FROM AUTHOR]