[Factors Influencing and Adverse Reactions of Voriconazole Clearance in Patients with Hematological Diseases].

Objective: To monitor the changes of voriconazole minimum concentration(C _min ) in patients with hematological diseases, and evaluate the factors influencing and adverse reactions of voriconazole clearance in patients with hematological diseases, so as to provide a theoretical basis for reasonable clinical use of voriconazole.
Methods: 136 patients with hematological diseases who used voriconazole in Wuhan NO.1 Hospital from May 2018 to December 2019 were selected. The correlation between C-reactive protein, albumin, creatinine and voriconazole C _min were analyzed, and the changes of voriconazole C _min after glucocorticoid treatment was also detected. In addition, stratified analysis was used to explore the adverse events of voriconazole.
Results: Among 136 patients, 77 were male (56.62%) and 59 were female (43.38%). There were positive correlations between voriconazole C _min and C-reactive protein and creatinine levels (r=0.277, r=0.208), while voriconazole C _min was negatively correlated with albumin level (r=-2.673). Voriconazole C _min in patients treated with glucocorticoid was decreased significantly (P<0.05). In addition, sratified analysis of voriconazole C _min showed that compared with voriconazole C _min 1.0-5.0 mg/L group, the incidence of adverse reactions of visual impairment in voriconazole C _min > 5.0 mg/L group was increased (χ ² =4.318, P=0.038).
Conclusion: The levels of C-reactive protein, albumin and creatinine are closely related to the voriconazole C _min , which indicate that inflammation and hyponutrition may prevent the clearance of voriconazole in patients with hematological diseases. It is necessary to monitor the voriconazole C _min of patients with hematological diseases, and adjust the dosage in time to reduce adverse reactions.