A Clinical Nomogram for Predicting Substandard Serum Valproic Acid Concentrations in Chinese Patients With Epilepsy
ABSTRACT: Background: It is well-known that substandard serum valproic acid (VPA) concentrations may lead to treatment failure of epilepsy. However, there is still a lack of a quick method to predict whether a patient's serum VPA concentration will reach the standard. Objective: The aims of th...
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Elsevier
2025-01-01
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| Series: | Current Therapeutic Research |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0011393X24000419 |
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| author | Zi-Hao Duan, MS Chun-Yuan He, MS Jie Chen, BS Jun-Jie Jiang, BS Zhi-Xiang Zhu, PhD Jing Li, MS Fa-Cai Wang, MD |
| author_facet | Zi-Hao Duan, MS Chun-Yuan He, MS Jie Chen, BS Jun-Jie Jiang, BS Zhi-Xiang Zhu, PhD Jing Li, MS Fa-Cai Wang, MD |
| author_sort | Zi-Hao Duan, MS |
| collection | DOAJ |
| description | ABSTRACT: Background: It is well-known that substandard serum valproic acid (VPA) concentrations may lead to treatment failure of epilepsy. However, there is still a lack of a quick method to predict whether a patient's serum VPA concentration will reach the standard. Objective: The aims of this study were to investigate the factors leading to substandard serum VPA concentrations in Chinese patients with epilepsy and develop a related nomogram for risk prediction. Methods: From January 2019 to March 2022, a total of 1143 serum VPA concentrations were collected from 630 hospitalized Chinese patients with epilepsy who were monitored by the Department of Pharmacy of Lu'an People's Hospital, and complete clinical data were collected from the corresponding patients for retrospective analysis. All monitored serum VPA concentrations were further divided into a training cohort and a validation cohort. For the training cohort, serum VPA concentrations below 50 µg/mL and between 50 and 100 µg/mL were classified into the subtherapeutic group and therapeutic group, respectively. The variables were selected from the clinical data, and differences between the variables of the subtherapeutic and therapeutic groups were analyzed. The influencing factors leading to substandard serum VPA concentrations were screened via logistic regression analysis, and the screened influencing factors were used to establish the nomogram prediction model. Results: Multivariate logistic regression analysis revealed that the daily dose per unit of body weight (mg/kg/d), route of administration, presence of hepatic lesions, hypoalbuminemia, and combination with carbapenems or barbiturates were independent factors influencing the occurrence of substandard serum VPA concentrations. On the basis of the results of the multivariate logistic regression analysis, a nomogram risk prediction model for substandard serum VPA concentration was established. The values of the C-index and internal verification results indicated that the nomogram model had good accuracy and discrimination. The decision curve revealed that the nomogram that predicted the risk of substandard serum VPA concentration had a greater net benefit value (ranging from 12% to 94%), indicating that the model had a wide prediction interval. Conclusions: Our study established a nomogram risk prediction model for substandard serum VPA concentrations in Chinese patients with epilepsy, which can help doctors or patients control the serum VPA concentration within the target concentration range as soon as possible. |
| format | Article |
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| institution | Kabale University |
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| publishDate | 2025-01-01 |
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| spelling | doaj-art-644c07af069f41c4b9983da9ac5ede9d2025-01-16T04:28:14ZengElsevierCurrent Therapeutic Research0011-393X2025-01-01102100771A Clinical Nomogram for Predicting Substandard Serum Valproic Acid Concentrations in Chinese Patients With EpilepsyZi-Hao Duan, MS0Chun-Yuan He, MS1Jie Chen, BS2Jun-Jie Jiang, BS3Zhi-Xiang Zhu, PhD4Jing Li, MS5Fa-Cai Wang, MD6Department of Pharmacy, Lu'an Affiliated Hospital of Anhui Medical University & Lu'an People's Hospital, Lu'an, Anhui, ChinaDepartment of Pharmacy, Lu'an Affiliated Hospital of Anhui Medical University & Lu'an People's Hospital, Lu'an, Anhui, ChinaDepartment of Pharmacy, Lu'an Affiliated Hospital of Anhui Medical University & Lu'an People's Hospital, Lu'an, Anhui, ChinaDepartment of Pharmacy, Lu'an Affiliated Hospital of Anhui Medical University & Lu'an People's Hospital, Lu'an, Anhui, ChinaModern Research Center for Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, ChinaDepartment of Pharmacy, Lu'an Affiliated Hospital of Anhui Medical University & Lu'an People's Hospital, Lu'an, Anhui, China; Address correspondence to: Jing Li, Department of Pharmacy, The Lu'an Affiliated Hospital of Anhui Medical University and Lu'an People's Hospital, 21, Wan-Xi West Road, Lu'an, 237000 Anhui, China.Department of Pharmacy, Lu'an Affiliated Hospital of Anhui Medical University & Lu'an People's Hospital, Lu'an, Anhui, ChinaABSTRACT: Background: It is well-known that substandard serum valproic acid (VPA) concentrations may lead to treatment failure of epilepsy. However, there is still a lack of a quick method to predict whether a patient's serum VPA concentration will reach the standard. Objective: The aims of this study were to investigate the factors leading to substandard serum VPA concentrations in Chinese patients with epilepsy and develop a related nomogram for risk prediction. Methods: From January 2019 to March 2022, a total of 1143 serum VPA concentrations were collected from 630 hospitalized Chinese patients with epilepsy who were monitored by the Department of Pharmacy of Lu'an People's Hospital, and complete clinical data were collected from the corresponding patients for retrospective analysis. All monitored serum VPA concentrations were further divided into a training cohort and a validation cohort. For the training cohort, serum VPA concentrations below 50 µg/mL and between 50 and 100 µg/mL were classified into the subtherapeutic group and therapeutic group, respectively. The variables were selected from the clinical data, and differences between the variables of the subtherapeutic and therapeutic groups were analyzed. The influencing factors leading to substandard serum VPA concentrations were screened via logistic regression analysis, and the screened influencing factors were used to establish the nomogram prediction model. Results: Multivariate logistic regression analysis revealed that the daily dose per unit of body weight (mg/kg/d), route of administration, presence of hepatic lesions, hypoalbuminemia, and combination with carbapenems or barbiturates were independent factors influencing the occurrence of substandard serum VPA concentrations. On the basis of the results of the multivariate logistic regression analysis, a nomogram risk prediction model for substandard serum VPA concentration was established. The values of the C-index and internal verification results indicated that the nomogram model had good accuracy and discrimination. The decision curve revealed that the nomogram that predicted the risk of substandard serum VPA concentration had a greater net benefit value (ranging from 12% to 94%), indicating that the model had a wide prediction interval. Conclusions: Our study established a nomogram risk prediction model for substandard serum VPA concentrations in Chinese patients with epilepsy, which can help doctors or patients control the serum VPA concentration within the target concentration range as soon as possible.http://www.sciencedirect.com/science/article/pii/S0011393X24000419epilepsyinfluencing factorsnomogramrisk prediction modelserum drug concentrationvalproic acid (VPA) |
| spellingShingle | Zi-Hao Duan, MS Chun-Yuan He, MS Jie Chen, BS Jun-Jie Jiang, BS Zhi-Xiang Zhu, PhD Jing Li, MS Fa-Cai Wang, MD A Clinical Nomogram for Predicting Substandard Serum Valproic Acid Concentrations in Chinese Patients With Epilepsy Current Therapeutic Research epilepsy influencing factors nomogram risk prediction model serum drug concentration valproic acid (VPA) |
| title | A Clinical Nomogram for Predicting Substandard Serum Valproic Acid Concentrations in Chinese Patients With Epilepsy |
| title_full | A Clinical Nomogram for Predicting Substandard Serum Valproic Acid Concentrations in Chinese Patients With Epilepsy |
| title_fullStr | A Clinical Nomogram for Predicting Substandard Serum Valproic Acid Concentrations in Chinese Patients With Epilepsy |
| title_full_unstemmed | A Clinical Nomogram for Predicting Substandard Serum Valproic Acid Concentrations in Chinese Patients With Epilepsy |
| title_short | A Clinical Nomogram for Predicting Substandard Serum Valproic Acid Concentrations in Chinese Patients With Epilepsy |
| title_sort | clinical nomogram for predicting substandard serum valproic acid concentrations in chinese patients with epilepsy |
| topic | epilepsy influencing factors nomogram risk prediction model serum drug concentration valproic acid (VPA) |
| url | http://www.sciencedirect.com/science/article/pii/S0011393X24000419 |
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