{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:19:12Z","timestamp":1789258752976,"version":"build-2803163510"},"reference-count":21,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,12]],"date-time":"2024-08-12T00:00:00Z","timestamp":1723420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Liposomal amphotericin B (L-AmB) has become the mainstay of treatment for severe invasive fungal infections. However, the potential for renal toxicity must be considered. Aims: To evaluate the incidence of acute kidney injury (AKI) in critically ill patients receiving L-AmB for more than 48 h. Methods: Retrospective, observational, single-center study. Clinical, demographic and laboratory variables were obtained automatically from the electronic medical record. AKI incidence was analyzed in the entire population and in patients with a \u201clow\u201d or \u201chigh\u201d risk of AKI based on their creatinine levels at the outset of the study. Factors associated with the development of AKI were studied using random forest models. Results: Finally, 67 patients with a median age of 61 (53\u201371) years, 67% male, a median SOFA of 4 (3\u20136.5) and a crude mortality of 34.3% were included. No variations in serum creatinine were observed during the observation period, except for a decrease in the high-risk subgroup. A total of 26.8% (total population), 25% (low risk) and 13% (high risk) of patients developed AKI. Norepinephrine, the SOFA score, furosemide (general model), potassium, C-reactive protein and procalcitonin (low-risk subgroup) were the variables identified by the random forest models as important contributing factors to the development of AKI other than L-AmB administration. Conclusions: The development of AKI is multifactorial and the administration of L-AmB appears to be safe in this group of patients.<\/jats:p>","DOI":"10.3390\/antibiotics13080760","type":"journal-article","created":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T13:35:49Z","timestamp":1723556149000},"page":"760","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A Real-World Data Observational Analysis of the Impact of Liposomal Amphotericin B on Renal Function Using Machine Learning in Critically Ill Patients"],"prefix":"10.3390","volume":"13","author":[{"given":"Ignasi","family":"Sacanella","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3534-3460","authenticated-orcid":false,"given":"Erika","family":"Esteve-Pitarch","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Guevara-Chaux","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"},{"name":"Postgrado Medicina Cr\u00edtica y Cuidado Intensivo, Facultad de Medicina, Fundaci\u00f3n Universitari Ciencias de la Salud, Distrito Especial, Cra. 54 No.67A-80, Bogot\u00e1 111221, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1015-9780","authenticated-orcid":false,"given":"Julen","family":"Berrueta","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"},{"name":"Tarragona Health Data Research Working Group (THeDaR), 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Garc\u00eda-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"},{"name":"Tarragona Health Data Research Working Group (THeDaR), 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josep","family":"G\u00f3mez","sequence":"additional","affiliation":[{"name":"Technical Secretary\u2019s Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Casarino","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Hospital de Pediatr\u00eda Garrahan, Buenos Aires C1245, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florencia","family":"Al\u00e9s","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"},{"name":"Internal Medicine Department, Hospital Dr. Alejandro Guti\u00e9rrez, Venado Tuerto S2600, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3666-2332","authenticated-orcid":false,"given":"Laura","family":"Canadell","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5834-4063","authenticated-orcid":false,"given":"Ignacio","family":"Mart\u00edn-Loeches","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James\u2019 Hospital, D08 NHY1 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8428-1836","authenticated-orcid":false,"given":"Santiago","family":"Grau","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Hospital del Mar, 08003 Barcelona, Spain"},{"name":"Department of Medicine, Pompeu Fabra University, 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9840-6556","authenticated-orcid":false,"given":"Francisco Javier","family":"Candel","sequence":"additional","affiliation":[{"name":"Clinical Microbiology & Infectious Diseases Department, Hospital Cl\u00ednico Universitario San Carlos, 28040 Madrid, Spain"},{"name":"San Carlos Hospital Health Research Institute (IdISSC & IML), 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7652-8379","authenticated-orcid":false,"given":"Mar\u00eda","family":"Bod\u00ed","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"},{"name":"Faculty of Medicine, Pere Virgili Health Research Institute, Rovira i Virgili University, 43005 Tarragona, Spain"},{"name":"Centre for Biomedical Research Network Respiratory Diseases (CIBERES), 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8828-5984","authenticated-orcid":false,"given":"Alejandro","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain"},{"name":"Faculty of Medicine, Pere Virgili Health Research Institute, Rovira i Virgili University, 43005 Tarragona, Spain"},{"name":"Centre for Biomedical Research Network Respiratory Diseases (CIBERES), 43005 Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1590\/S1806-37132006000500013","article-title":"An Update on the Use of Antifungal Agents","volume":"32","author":"Martinez","year":"2006","journal-title":"J. Bras. Pneumol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"225.e1","DOI":"10.1016\/j.jcrc.2010.08.005","article-title":"The Value of Amphotericin B in the Treatment of Invasive Fungal Infections","volume":"26","author":"Klepser","year":"2011","journal-title":"J. Crit. Care"},{"key":"ref_3","first-page":"7","article-title":"Antif\u00fangicos Poli\u00e9nicos","volume":"63","year":"2020","journal-title":"Mec. Acci\u00f3n Aplicaciones. Rev. Fac. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"E158","DOI":"10.1086\/320521","article-title":"Disseminated infection and colonization by Scedosporium prolificans: A review of 18 cases, 1990\u20131999","volume":"32","author":"Piniero","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/00005792-199707000-00004","article-title":"Deep infections caused by Scedosporium prolificans. A report on 16 cases in Spain and a review of the literature","volume":"76","author":"Berenguer","year":"1997","journal-title":"Medicine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1128\/AAC.02456-15","article-title":"An international evaluation of MIC distributions and ECV definition for Fusarium species identified by molecular methods for the CLSI broth microdilution method","volume":"60","author":"Colombo","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1056\/NEJM199903113401004","article-title":"Liposomal Amphotericin B for Empirical Therapy in Patients with Persistent Fever and Neutropenia","volume":"340","author":"Walsh","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1093\/jac\/49.suppl_1.37","article-title":"Amphotericin B Nephrotoxicity","volume":"49","author":"Deray","year":"2002","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1038\/s41572-021-00284-z","article-title":"Acute Kidney Injury","volume":"7","author":"Kellum","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"(2012). KDIGO International Section 2: AKI Definition. Kidney Int. Suppl., 2, 19\u201336.","DOI":"10.1038\/kisup.2011.32"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1023\/A:1010933404324","article-title":"Random Forests","volume":"45","author":"Breiman","year":"2001","journal-title":"Mach. Learn."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4759","DOI":"10.1128\/AAC.00525-15","article-title":"Incidence, Predictors, and Impact on Hospital Mortality of Amphotericin B Nephrotoxicity Defined Using Newer Acute Kidney Injury Diagnostic Criteria","volume":"59","author":"Rocha","year":"2015","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Takazono, T., Tashiro, M., Ota, Y., Obata, Y., Wakamura, T., Miyazaki, T., Nishino, T., and Izumikawa, K. (2020). Factor Analysis of Acute Kidney Injury in Patients Administered Liposomal Amphotericin B in a Real-World Clinical Setting in Japan. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-72135-y"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"8629891","DOI":"10.1155\/2019\/8629891","article-title":"Renal Recovery Following Liposomal Amphotericin B-Induced Nephrotoxicity","volume":"2019","author":"Personett","year":"2019","journal-title":"Int. J. Nephrol."},{"key":"ref_15","first-page":"206","article-title":"Impact of Liposomal Amphotericin B on Renal Function in Critically Ill Patients with Renal Function Impairment","volume":"25","author":"Vidart","year":"2012","journal-title":"Rev. Espa\u00f1ola Quimioter."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e29","DOI":"10.1086\/505969","article-title":"Prospective Study of Amphotericin B Formulations in Immunocompromised Patients in 4 European Countries","volume":"43","author":"Ullmann","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1002\/cncr.23311","article-title":"Amphotericin B Lipid Complex Versus Liposomal Amphotericin B Monotherapy for Invasive Aspergillosis in Patients with Hematologic Malignancy","volume":"112","author":"Hachem","year":"2008","journal-title":"Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1086\/317451","article-title":"A Randomized, Double-Blind Comparative Trial Evaluating the Safety of Liposomal Amphotericin B versus Amphotericin B Lipid Complex in the Empirical Treatment of Febrile Neutropenia","volume":"31","author":"Wingard","year":"2000","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1086\/514341","article-title":"Liposomal Amphotericin B as Initial Therapy for Invasive Mold Infection: A Randomized Trial Comparing a High-Loading Dose Regimen with Standard Dosing (AmBiLoad Trial)","volume":"44","author":"Cornely","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"94","DOI":"10.2165\/00002018-199005020-00003","article-title":"Amphotericin B Nephrotoxicity","volume":"5","author":"Sabra","year":"1990","journal-title":"Drug-Saf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/S0953-6205(02)00065-1","article-title":"Amphotericin B and liver function","volume":"13","author":"Inselmann","year":"2002","journal-title":"Eur. J. Intern. Med."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/8\/760\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:35:12Z","timestamp":1760110512000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/8\/760"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,12]]},"references-count":21,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["antibiotics13080760"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics13080760","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,12]]}}}