Optimizing Predictive Performance of Bayesian Forecasting for Vancomycin Concentration in Intensive Care Patients

Pharmaceutical Research, vol. 37, pp. 171

Abstract

PURPOSE: Bayesian forecasting is crucial for model-based dose optimization based on therapeutic drug monitoring (TDM) data of vancomycin in intensive care (ICU) patients. We aimed to evaluate the performance of Bayesian forecasting using maximum a posteriori (MAP) estimation for model-based TDM. METHODS: We used a vancomycin TDM data set (n = 408 patients). We compared standard MAP-based Bayesian forecasting with two alternative approaches: (i) adaptive MAP which handles data over multiple iterations, and (ii) weighted MAP which weights the likelihood contribution of data. We evaluated the percentage error (PE) for seven scenarios including historical TDM data from the preceding day up to seven days. RESULTS: The mean of median PEs of all scenarios for the standard MAP, adaptive MAP and weighted MAP method were - 7.7%, -4.5% and - 6.7%. The adaptive MAP also showed the narrowest inter-quartile range of PE. In addition, regardless of MAP method, including historical TDM data further in the past will increase prediction errors. CONCLUSIONS: The proposed adaptive MAP method outperforms standard MAP in predictive performance and may be considered for improvement of model-based dose optimization. The inclusion of historical data beyond either one day (standard MAP and weighted MAP) or two days (adaptive MAP) reduces predictive performance.

Authors 11

1. Tingjie Guo corresponding Aachen Division of Systems Biomedicine and Pharmacology Leiden Academic Centre for Drug Research

   Leiden University · Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam · University of Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Intensive Care Medicine | Research VUmc Intensive Care (REVIVE) | Amsterdam Cardiovascular Sciences (ACS) | Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. t.guo@amsterdamumc.nl

   Department of Pharmacy, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. t.guo@amsterdamumc.nl

   Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, The Netherlands. t.guo@amsterdamumc.nl

   Department of Intensive Care Medicine | Research VUmc Intensive Care (REVIVE) | Amsterdam Cardiovascular Sciences (ACS) | Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

2. Reinier M. van Hest

   Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Pharmacy, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

3. Laura B. Zwep Aachen Division of Systems Biomedicine and Pharmacology Leiden Academic Centre for Drug Research Mathematical Institute

   Leiden University

   Affiliation as printed

   Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, The Netherlands

   Mathematical Institute, Leiden University, Leiden, The Netherlands

4. Luca F. Roggeveen

   Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Intensive Care Medicine | Research VUmc Intensive Care (REVIVE) | Amsterdam Cardiovascular Sciences (ACS) | Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

5. Lucas M. Fleuren

   Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Intensive Care Medicine | Research VUmc Intensive Care (REVIVE) | Amsterdam Cardiovascular Sciences (ACS) | Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

6. Rob J. Bosman

   OLVG

   Affiliation as printed

   Intensive Care Unit, OLVG Oost, Amsterdam, The Netherlands

7. Peter H. J. van der Voort

   OLVG

   Affiliation as printed

   Intensive Care Unit, OLVG Oost, Amsterdam, The Netherlands

8. Armand R. J. Girbes

   Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Intensive Care Medicine | Research VUmc Intensive Care (REVIVE) | Amsterdam Cardiovascular Sciences (ACS) | Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

9. Ron A. A. Mathôt

   Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Pharmacy, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

10. Paul Elbers

    Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam

    Affiliation as printed

    Department of Intensive Care Medicine | Research VUmc Intensive Care (REVIVE) | Amsterdam Cardiovascular Sciences (ACS) | Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

11. J. G. Coen van Hasselt Aachen Division of Systems Biomedicine and Pharmacology Leiden Academic Centre for Drug Research

    Leiden University

    Affiliation as printed

    Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, The Netherlands