Multimodal data-driven predictive model for vancomycin serum concentrations in postoperative cardiac surgery patients under cardiopulmonary bypass: a single-center retrospective study

Background: This study analyzed the pharmacokinetic data of vancomycin in patients after cardiac surgery under cardiopulmonary bypass (CPB). It aimed to identify factors affecting vancomycin plasma concentrations and develop a multi-modal data-driven prediction model for these concentrations. Methods: A retrospective study included hospitalized patients who underwent cardiac surgery under cardiopulmonary bypass, received intravenous vancomycin for postoperative infection, and had plasma concentration monitoring. Patient demographic and other relevant information was collected. A dual-risk model based on the therapeutic window (10-20 mg/L) was established: ① nephrotoxicity risk group (≥20 mg/L vs. < 20 mg/L, n = 350); ② subtherapeutic concentration risk group ( 0.05) on the Hosmer-Lemeshow test, with better discrimination in the low concentration risk group. DCA confirmed superior clinical net benefit for both models over full/intervention strategies. In ten-fold cross-validation, the AUC fluctuation was