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High-dose vancomycin treatment increases the likelihood of vancomycin-related nephrotoxicity.C-reactive protein(CRP)is a sensitive marker of systemic inflammation.In the present study,we evaluated the pretreatment serum CRP level as a risk factor of the development of nephrotoxicity in patients receiving total daily doses of ≥4g of vancomycin.Data extracted from medical records for 174 patients who received total daily doses of ≥4g of intravenous vancomycin for a minimum of 48 hours and had their serum CRP level and erythrocyte sedimentation rate(ESR)tested within 24 hours before vancomycin treatment were subject to final analyses.Univariate analyses showed that patients who developed nephrotoxicity during vancomycin treatment had significantly higher median vancomycin serum concentration,duration of vancomycin treatment,and the serum CRP level within 24 hours before vancomycin treatment than the non-nephrotoxicity group.Multivariate logistic regression analysis showed that after adjusting for potential confounders including age,sex,body mass index,median vancomycin serum concentration,average vancomycin daily dose,duration of vancomycin treatment,ICU admission status,administration of intravenous contrast or nephrotoxic agents,administration of vasopressors,serum CRP level and ESR within 24 hours before vancomycin treatment,and co-morbidities,median vancomycin serum concentration,duration of treatment,serum CRP level within 24 hours before vancomycin treatment,and nephrotoxic medication were found significantly associated with the development of nephrotoxicity.This was confirmed by multivariate hazard ratio analysis after adjusting for the above potential confounders.In conclusion,this study provides the first evidence supporting that the serum CRP level within 24 hours before vancomycin treatment is an independent risk factor for the development of nephrotoxicity in patients receiving total daily doses of ≥4g of vancomycin.Therefore,the serum CRP level within 24 hours before vancomycin treatment could be a potential biomarker or prognostic factor for the development of vancomycin nephrotoxicity.