RESUMEN
Acute kidney injury (AKI) is detrimental after cardiac surgery. In this multicenter study, the novel biomarker hemojuvelin (HJV) was evaluated for AKI prediction following cardiac surgery. Urinary HJV, neutrophil gelatinase-associated lipocalin (NGAL), and urinary creatinine were measured in 151 patients after surgery. The outcomes of advanced AKI (KDIGO stages 2 and 3) and all causes of in-hospital mortality as the composite outcome were recorded. Areas under the receiver operator characteristic curves (AUC) and a multivariate generalized additive model (GAM) were applied to predict these outcomes of interest. Urinary HJV differentiated patients with/without AKI, advanced AKI or composite outcome after surgery (p < 0.001, by a generalized estimating equation) in this study. At three hours post-surgery, urinary HJV predicted advanced AKI (p < 0.001) and composite outcome (p < 0.001) with corresponding AUC values of 0.768 and 0.828, respectively. The performance of creatinine-adjusted HJV was also superior to NGAL in predicting advanced AKI (AUC = 0.784 and 0.694; p = 0.037) and composite outcome (AUC = 0.842 and 0.676; p = 0.002). The integration of HJV into the Cleveland Clinic score for advanced AKI led to a significant increase in risk stratification (net reclassification improvement [NRI] = 0.598; p < 0.001).
Asunto(s)
Lesión Renal Aguda/etiología , Lesión Renal Aguda/orina , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Proteínas Ligadas a GPI/orina , Lesión Renal Aguda/mortalidad , Procedimientos Quirúrgicos Cardíacos/mortalidad , Creatinina/orina , Femenino , Proteína de la Hemocromatosis , Mortalidad Hospitalaria , Humanos , Lipocalina 2/orina , Masculino , Persona de Mediana Edad , Modelos Biológicos , Análisis Multivariante , Curva ROC , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIMS: To compare prediction power between ICNARC model and RIFLE classification in postoperative patients receiving acute dialysis. MATERIAL AND METHOD: Between January 2002 and December 2008, 529 patients received acute dialysis during their ICU stay were enrolled. Patients' demographic, clinical and laboratory variables were analyzed as predictors of mortality. The RIFLE logistic regression and the ICNARC model on ICU admission were evaluated to predict the patient's hospital mortality. RESULTS: Hospital mortality for the study group was 29.3%. Between two score systems, the ICNARC model showed better mortality prediction in this patient group by using the area under the receiver operating characteristic curve (ICNARC 0.836, RIFLE 0.702, p < 0.05). Multiple logistic regression analysis indicated that age, surgery category, metastatic carcinoma, ventilator use, and previous history of hypertension were also affecting factors for hospital mortality. CONCLUSIONS: The RIFLE classification and the ICNARC model were both correlated with mortality in critically ill patient with acute dialysis. However, the ICNARC model was a better mortality predictor compared to the RIFLE classification.
Asunto(s)
Indicadores de Salud , Enfermedades Renales/mortalidad , Enfermedades Renales/terapia , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/terapia , Diálisis Renal/mortalidad , APACHE , Anciano , Distribución de Chi-Cuadrado , Enfermedad Crítica , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Enfermedades Renales/etiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Pronóstico , Curva ROC , Diálisis Renal/efectos adversos , Medición de Riesgo , Factores de Riesgo , Análisis de Supervivencia , Taiwán/epidemiologíaRESUMEN
We report a fatal case of community-acquired empyema thoracis and candidemia caused by Candida albicans. The patient responded poorly to human recombinant activated protein C and intravenous fluconazole treatment and died of profound shock with multiple organ failure 8 days after admission.