Identification of risk factors for iatrogenic hypophosphatemia: A retrospective case-control study.

BACKGROUND AND OBJECTIVES: To investigate the iatrogenic risk factors for hypophosphatemia in intensive care unit (ICU) patients. METHODS AND STUDY DESIGN: A total of 120 patients were enrolled and further divided into 4 groups, namely normal, mild, moderate or severe, according to the degree of hypophosphatemia. A number of related factors were analyzed and compared among the 4 groups, including the treatment method and outcomes. Univariate and multivariate regression analyses were employed to identify and confirm the risk factors associated with the occurrence of hypophosphatemia. RESULTS: The results revealed that the acute physiology and chronic health evaluation II (APACHEII), Sequential Organ Failure Assessment (SOFA), modified NUTrition Risk in Critically ill (NUTRIC) scores as well as the length of patient stays in ICUs exhibited a gradually increasing trend of aggravation of hypophosphatemia. Univariate regression analysis identified the use of dehydrating drugs to be closely associated with the occurrence of hypophosphatemia, which was further confirmed by a multivariate regression analysis. CONCLUSIONS: The use of dehydrating drugs led to hypophosphatemia; therefore blood phosphorus concentrations should be closely monitored during treatment of ICU patients.

Effects of acute kidney injury on acute pancreatitis patients' survival rate in intensive care unit: A retrospective study.

BACKGROUND: Acute kidney injury (AKI) is one of the most common acute pancreatitis (AP)-associated complications that has a significant effect on AP, but the factors affecting the AP patients' survival rate remains unclear. AIM: To assess the influences of AKI on the survival rate in AP patients. METHODS: A total of 139 AP patients were included in this retrospective study. Patients were divided into AKI group (n = 72) and non-AKI group (n = 67) according to the occurrence of AKI. Data were collected from medical records of hospitalized patients. Then, these data were compared between the two groups and further analysis was performed. RESULTS: AKI is more likely to occur in male AP patients (P = 0.009). AP patients in AKI group exhibited a significantly higher acute physiologic assessment and chronic health evaluation II score, higher Sequential Organ Failure Assessment score, lower Glasgow Coma Scale score, and higher demand for mechanical ventilation, infusion of vasopressors, and renal replacement therapy than AP patients in non-AKI group (P < 0.01, P < 0.01, P = 0.01, P = 0.001, P < 0.01, P < 0.01, respectively). Significant differences were noted in dose of norepinephrine and adrenaline, duration of mechanical ventilation, maximum and mean values of intra-peritoneal pressure (IPP), maximum and mean values of procalcitonin, maximum and mean serum levels of creatinine, minimum platelet count, and length of hospitalization. Among AP patients with AKI, the survival rate of surgical intensive care unit and in-hospital were only 23% and 21% of the corresponding rates in AP patients without AKI, respectively. The factors that influenced the AP patients' survival rate included body mass index (BMI), mean values of IPP, minimum platelet count, and hospital day, of which mean values of IPP showed the greatest impact. CONCLUSION: AP patients with AKI had a lower survival rate and worse relevant clinical outcomes than AP patients without AKI, which necessitates further attention to AP patients with AKI in surgical intensive care unit.

Effect of initiation of renal replacement therapy on mortality in acute pancreatitis patients.

This study aims to explore effect of initiation of renal replacement therapy (RRT) on mortality in acute pancreatitis (AP) patients. In this study, a total of 92 patients from the surgical intensive care unit (SICU) of the Second Affiliated Hospital of Harbin Medical University who were diagnosed with AP and underwent RRT or not between January 2014 and December 2018 were included in this retrospective study. Demographic and clinical data were obtained on admission to SICU. Patients were divided into early initiation of RRT group (n = 44) and delayed initiation of RRT group (n = 48). Duration of mechanical ventilation (MV), intra-peritoneal pressure, vasopressors infusion, body temperature, procalcitonin, creatinine, platelet counts, length of hospital stay and prognosis were recorded during hospitalization, and then compared between groups. Patients with delayed initiation of RRT exhibited significantly higher APACHE II score, SOFA score and lower GCS score than those with early initiation of RRT (P < 0.001, <0.001,  = 0.04, respectively). No difference in the rest of the baseline data and vasopressors infusion was found. Dose of Norepinephrine, maximum and mean PCT, maximum and mean creatinine, maximum and mean intra-peritoneal pressure, length of hospital stay, prognosis of ICU and hospitalization showed significant difference between groups. Early initiation of RRT may be beneficial for AP patients, which can provide some insight and support for patients' treatment in clinic.

Pharmacokinetics and Pharmacodynamics of Linezolid in Patients With Sepsis Receiving Continuous Venovenous Hemofiltration and Extended Daily Hemofiltration.

BACKGROUND: This prospective study compared pharmacokinetics (PK) and pharmacodynamics (PD) of linezolid in patients with sepsis receiving continuous venovenous hemofiltration (CVVH) with patients receiving extended daily hemofiltration (EDH). METHODS: Patients with sepsis treated with linezolid and CVVH or EDH were included. Serial blood samples were collected and linezolid concentrations measured. PKs were analyzed using Pmetrics. Monte Carlo simulations were used to evaluate PD target achievement. RESULTS: From 20 patients, 320 blood samples were collected for PK and PD analysis. PK profiles of linezolid were best described by a 2-compartment model. PK parameters were not significantly different between EDH and CVVH groups and were associated with body weight, renal replacement therapy (RRT) duration, and sequential organ failure assessment score. Monte Carlo simulations showed poor fractional target attainment for a minimum inhibitory concentration (MIC) of 2 mg/L with standard 600 mg intravenous administration every 12 hours. CONCLUSIONS: Patients with sepsis receiving RRT exhibited variability in PK/PD parameters for linezolid. PK parameters were not significantly different between CVVH- and EDH-treated patients. Higher probability of target attainment would be achievable at a MIC of 2 mg/L in EDH patients. Higher linezolid doses should be considered for patients on RRT to achieve adequate blood levels.

Safety research of extracorporeal membrane oxygenation treatment on cardiogenic shock: a multicenter clinical study.

BACKGROUND: Study the survival rate of extracorporeal membrane oxygenation (ECMO) and control group to treat cardiogenic shock and the complication and safety of the ECMO. METHODS: We collected patients with cardiogenic shock in the ICU of six hospitals from March 2013 to November 2014. There were 29 cases in the ECMO treatment group and 28 cases in the control group. The survival rate between ECMO treatment group and control group for 30 days and the occurrence rate of complication in the ECMO treatment group were compared. RESULTS: For the 29 patients in the ECMO group, 11 patients survived (with a survival rate of 37.9%) for 30 days, and 18 patients died (with a mortality rate of 62.1%). For the 28 patients in the control group, three patients survived (with a survival rate of 10.7%) and 25 patients died (with a mortality rate of 89.3%). Fifteen patients succeeded in separating from the ECMO machine within 14 days in the ECMO group. There were 11 patients that survived and left the hospital, with the time of 272.91±397.98 hours on ECMO, and 14 patients could not separate from the machine and died. For complications in the ECMO group, 11 patients had hemorrhaging (37.93%), 5 patients with neurological complications (17.21%), 1 patient with pneumothorax (3.44%), 8 patients with renal failure (27.59%), 12 patients with heart complication (41.38%), 9 patients with infection (31.03%), 7 patients with hyperbilirubinemia (24.14%). Twenty nine patients on the ECMO all used ventilator for support, among which, 17 patients adopted intra-aortic balloon pump (IABP) simultaneously, 8 patients with continuous hemofiltration due to renal failure (27.59%), for the death patients in ECMO group, 12 patients died from cardiogenic shock (48%), 3 patients with brain death (12%), 2 patients with septic shock (8%), and one patient with multiple organ failure (4%). CONCLUSIONS: The ECMO treatment can decrease the mortality rate with a low occurrence rate of complication, effective to rescue cardiogenic shock.

Involvement of the calcium-sensing receptor in cyclosporin A-induced cardiomyocyte apoptosis in rats.

In this study, we sought to determine whether the calcium-sensing receptor (CaSR) is involved in Cyclosporin A (CsA)-induced cardiomyocyte apoptosis and identify its signal transduction pathway. Forty Wistar rats were randomly divided into four groups: the control group, the CsA group (CsA 15 mg/kg/day intraperitoneally, i.p.), the GdCl3 group (GdCI3 10 mg/kg, every other day, i.p.), and the CsA + GdCl3 group (CsA 15 mg/kg/day, i.p. and GdCl3 10 mg/kg, every other day, i.p.). The groups were treated for two weeks. Cardiomyocyte apoptosis and injury were observed by light microscopy, electron microscopy and TUNEL staining. CaSR mRNA expression was determined by RT-PCR, and CaSR protein expression was detected by western blot and immunohistochemistry. The protein expression levels of cytochrome c, cleaved caspase-9, cleaved caspase-3, Bax, and Bcl-2 were detected by western blot and immunohistochemistry. CsA increased the expression of CaSR mRNA and protein and enhanced cardiomyocyte apoptosis. GdCl3, a specific activator of CaSR, further enhanced CaSR expression and cardiomyocyte apoptosis and led to the upregulation of cytochrome c, cleaved caspase-9, cleaved caspase-3, and Bax, as well as the downregulation of Bcl-2. The present in vivo study provides further information on CsA-induced cardiomyocyte apoptosis. We determined for the first time that CaSR is involved in CsA-induced cardiomyocyte apoptosis in the rat through the activation of downstream cytochrome c-caspase-3 pathways. Furthermore, we offer evidence that the Bcl-2 family is involved in this process. These findings could provide novel strategies for the prevention and cure of CsA-induced cardiotoxicity.

Common variant in GAB2 is associated with late-onset Alzheimer's disease in Han Chinese.

BACKGROUND: GRB-associated binding protein 2 (GAB2) may function as a risk factor in the pathogenesis of Alzheimer disease (AD). A recent large genome-wide association study (GWAS) has identified a significant association of rs10793294 polymorphism within the GAB2 gene with AD in Caucasians. While there are no studies on the association of rs10793294 polymorphism with AD risk in the Chinese population. METHODS: The study investigated 358 sporadic late-onset AD (LOAD) and 366 healthy controls matched for sex and age in a Han Chinese population. The rs10793294 polymorphism within the GAB2 gene was genotyped using MALDI-TOF mass spectrometry. RESULTS: The C allele of the rs10793294 polymorphism within GAB2 was significantly associated with an increased risk of LOAD (OR=1.33, 95% CI=1.04-1.72, P=0.029). Significance was observed in APOEε4 carriers (genotype P=0.039, allele P=0.016). While in APOE ε4 non-carriers, significant differences were observed in alleles (P=0.039) but not in genotypes (P=0.304). Logistic regression revealed that rs10793294 polymorphism was still strongly associated with LOAD in dominant model (OR=2.58, 95% CI=1.22-5.45, P=0.013) and additive model (OR=1.38, 95% CI=1.05-1.80, P=0.020) after adjusting for age, gender, and the APOE ε4 status. CONCLUSIONS: Our findings implicate GAB2 as a susceptibility gene for LOAD in Han Chinese.