ABSTRACT
Background: Determining the timing of renal replacement therapy (RRT) in patients with acute kidney injury (AKI) and heart failure (HF) can optimize the clinical management strategy. We compared the impact of "early" and "delayed" timing of RRT on the prognosis of patients with AKI and HF. Methods: Clinical data from September 2012 to September 2022 were retrospectively analyzed. Patients with AKI complicated by HF and undergoing RRT in the intensive care unit (ICU) were enrolled. Patients with stage 3 AKI and fluid overload present (FOP) or who met the emergency indications for RRT were assigned to the delayed RRT group. Patients with stage 1 AKI or stage 2 AKI and without urgent indications for RRT and patients with stage 3 AKI without FOP and without urgent indications for RRT were enrolled in the Early RRT group. At 90-day follow-up after initiation of RRT, the mortality was compared between the two groups. Logistic regression analysis was performed to adjust for confounding factors affecting 90-day mortality. Results: A total of 151 patients were enrolled, including 77 in the early RRT group and 74 in the delayed RRT group. For baseline characteristics, patients in the early RRT group had significantly lower acute physiology and chronic health evaluation-II (APACHE-II) score, sequential organ failure assessment (SOFA), serum creatinine (Scr) values and blood urea nitrogen (BUN) values on the day of ICU admission than those in the delayed RRT group (both P values <0.05), there were no significant differences in other baseline characteristics. The number of RRT-free days in the ICU was significantly longer in the early RRT group than in the delayed RRT group [1.69 (0.35-10.87) vs. 0.88 (0.20-4.55) days; P=0.046]. However, clinical outcomes (except for the number of RRT-free days) and complications showed no significant differences between these 2 groups (all P values >0.05). Multivariate binary logistic regression analysis showed early initiation of RRT was not an independent risk factor for increased 90-day mortality [odds ratio (OR): 0.671; 95% confidence interval (CI): 0.314-1.434; P=0.303]. Conclusions: Early initiation of RRT is not recommended to reduce mortality in AKI patients with HF.
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OBJECTIVE: The present study explored the risk factors of postoperative mortality in patients with acute Stanford type A aortic dissection (AD). METHODS: The study included 149 patients with acute Stanford type A AD who were treated at the Fourth Hospital of Hebei Medical University, China, from October 2016 to October 2018. The patients were divided into a death (n = 42) and survival group (n = 107) according to individual prognosis. Univariate analysis of all possible related risk factors was conducted; multivariate logistic regression analysis of the potential risk factors that showed statistical differences in the univariate analysis was also performed. RESULTS: The results of the univariate analysis showed that a body mass index (BMI) ≥25 kg/m2, surgery duration, duration of cardiopulmonary bypass, duration of cardiopulmonary bypass assistance, total transfusion of red blood cells, postoperative APACHE II score, sequential organ failure assessment (SOFA) score, low cardiac output, acute kidney injury (AKI), hypoxemia, diffuse intravascular coagulation (DIC), hepatic failure and other related complications, as well as postoperative stay duration in the intensive care unit (ICU), were closely correlated with a poor prognosis among patients. Multivariate logistic regression analysis showed that a BMI ≥25 kg/m2, SOFA score >8, duration of cardiopulmonary bypass assistance >70 minutes, postoperative low cardiac output, and postoperative DIC were independent risk factors for postoperative death in patients with acute Stanford type A AD. CONCLUSION: A BMI ≥25 kg/m2, SOFA score >8, duration of cardiopulmonary bypass assistance >70 min, postoperative DIC, and postoperative low cardiac output were the independent risk factors for postoperative death in acute Stanford type A AD. Intraoperative blood transfusion, postoperative hepatic failure, and AKI, among others, correlated with an increased risk of death but were not independent risk factors for death.
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BACKGROUND: Evaluate the accuracy of IWI predicting weaning in patients with mechanical ventilation greater than 72 hours. METHODS: All patients were divided into two groups, according to FiO2 in the intensive care unit (ICU) with mechanically ventilated for more than 72 hours. Recorded Integrative weaning index (IWI) related indicators in all patients. Evaluate the accuracy of IWI predicting weaning success. RESULTS: Within these 50 patients, 32 of them were weaning successfully, and 18 of the patients failed. Using IWI >45.70 mL/cmH2O breaths/minute/liter as a threshold of predicting successful weaning, the sensitivity is 0.91, and the specificity is 0.83. The AUC of IWI was 0.91. In the group with FiO2 =0.40, 17 patients were successfully liberated from MV, while 8 patients failed. The sensitivity is 0.8235, and specificity is 0.88 using IWI >50.40 mL/cmH2O breath/minute/liter as a threshold for predicting the outcome of weaning. The AUC of IWI was 0.846±0.117. In the FiO2 =0.35 group, 15 patients were successfully liberated from MV, while 10 patients failed. Using IWI >39.33 mL/cmH2O breaths/minute/liter, as a threshold to predict successful weaning, results in a sensitivity of 0.93 and a specificity of 0.90. The AUC of IWI was 0.953±0.395. CONCLUSIONS: Results showed IWI has a significantly higher AUC value compared with other traditional weaning indexes. Hence, it can be a significant predictor for weaning outcomes.
