[Obese children 10 years later: an observational study]. / Que deviennent 10ans après, les enfants suivis pour surpoids ou obésité ? : étude observationnelle.

INTRODUCTION: Although childhood obesity is a major public health problem, the long-term follow-up of children who are overweight and obese has rarely been studied in France. METHODS: We conducted a single-center observational study of 85 subjects who received medical follow-up for weight problems or obesity in 2001, at which time they were aged between 2 and 17 years. The study followed-up these subjects in 2012, after a mean of 10 years. We separated the study into two time periods. Initial follow-up periods - (A) from the first consultation to the end of individual or group care -and latency periods - (B) from the end of medical care to the year 2012 - were distinguished. A declarative survey based on questionnaires on dietary habits, activity levels, and anthropometric data of children and their parents was conducted in 2012. Two indicators of effectiveness monitoring (α) and post-follow-up (ß) were created. RESULTS: Although 77% of patients had a favorable α indicator, demonstrating the effectiveness of initial management, especially if it was prolonged (>32 months, P=0.007), a re-ascent of the BMI curve after ceasing monitoring occurred in half of the cases (47%) with subjects' BMI significantly correlated with their parents' BMI (P=0.004 for the mother and P=0.02 for the father). CONCLUSION: These observations encourage us to improve the medical follow-up on offer by educating and strengthening the role of parents to achieve a significant and lasting improvement in BMI and weight. In case of medical failure in supporting patients to achieve enough weight loss, the option of bariatric surgery can be considered, even if its recent introduction means that a long-term risk/benefit analysis has yet to be conducted.

Positive fluid balance is associated with reduced survival in critically ill patients with cancer.

BACKGROUND: There are no studies that describe the impact of the cumulative fluid balance on the outcomes of cancer patients admitted to intensive care units ICUs. The aim of our study was to evaluate the relationship between fluid balance and clinical outcomes in these patients. METHOD: One hundred twenty-two cancer patients were prospectively evaluated for survival during a 30-day period. Univariate (Chi-square, t-test, Mann-Whitney) and multiple logistic regression analyses were used to identify the admission parameters associated with mortality. RESULTS: The mean cumulative fluid balance was significantly higher in non-survivors than in survivors [1675 ml/24 h (471-2921) vs. 887 ml/24 h (104-557), P = 0.017]. We used the area under the curve and the intersection of the sensibility and specificity curves to define a cumulative fluid balance value of 1100 ml/24 h. This value was used in the univariate model. In the multivariate model, the following variables were significantly associated with mortality in cancer patients: the Acute Physiology and Chronic Health Evaluation II score at admission [Odds ratio (OR) 1.15; 95% confidence interval (CI) (1.05-1.26), P = 0.003], the Lung Injury Score at admission [OR 2.23; 95% CI (1.29-3.87), P = 0.004] and a positive fluid balance higher than 1100 ml/24 h at ICU [OR 5.14; 95% CI (1.45-18.24), P = 0.011]. CONCLUSION: A cumulative positive fluid balance higher than 1100 ml/24 h was independently associated with mortality in patients with cancer. These findings highlight the importance of improving the evaluation of these patients' volemic state and indicate that defined goals should be used to guide fluid therapy.

Acute kidney injury prediction following elective cardiac surgery: AKICS Score.

Acute kidney injury (AKI) following cardiac surgery (AKICS) is associated with increased postoperative (post-op) morbidity and mortality. A prognostic score system for AKI would help anticipate patient (pt) treatment. To develop a predictive score (AKICS) for AKI following cardiac surgery, we used a broad definition of AKI, which included perioperative variables. Six hundred three pts undergoing cardiac surgery were prospectively evaluated for AKI defined as serum creatinine above 2.0 mg/dl or an increase of 50% above baseline value. Univariate and multivariate analyses were used to evaluate pre-, intra-, and post-op parameters associated with AKI. The AKICS scoring system was prospectively validated in a new data set of 215 pts with an incidence of AKI of 14%. Variables included in the AKICS score were age greater than 65, pre-op creatinine above 1.2 mg/dl, pre-op capillary glucose above 140 mg/dl, heart failure, combined surgeries, cardiopulmonary bypass time above 2 h, low cardiac output, and low central venous pressure. The AKICS score presented good calibration and discrimination in both the study group and validation data set. The AKICS system that we developed, which incorporates five risk categories, accurately predicts AKI following cardiac surgery.