ABSTRACT
[This corrects the article DOI: 10.1371/journal.pone.0284248.].
ABSTRACT
This study describes the incidence, evolution and prognosis of acute kidney injury (AKI) in critical COVID-19 during the first pandemic wave. We performed a prospective, observational, multicenter study of confirmed COVID-19 patients admitted to 19 intensive care units (ICUs) in Catalonia (Spain). Data regarding demographics, comorbidities, drug and medical treatment, physiological and laboratory results, AKI development, need for renal replacement therapy (RRT) and clinical outcomes were collected. Descriptive statistics and logistic regression analysis for AKI development and mortality were used. A total of 1,642 patients were enrolled (mean age 63 (15.95) years, 67.5% male). Mechanical ventilation (MV) was required for 80.8% and 64.4% of these patients, who were in prone position, while 67.7% received vasopressors. AKI at ICU admission was 28.4% and increased to 40.1% during ICU stay. A total of 172 (10.9%) patients required RRT, which represents 27.8% of the patients who developed AKI. AKI was more frequent in severe acute respiratory distress syndrome (ARDS) ARDS patients (68% vs 53.6%, p<0.001) and in MV patients (91.9% vs 77.7%, p<0.001), who required the prone position more frequently (74.8 vs 61%, p<0.001) and developed more infections. ICU and hospital mortality were increased in AKI patients (48.2% vs 17.7% and 51.1% vs 19%, p <0.001) respectively). AKI was an independent factor associated with mortality (IC 1.587-3.190). Mortality was higher in AKI patients who required RRT (55.8% vs 48.2%, p <0.04). Conclusions There is a high incidence of AKI in critically ill patients with COVID-19 disease and it is associated with higher mortality, increased organ failure, nosocomial infections and prolonged ICU stay.
Subject(s)
Acute Kidney Injury , COVID-19 , Humans , Male , Middle Aged , Female , Spain/epidemiology , COVID-19/complications , COVID-19/epidemiology , Prospective Studies , Critical Illness , Intensive Care Units , Renal Replacement Therapy , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Retrospective Studies , Risk FactorsABSTRACT
OBJECTIVES: Patients with COVID-19-associated acute respiratory distress syndrome (ARDS) have a high risk for developing acute kidney injury (AKI) which is associated with an increased risk of death and persistent renal failure. Early prediction of AKI is crucial in order to implement preventive strategies. The purpose of this study was to investigate the predictive performance of tissue inhibitor of metalloproteinases 2 and insulin like growth factor binding protein 7 (TIMP-2) × (IGFBP7) in critically ill patients with COVID-19-associated ARDS. DESIGN: Multicenter, prospective, observational study. SETTING: Twelve centers across Europe and United Kingdom. PATIENTS: Patients with moderate or severe COVID-19-associated ARDS were included and serial measurements of (TIMP-2) × (IGFBP7) were performed. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the development of moderate or severe AKI according to the Kidney Disease: Improving Global Outcomes definition. Three hundred patients were available for the primary analysis, and 39 met the primary endpoint. At enrollment, urinary (TIMP-2) × (IGFBP7) had high predictive value for the primary endpoint with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.84-0.93). (TIMP-2) × (IGFBP7) was significantly higher in endpoint-positive patients at enrollment and at 12 hours. CONCLUSIONS: Urinary (TIMP-2) × (IGFBP7) predicts the occurrence of AKI in critically ill patients with COVID-19-associated ARDS.
Subject(s)
Acute Kidney Injury , COVID-19 , Humans , Tissue Inhibitor of Metalloproteinase-2 , Prospective Studies , Critical Illness , COVID-19/complications , Biomarkers , Cell Cycle Checkpoints , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Insulin-Like Growth Factor Binding ProteinsABSTRACT
INTRODUCCIÓN: el paciente oncológico presenta un estado de hipermetabolismo generalizado que, sumado a los efectos sistémicos del acto quirúrgico, lo convierten en un paciente con riesgo aumentado de padecer complicaciones. OBJETIVO: el objetivo de este estudio fue evaluar el efecto de la implantación de un Programa de Evaluación y Soporte Nutricional en pacientes intervenidos de cirugía colorrectal con diagnóstico de neoplasia. MATERIAL Y MÉTODOS: se realizó un estudio cuasiexperimental con análisis antes y después de la implantación del Programa de Evaluación y Soporte Nutricional. Se incluyeron pacientes intervenidos de neoplasia de colon o recto. Se estudiaron la incidencia de las complicaciones y la estancia media. Se evaluó el efecto de la intervención con la odds ratio (OR) ajustada con un método de regresión logística. RESULTADOS: se incluyó un total de 130 pacientes, 65 en el periodo 2016-2017 (antes del programa) y 65 durante el año 2018 (después del programa). La incidencia de infección de sitio quirúrgico descendió del 18,5 % al 6,2 % (OR = 0,29; IC 95 %: 0,09-0,95) (p = 0,033). También se evidenció una reducción en el registro de fiebre postoperatoria del 50 % (OR = 0,41; IC 95 %: 0,17-0,96) (p = 0,037). Se redujo la estancia hospitalaria de 11,3 días (DE = 8) a 7,18 días (DE = 2,5) (p = 0,02). Hubo un mayor registro de información clínica y analítica referente al estado y riesgo nutricional de los pacientes. CONCLUSIÓN: la implantación de un Programa de Evaluación y Soporte Nutricional en pacientes intervenidos de cirugía colorrectal ha presentado diferencias estadísticamente significativas en la reducción de infección de sitio quirúrgico, reducción de fiebre postoperatoria y de estancia hospitalaria
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Subject(s)
Humans , Male , Aged , Health Impact Assessment , Nutrition Programs and Policies , Preoperative Period , Colorectal Surgery/methods , Colorectal Neoplasms/epidemiology , Nutritional Support , Surgical Wound Infection/therapy , Enteral Nutrition/methods , Colorectal Neoplasms/complicationsABSTRACT
INTRODUCTION: generalized hypermetabolism is common in cancer patients and increases the risk of complications when combined with the systemic effects of surgery. OBJECTIVE: the aim of this study was to clinically assess the implementation of a Nutritional Assessment and Support Program for patients undergoing colorectal surgery with a diagnosed neoplasia. MATERIAL AND METHODS: a quasi-experimental study was performed with analyses before and after the implementation of the Nutritional Assessment and Support Program. Patients who underwent surgery for colon or rectal neoplasia were included. The incidence of complications and the average hospital stay were studied. The effect of the intervention was evaluated using a logistic regression analysis to yield adjusted odds ratios (OR). RESULTS: a total of 130 patients were included in the study, 65 from 2016-2017 (pre-program) and 65 in 2018 (post-program). The incidence of surgical site infection decreased from 18.5 % to 6.2 % (OR = 0.29; 95 % CI: 0.09-0.95) (p = 0.033). Postoperative fevers were also reduced by 50 % (OR = 0.41; 95 % CI: 0.17-0.96) (p = 0.037). Average hospital stay was reduced from 11.3 days (DE = 8) to 7.18 days (DE = 2.5) (p = 0.02). More clinical and analytical information was logged about the patients' nutritional status and risk. CONCLUSION: the implementation of a Nutritional Assessment and Support Program for patients undergoing colorectal surgery has shown statistically significant differences in the reduction of surgical site infection, postoperative fever and the length of hospital stay.
Subject(s)
Colorectal Surgery , Digestive System Surgical Procedures , Colon , Humans , Length of Stay , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Surgical Wound InfectionABSTRACT
The signaling pathways that control T cell differentiation have only begun to be elucidated. Using T cell lines, it has been shown that class IA phosphatidylinositol 3-kinase (PI3K), a heterodimer composed of a p85 regulatory and a p110 catalytic subunit, is activated after TCR stimulation. Nonetheless, the contribution of p85/p110 PI3K isoforms in T cell development has not been described. Mice deficient in the other family of class I PI3K, p110gamma, which is regulated by G protein-coupled receptors, exhibit reduced thymus size. Here we examine T cell development in p110gamma-deficient mice and in mice expressing an activating mutation of the p85 regulatory subunit, p65(PI3K), in T cells. We show that p110gamma-deficient mice have a partial defect in pre-TCR-dependent differentiation, which is restored after expression of the p65(PI3K) activating mutation. Genetic alteration of both PI3K isoforms also affects positive selection; p110gamma deletion decreased and p65(PI3K) expression augmented the CD4(+)/CD8(+) differentiation ratio. Finally, data are presented showing that both PI3K isoforms influenced mature thymocyte migration to the periphery. These observations underscore the contribution of PI3K in T cell development, as well as its implication in determining the CD4(+)/CD8(+) T cell differentiation ratio in vivo.
