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1.
Medicina (B Aires) ; 79(5): 367-372, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31671386

RESUMO

We developed a prospective observational study, obtaining clinical and analytical data of patients admitted to the intensive care unit of the Hospital Reina Sofía, who required noninvasive ventilation, from January 1, 2013 to December 31, 2015. The main objective was to determine the 90-day mortality in these patients and conditions, who required noninvasive ventilation as treatment for acute respiratory failure and who developed acute kidney injury. Acute renal failure was defined as an increase in serum creatinine > 0.3 mg/dl at 48 hours with respect to the baseline. The patients were followed for 90 days. We analyzed 221 patients, 65 (29.4%) presented acute kidney injury and 156 (70.6%) normal renal function. Overall mortality at 90 days was 44 (19.9%). In the group of acute kidneys injury, it was 33 (51.6%), being 11 (7.1%) in patients without acute kidney injury (RR 7.340, 95% CI: 3.974-13.559, p < 0.001). Hospital stay in days was 24.2 ± 24.1 with acute kidney injury vs. 21.5 ± 0.7, p = 0.429; stay in the intensive care unit in days was 10.9 ± 14.4 with acute kidney injury vs. 7.3 ± 9.6, p = 0.357, and days of non-invasive ventilation 3.4 ± 3.0 with acute kidney injury vs. 2.7 ± 1.9, p = 0.569, in those patients not affected by the presence of acute kidney injury. In conclusion, the presence of acute kidney injury is an independent factor of mortality in patients with acute respiratory failure requiring noninvasive ventilation.


Assuntos
Lesão Renal Aguda/mortalidade , Ventilação não Invasiva/mortalidade , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Creatinina/sangue , Feminino , Humanos , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/terapia , Espanha , Estatísticas não Paramétricas , Fatores de Tempo
2.
J Cardiothorac Surg ; 14(1): 191, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699143

RESUMO

BACKGROUND: Mild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG. METHODS: After propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60-89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria. RESULTS: The 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09-2.90, p = 0.035; 95%CI 1.14-2.49, p = 0.027). CONCLUSIONS: Comparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.


Assuntos
Ponte de Artéria Coronária , Complicações Pós-Operatórias/etiologia , Insuficiência Renal/complicações , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Idoso , Feminino , Seguimentos , Taxa de Filtração Glomerular , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Período Pré-Operatório , Pontuação de Propensão , Diálise Renal , Insuficiência Renal/diagnóstico , Insuficiência Renal/mortalidade , Insuficiência Renal/terapia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
3.
Clin Interv Aging ; 14: 1763-1769, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31695346

RESUMO

Background: Critically ill older patients with acute kidney injury (AKI), also referred to as acute renal failure, are associated with high in-hospital mortalities. Preexisting malnutrition is highly prevalent among AKI patients and increases in-hospital mortality rate. This study is to evaluate the predictive power of some serum nutritional related biomarkers predicting the 90 days in-hospital mortality of critically ill older patients with AKI. Methods: A prospective, observational study was conducted in a university teaching hospital. One hundred and five critically ill older patients with AKI aged 60-95 were enrolled and were divided into survival group (n=44) and non-survival group (n=61) in the light of their final outcomes. Receiver operating characteristic analyses (ROC) were performed to calculate the area under ROC curve (AUC). Sensitivity and specificity of in-hospital mortality prediction were calculated. Results: Significant differences were found between the survival group and non-survival group of critically ill older patients with AKI. AUC of low density lipoprotein (LDL) and albumin were 0.686 and 0.595, respectively. The asymptotic 95% confidence intervals of LDL and albumin were 0.524-0.820 and 0.488-0.696, respectively. Sensitivity of the 90 days in-hospital mortality prediction of LDL and albumin were 68.71% and 69.09%, respectively. Specificity of 90 days in-hospital mortality prediction of LDL and albumin were 69.23% and 50.0%, respectively. Conclusion: LDL and albumin did not have sufficient power to predict the 90 days in-hospital mortality of critically ill older patients with AKI. Further research on the association between malnutrition and poor prognosis of critically ill older patients with AKI is needed in the future.Trial registration: ClinicalTrials.gov identifier: NCT00953992.


Assuntos
Lesão Renal Aguda/sangue , Lesão Renal Aguda/mortalidade , Mortalidade Hospitalar , Lipoproteínas LDL/sangue , Albumina Sérica/metabolismo , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estado Terminal/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC
4.
Rev Assoc Med Bras (1992) ; 65(8): 1094-1101, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531608

RESUMO

INTRODUCTION: Acute kidney injury (AKI) is a frequent event among critically ill patients hospitalized in intensive care units (ICU) and represents a global public health problem, being imperative an interdisciplinary approach. OBJECTIV: To investigate, through literature review, the AKI epidemiology in ICUs. METHODS: Online research in Medline, Scientific Electronic Library Online, and Latin American and Caribbean Literature in Health Sciences databases, with analysis of the most relevant 47 studies published between 2010 and 2017. RESULTS: Data of the 67,033 patients from more than 300 ICUs from different regions of the world were analyzed. The overall incidence of AKI ranged from 2.5% to 92.2%, and the mortality from 5% to 80%. The length of ICU stay ranged from five to twenty-one days, and the need for renal replacement therapy from 0.8% to 59.2%. AKI patients had substantially higher mortality rates and longer hospital stays than patients without AKI. CONCLUSION: AKI incidence presented high variability among the studies. One of the reasons for that were the different criteria used to define the cases. Availability of local resources, renal replacement therapy needs, serum creatinine at ICU admission, volume overload, and sepsis, among others, influence mortality rates in AKI patients.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação , Fatores de Risco
5.
Medicine (Baltimore) ; 98(33): e16800, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415389

RESUMO

BACKGROUND: The effects of early continuous renal replacement therapy (CRRT) on mortality in patients with septic acute kidney injury (AKI) remain controversial. A systematic review and meta-analysis was performed to investigate the impact of timing of CRRT on clinical outcomes in patients with septic AKI. METHODS: The PubMed, Cochrane, and Embase databases were searched from inception to the 31st of March 2019, to identify trials that assessed the timing of initiation of CRRT in patients with septic AKI. RESULTS: Five trials including 900 patients were included. The results of this meta-analysis showed that there was no significant difference between 28-day mortality (odds ratio = 0.76;95% CI, 0.58-1.00; P = .05) and 90-day mortality(odds ratio = 0.79;95% CI, 0.59-1.06; P = .12)of early and late initiation of CRRT group. In addition, compared with late initiation strategy, early initiation showed no significant advantage in length of stay in ICU (Mean difference = -0.9;95% CI, -2.37 to 0.57; P = .23) and length of stay in hospital (Mean difference = -1.43;95% CI, -5.28 to 2.41; P = .47). CONCLUSION: Our meta-analysis revealed that early initiation of CRRT could not reduce mortality in patients with septic AKI. The study also showed no significant difference in ICU length of stay or hospital length of stay between early and late CRRT group. To achieve optimal timing of CRRT for septic AKI, large multicenter randomized trials with better design are still needed.


Assuntos
Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Terapia de Substituição Renal/mortalidade , Sepse/mortalidade , Tempo para o Tratamento/estatística & dados numéricos , Lesão Renal Aguda/complicações , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Sepse/etiologia , Fatores de Tempo
6.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(7): 832-836, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31441405

RESUMO

OBJECTIVE: To investigate the predict value of interleukin-18 (IL-18) combine with kidney injury molecule-1 (KIM-1) on 28-day mortality in patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT) in intensive care unit (ICU), and to look for the start time of CRRT. METHODS: A prospective observational study was conducted. The consecutive AKI critical patients who underwent CRRT from June 2017 to February 2018 admitted to ICU of the Fourth Hospital of Hebei Medical University were enrolled. Patients were divided into AKI 2 stage and AKI 3 stage groups according to the guidelines for Kidney Disease: Improving Global Outcomes (KDIGO). Basic vital signs were recorded for all enrolled patients, and ventilator parameters were recorded for patients on ventilation. Urine specimens were collected before CRRT, and IL-18 and KIM-1 levels were measured by enzyme-linked immunosorbent assay (ELISA). The patients were followed up for 28 days. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of urinary IL-18 and KIM-1 for prognosis. RESULTS: During the study period, 38 patients were treated. The patients with ICU stayed for less than 3 days, chronic obstructive kidney disease, intra-abdominal hypertension (IAH), diuretics usage within 4 hours or renal replacement therapy before urine collection were excluded. Finally, 30 patients were enrolled, including 12 patients with AKI phase 2 and 18 patients with AKI phase 3. There was no significant difference in basic medical characteristics such as gender, age, height, weight, basic vital signs, basic renal function, or severity of disease between AKI 2 stage and AKI 3 stage groups. Compared with the AKI 2 stage group, the level of urine KIM-1 in the AKI 3 stage group was significantly increased [ng/L: 6 195.6 (5 892.6, 7 935.4) vs. 5 487.5 (4 769.8, 6 353.4), P < 0.01], but urine IL-18 level was not statistically significant [ng/L: 52.1 (48.1, 62.6) vs. 53.9 (52.0, 57.2), P > 0.05]. All patients were followed up for 28 days. The 28-day all-cause mortality rate of AKI 2 stage group was significantly lower than that of AKI 3 stage group [16.7% (2/12) vs. 66.7% (12/18), P < 0.05]. ROC curve analysis showed that urinary IL-18 had a small predictive value for the 28-day mortality of AKI patients undergoing CRRT, and KIM-1 had a certain predictive value, and the combined value of the combined detection was greater, and the area under ROC curve (AUC) was 0.786 [95% confidence interval (95%CI) = 0.598-0.914, P = 0.001] with a sensitivity of 50.0% and a specificity of 100%. CONCLUSIONS: Urine IL-18 combined with urine KIM-1 has a high predictive value for the prognosis of patients with AKI. For critically ill patients with AKI, initiation of CRRT treatment in AKI 2 stage can significantly reduce the 28-day mortality as compared with that in AKI 3 stage.


Assuntos
Lesão Renal Aguda/mortalidade , Interleucina-18/metabolismo , Terapia de Substituição Renal , Lesão Renal Aguda/metabolismo , Humanos , Unidades de Terapia Intensiva , Estudos Prospectivos
7.
Biomed Res Int ; 2019: 4572130, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467891

RESUMO

Purpose: Acute kidney injury (AKI) is a major and severe complication following donation-after-circulatory-death (DCD) liver transplantation (LT) and is associated with increased postoperative morbidity and mortality. However, the risk factors and the prognosis factors of AKI still need to be further explored, and the relativity of intraoperative hepatic blood inflow (HBI) and AKI following LT has not been discussed yet. The purpose of this study was to investigate the correlation between HBI and AKI and to construct a prediction model of early acute kidney injury (EAKI) following DCD LT with the combination of HBI and other clinical parameters. Methods: Clinical data of 132 patients who underwent DCD liver transplantation at the first hospital of China Medical University from April 2005 to March 2017 were analyzed. Data of 105 patients (the first ten years of patients) were used to develop the prediction model. Then we assessed the clinical usefulness of the prediction models in the validation cohort (27 patients). EAKI according to Kidney Disease Improving Global Outcomes (KDIGO) criteria based on serum creatinine increase during 7-day of postoperative follow-up. Results: After Least Absolute Shrinkage and Selection Operator (LASSO) regression and simplification, a simplified prediction model consisting of the Child-Turcotte-Pugh (CTP) score (p=0.033), anhepatic phase (p=0.014), packed red blood cell (pRBC) transfusion (p=0.027), and the HBI indexed by height (HBI/h) (p=0.002) was established. The C-indexes of the model in the development and validation cohort were 0.823 [95% CI, 0.738-0.908] and 0.921 [95% CI, 0.816-1.000], respectively. Conclusions: In this study, we demonstrated the utility of HBI/h as a predictor for EAKI following DCD LT, as well as the clinical usefulness of the prediction model through the combination of the CTP score, anhepatic phase, pRBC transfusion and HBI/h.


Assuntos
Lesão Renal Aguda/diagnóstico , Complicações Intraoperatórias/diagnóstico , Transplante de Fígado/efeitos adversos , Fígado/irrigação sanguínea , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Adulto , Creatinina/metabolismo , Feminino , Sobrevivência de Enxerto , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/mortalidade , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Obtenção de Tecidos e Órgãos
8.
Scand J Trauma Resusc Emerg Med ; 27(1): 68, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319855

RESUMO

BACKGROUND: In-hospital renal replacement therapy (RRT) is widely used for the treatments of acute kidney injury (AKI) in crush injury (CI) victims. This study was designed to investigate whether preventive peritoneal dialysis (PPD) is useful for renal protection in CI. METHODS: Animals received hindlimb compressions for 6 h to induce CI. Then, animals were untreated or treated with PPD and/or massive fluid resuscitation (MFR) for 8 h since the onset of compression release. Blood and renal tissue samples were collected at various time points for biological and morphological analysis. RESULTS: PPD attenuated lactic acidosis and reduced serum K+ and myoglobin levels in CI animals. In addition, PPD was effective in removing blood urea nitrogen (BUN) and creatinine, and reduced renal expressions of neutrophil gelatinase-associated lipocalin (NGAL). The combination of PPD and MFR furtherly attenuated AKI with significantly decreased histological scores (p = 0.037) and reduced NGAL expressions (p = 0.0002) as compared with the MFR group. Moreover, MFR + PPD group had a significantly higher survival rate than that in the MFR and the PPD groups (p < 0.05, respectively). CONCLUSION: The use of PPD at the onset of compression release is beneficial for renal protection and survival outcome in a rabbit model of CI.


Assuntos
Lesão Renal Aguda/terapia , Lesões por Esmagamento/complicações , Hidratação/métodos , Terapia de Substituição Renal/métodos , Ressuscitação/métodos , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Animais , Biomarcadores/sangue , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Modelos Animais de Doenças , Masculino , Coelhos
9.
Crit Care ; 23(1): 256, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307504

RESUMO

BACKGROUND: Acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) is a well-known predictor for mortality. However, the natural course of AKI including recovery rate after OHCA is uncertain. This study investigated the clinical course of AKI after OHCA and determined whether recovery from AKI impacted the outcomes of OHCA. METHODS: This retrospective multicentre cohort study included adult OHCA patients treated with targeted temperature management (TTM) between January 2016 and December 2017. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. The primary outcome was the recovery rate after AKI and its association with survival and good neurological outcome at discharge. RESULTS: A total of 3697 OHCA patients from six hospitals were screened and 275 were finally included. AKI developed in 175/275 (64%) patients and 69/175 (39%) patients recovered from AKI. In most cases, AKI developed within three days of return of spontaneous circulation [155/175 (89%), median time to AKI development 1 (1-2) day] and patients recovered within seven days of return of spontaneous circulation [59/69 (86%), median time to AKI recovery 3 (2-7) days]. Duration of AKI was significantly longer in the AKI non-recovery group than in the AKI recovery group [5 (2-9) vs. 1 (1-5) days; P < 0.001]. Most patients were diagnosed with AKI stage 1 initially [120/175 (69%)]. However, the number of stage 3 AKI patients increased from 30/175 (17%) to 77/175 (44%) after the initial diagnosis of AKI. The rate of survival discharge was significantly higher in the AKI recovery group than in the AKI non-recovery group [45/69 (65%) vs. 17/106 (16%); P < 0.001]. Recovery from AKI was a potent predictor of survival and good neurological outcome at discharge in the multivariate analysis (adjusted odds ratio, 8.308; 95% confidence interval, 3.120-22.123; P < 0.001 and adjusted odds ratio, 36.822; 95% confidence interval, 4.097-330.926; P = 0.001). CONCLUSIONS: In our cohort of adult OHCA patients treated with TTM (n = 275), the recovery rate from AKI after OHCA was 39%, and recovery from AKI was a potent predictor of survival and good neurological outcome at discharge.


Assuntos
Lesão Renal Aguda/reabilitação , Parada Cardíaca Extra-Hospitalar/complicações , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/fisiopatologia , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , República da Coreia , Estudos Retrospectivos , Estatísticas não Paramétricas , Análise de Sobrevida
10.
Mayo Clin Proc ; 94(8): 1509-1515, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31279541

RESUMO

OBJECTIVE: To assess whether loop diuretic challenge predicts the need for dialysis among critically ill patients with acute kidney injury (AKI) stage 3. PATIENTS AND METHODS: Adult patients admitted to intensive care units between January 1, 2004, and December 31, 2016, were screened. Acute kidney injury stage 3 was identified by an electronic surveillance tool, and patients who received loop diuretics in a dosage of at least 1mg/kg intravenous bolus furosemide equivalent were included. Urine output following loop diuretic challenge was modeled as a restricted cubic spline. We then compared the area under the receiver operating characteristic curve for urine outputs at 2 hours and 6 hours after loop diuretic challenge to predict the need for dialysis within the next 24 hours. RESULTS: Of 687 patients included in the study, those who received dialysis were younger and had higher Sequential Organ Failure Assessment scores on the day of loop diuretic challenge. Urine outputs at 2 hours and 6 hours were lower in patients who needed dialysis, but urine output by 6 hours was better in predicting dialysis initiation within 24 hours (area under the curve, 0.71 vs 0.67; P=.02). The sensitivity and specificity of 6-hour urine output cutoff of 600 mL or less to predict dialysis was 80.9% and 50.5%, respectively, and that for 300 mL or less was 64.2% and 68.2%, respectively. CONCLUSION: Among patients with stage 3 AKI, 6-hour urine output after the loop diuretic challenge had a modest discriminant capacity to identify dialysis initiation within the next 24 hours.


Assuntos
Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Estado Terminal/terapia , Unidades de Terapia Intensiva , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Centros Médicos Acadêmicos , Lesão Renal Aguda/diagnóstico , Adulto , Fatores Etários , Idoso , Área Sob a Curva , Estudos de Coortes , Estado Terminal/mortalidade , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Prognóstico , Diálise Renal/métodos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Taxa de Sobrevida , Resultado do Tratamento , Micção/fisiologia
11.
Transplant Proc ; 51(7): 2430-2433, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31280887

RESUMO

PURPOSE: The aim of this study is to investigate the effects of risk scores (Pediatric End-stage Liver Disease [PELD], Child-Turcotte-Pugh [CTP], and Pediatric Risk of Mortality [PRISM-III]) of pediatric liver transplant patients on the postoperative period. METHOD: Seven cadaveric and 45 living donors, totaling 52 pediatric liver transplantation (LT) patients, were reviewed retrospectively. PELD and CTP scores were calculated based on data at hospital admission. PRISM-III score was calculated from data during the first 24 hours of intensive care unit (ICU) admission. Hospital length of stay (LOS), ICU LOS, patients who developed acute kidney injury (AKI), requirement for inotropic-vasopressor therapy, hospital mortality, long-term mortality, duration of mechanical ventilation, metabolic disease, and demographic features were documented.For CTP score, class C was defined as high, and A and B as low. Cutoff values of PELD and PRISM-III scores were detected by using receiver operating characteristic curves. According to these cutoff values, patients were divided into 2 groups as high and low for each score. Documented data was analyzed and compared in groups for each score. RESULTS: Hospital LOS was significantly longer in the high-PELD (P = .01) and high-CTP (P = .01) groups. ICU LOS was significantly longer in the high-PRISM-III group (P = .01). Requirement for inotropic-vasopressor therapy was significantly higher in the high-PELD (P = .04) and high-CTP (P = .04) groups. CONCLUSION: Hemodynamic instability and long hospital LOS can be expected in pediatric post-LT patients with high PELD or CTP scores; there is also the risk that AKI maybe higher for high-PELD score patients. Unexpectedly, the PRISM-III score did not have any correlation with the severity of physiological condition and mortality.


Assuntos
Doença Hepática Terminal/mortalidade , Transplante de Fígado/mortalidade , Medição de Risco/métodos , Índice de Gravidade de Doença , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Criança , Doença Hepática Terminal/cirurgia , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Transplante de Fígado/métodos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Período Pós-Operatório , Curva ROC , Valores de Referência , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
12.
Int J Clin Pract ; 73(10): e13394, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31332896

RESUMO

BACKGROUND: Intra-operative hypotension might induce poor postoperative outcomes in non-cardiac surgery, and the relationship between the level or duration of Intra-operative hypotension (IOH) and postoperative adverse events is still unclear. In this study, we performed a meta-analysis to determine how IOH could affect acute kidney injury (AKI), myocardial injury and mortality in non-cardiac surgery. METHODS: We searched PubMed (Medline), Embase, Springer, The Cochrane Library, Ovid and Google Scholar, and retrieved the related clinical trials on intra-operative hypotension and prognosis in non-cardiac surgery. RESULTS: Fifteen observational studies were included. The meta-analysis showed that in non-cardiac surgery, intra-operative hypotension (mean arterial pressure [MAP]) <60 mm Hg for more than 1 minute was associated with an increased risk of postoperative acute kidney injury(AKI) [1-5 minutes: odds ratio (OR) = 1.13, 95% CI (1.04, 1.23), I2  = 0, P = .003; 5-10 minutes: OR = 1.18, 95% CI (1.07, 1.31), I2  = 0, P = .001; >10 minutes: OR = 1.35, 95% CI (1.1, 1.67), I2  = 52.6%, P = .004] and myocardial injury [1-5 minutes: OR = 1.16, 95% CI (1.01, 1.33), I2  = 30.6%, P = .04; 5-10 minutes: OR = 1.34, 95% CI (1.01, 1.77), I2  = 70.4%, P = .046; >10 minutes: OR = 1.43, 95% CI (1.18, 1.72), I2  = 39.4%, P < .0001]. Intra-operative hypotension (MAP < 60 mm Hg) for 1-5 minutes was not associated with postoperative 30-day mortality [OR = 1.15, 95% CI (0.95, 1.4), I2  = 0, P = .154], but intra-operative hypotension (MAP < 60 mm Hg) for more than 5 min was associated with an increased risk of postoperative 30-day mortality [OR = 1.11, 95% CI (1.06, 1.17), I2  = 51.9%, P < .0001]. CONCLUSION: Intra-operative hypotension was associated with an increased risk of postoperative AKI, myocardial injury and 30-day mortality in non-cardiac surgery. Intra-operative MAP < 60 mm Hg more than 1 minute should be avoided.


Assuntos
Lesão Renal Aguda/mortalidade , Hipotensão/mortalidade , Complicações Intraoperatórias , Infarto do Miocárdio/mortalidade , Lesão Renal Aguda/complicações , Humanos , Hipotensão/complicações , Infarto do Miocárdio/complicações
13.
PLoS Med ; 16(7): e1002861, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31306408

RESUMO

BACKGROUND: Acute kidney injury (AKI) is an adverse event that carries significant morbidity. Given that interventions after AKI occurrence have poor performance, there is substantial interest in prediction of AKI prior to its diagnosis. However, integration of real-time prognostic modeling into the electronic health record (EHR) has been challenging, as complex models increase the risk of error and complicate deployment. Our goal in this study was to create an implementable predictive model to accurately predict AKI in hospitalized patients and could be easily integrated within an existing EHR system. METHODS AND FINDINGS: We performed a retrospective analysis looking at data of 169,859 hospitalized adults admitted to one of three study hospitals in the United States (in New Haven and Bridgeport, Connecticut) from December 2012 to February 2016. Demographics, medical comorbidities, hospital procedures, medications, and laboratory data were used to develop a model to predict AKI within 24 hours of a given observation. Outcomes of AKI severity, requirement for renal replacement therapy, and mortality were also measured and predicted. Models were trained using discrete-time logistic regression in a subset of Hospital 1, internally validated in the remainder of Hospital 1, and externally validated in Hospital 2 and Hospital 3. Model performance was assessed via the area under the receiver-operator characteristic (ROC) curve (AUC). The training set cohort contained 60,701 patients, and the internal validation set contained 30,599 patients. External validation data sets contained 43,534 and 35,025 patients. Patients in the overall cohort were generally older (median age ranging from 61 to 68 across hospitals); 44%-49% were male, 16%-20% were black, and 23%-29% were admitted to surgical wards. In the training set and external validation set, 19.1% and 18.9% of patients, respectively, developed AKI. The full model, including all covariates, had good ability to predict imminent AKI for the validation set, sustained AKI, dialysis, and death with AUCs of 0.74 (95% CI 0.73-0.74), 0.77 (95% CI 0.76-0.78), 0.79 (95% CI 0.73-0.85), and 0.69 (95% CI 0.67-0.72), respectively. A simple model using only readily available, time-updated laboratory values had very similar predictive performance to the complete model. The main limitation of this study is that it is observational in nature; thus, we are unable to conclude a causal relationship between covariates and AKI and do not provide an optimal treatment strategy for those predicted to develop AKI. CONCLUSIONS: In this study, we observed that a simple model using readily available laboratory data could be developed to predict imminent AKI with good discrimination. This model may lend itself well to integration into the EHR without sacrificing the performance seen in more complex models.


Assuntos
Lesão Renal Aguda/epidemiologia , Técnicas de Apoio para a Decisão , Pacientes Internados , Admissão do Paciente/tendências , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Connecticut/epidemiologia , Registros Eletrônicos de Saúde , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Diálise Renal , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
14.
Einstein (Sao Paulo) ; 17(3): eAO4399, 2019 May 30.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31166482

RESUMO

OBJECTIVE: To determine whether pre-hospital statin use is associated with lower renal replacement therapy requirement and/or death during intensive care unit stay. METHODS: Prospective cohort analysis. We analyzed 670 patients consecutively admitted to the intensive care unit of an academic tertiary-care hospital. Patients with ages ranging from 18 to 80 years admitted to the intensive care unit within the last 48 hours were included in the study. RESULTS: Mean age was 66±16.1 years old, mean body mass index 26.6±4/9kg/m2 and mean abdominal circumference was of 97±22cm. The statin group comprised 18.2% of patients and had lower renal replacement therapy requirement and/or mortality (OR: 0.41; 95%CI: 0.18-0.93; p=0.03). The statin group also had lower risk of developing sepsis during intensive care unit stay (OR: 0.42; 95%CI: 0.22-0.77; p=0.006) and had a reduction in hospital length-of-stay (14.7±17.5 days versus 22.3±48 days; p=0.006). Statin therapy was associated with a protective role in critical care setting independently of confounding variables, such as gender, age, C-reactive protein, need of mechanical ventilation, use of pressor agents and presence of diabetes and/or coronary disease. CONCLUSION: Statin therapy prior to hospital admission was associated with lower mortality, lower renal replacement therapy requirement and sepsis rates.


Assuntos
Lesão Renal Aguda/terapia , HDL-Colesterol/efeitos dos fármacos , LDL-Colesterol/efeitos dos fármacos , Colesterol , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Terapia de Substituição Renal/estatística & dados numéricos , Triglicerídeos , APACHE , Lesão Renal Aguda/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/análise , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Creatinina/sangue , Cuidados Críticos/métodos , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Valores de Referência , Terapia de Substituição Renal/mortalidade , Reprodutibilidade dos Testes , Fatores de Risco , Resultado do Tratamento , Triglicerídeos/sangue , Adulto Jovem
15.
Saudi J Kidney Dis Transpl ; 30(3): 678-685, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249233

RESUMO

The increased incidence of the acute kidney injury (AKI) in the elderly is becoming a disturbing reality in our days, mainly with the aging of the general population, and the predisposition of old persons to chronic diseases, drug toxicity, and infections. The aim of this study was to investigate the epidemiological, clinical, and biological features and to assess variant etiologies and outcomes of AKI in the elderly. Data were collected from the medical records of patients older than 65 years age having AKI admitted in the Internal Medicine Department of the Military Hospital of Tunis from January 2006 to June 2014. One hundred and seventeen cases were included in the study. The median age was 74.2 years. Male:female ratio was 1.6. Hypertension and diabetes were the most frequently found comorbidities seen in 69.2% and 48.7% of patients, respectively. The percentage of patients having acute-on-chronic renal failure was 13.7%. The AKI was manifested by nausea or vomiting in 33.3% of cases. One patient had hematemesis. The other symptoms were dyspnea in 14.5% of cases, uremic encephalopathy in 6.8% of cases, and oligoanuria in 16.2% of cases. The AKI was discovered fortuitously in 31.6% of cases and was diagnosed early within the 48 h after admission in 94% of cases and after this delay, in 6% of cases. It was ranked Acute Kidney Injury Network 1, 2, or 3, respectively, in 29.9%, 24.8%, and 45.3% of cases. Organic etiologies were observed more frequently (53.8%) followed by functional etiologies (37.6%) and then by obstructive ones (8.5%). Hemodialysis was performed for 9.4% of the patients. Of all the patients, 70.1% had favorable outcome, 49.6% of patients recovered totally. There was aggravation of the AKI in 29.9% of cases. Death occurred in eight cases (6.8%). The epidemiological, clinical, biological, and etiological profile of AKI in the elderly emphasizes the effect of aging of the human being on determining the pathology.


Assuntos
Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Fatores Etários , Idoso , Comorbidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diagnóstico Precoce , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Registros Médicos , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tunísia/epidemiologia
16.
Indian J Public Health ; 63(2): 154-156, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31219067

RESUMO

Most deaths related to Hymenoptera are a result of immediate hypersensitivity reactions causing anaphylaxis to one or few stings. However, if the patient is exposed to a large quantity of the venom due to mass/multiple stings, massive envenomation can cause death in nonallergic individuals. Thirty-nine cases of acute kidney injury (AKI) who followed mass attacks by Hymenoptera were seen over 15 years, with a reference period between 2003 and 2017. AKI was severe; most (85%) of them required dialysis and one-third died. Mass attacks by Hymenoptera have become a serious public health problem in tropics. There is no antivenom, and treatment in such cases is supportive. Early hospitalization is vital to reduce morbidity and mortality.


Assuntos
Himenópteros , Mordeduras e Picadas de Insetos/mortalidade , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Adolescente , Adulto , Animais , Abelhas , Feminino , Humanos , Índia/epidemiologia , Mordeduras e Picadas de Insetos/complicações , Masculino , Pessoa de Meia-Idade , Vespas , Adulto Jovem
17.
J Cardiothorac Surg ; 14(1): 90, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064409

RESUMO

BACKGROUND: Thoracic aortic surgery and cardiopulmonary bypass are both associated with development of postoperative acute kidney injury. In this study, we undertook to investigate the relationship between cardiopulmonary bypass time and postoperative acute kidney injury in patients undergoing thoracic aortic surgery for acute DeBakey Type I aortic dissection. METHODS: All patients receiving thoracic aortic surgery for acute DeBakey Type I aortic dissection in Beijing Anzhen hospital from December 2015 to April 2017 were included. Cardiopulmonary bypass time was recorded during surgery. Acute kidney injury was defined based on the Kidney Disease Improving Global Outcomes criteria. A total of 115 consecutive patients were eventually analyzed. RESULTS: The overall incidence of acute kidney injury was 53.0% (n = 61). The average age was 47.8 ± 10.7 years; 74.8% were male. Mean cardiopulmonary bypass time was 211 ± 56 min. In-hospital mortality was 7.8%. Multivariate logistic regression revealed that cardiopulmonary bypass time was independently associated with the occurrence of postoperative acute kidney injury after adjust confounding factors (odds ratio = 1.171; 95% confidence interval: 1.002-1.368; P = 0.047). CONCLUSIONS: Cardiopulmonary bypass time is independently associated with an increased hazard of acute kidney injury after thoracic aortic surgery for acute DeBakey Type I aortic dissection. Further understanding of the mechanism of this association is crucial to the design of preventative strategies.


Assuntos
Lesão Renal Aguda/etiologia , Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Ponte Cardiopulmonar/efeitos adversos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/mortalidade , Adulto , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
Anesthesiology ; 131(1): 105-118, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31045897

RESUMO

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Toll-like receptor 7 responds to elevated single-stranded RNA by increasing cytokine production. Sepsis is characterized by elevated plasma levels of tissue damage (and pathogen)-associated molecular patterns, including RNA. WHAT THIS ARTICLE TELLS US THAT IS NEW: Using murine models of bacterial sepsis, knockout of the Toll-like receptor 7 resulted in lower mortality and cytokine levels and less end-organ injury. Therefore, Toll-like receptor 7, which mediates innate immune response, contributes to harm in experimental sepsis. BACKGROUND: Sepsis remains a critical illness with high mortality. The authors have recently reported that mouse plasma RNA concentrations are markedly increased during sepsis and closely associated with its severity. Toll-like receptor 7, originally identified as the sensor for single-stranded RNA virus, also mediates host extracellular RNA-induced innate immune responses in vitro and in vivo. Here, the authors hypothesize that innate immune signaling via Toll-like receptor 7 contributes to inflammatory response, organ injury, and mortality during polymicrobial sepsis. METHODS: Sepsis was created by (1) cecal ligation and puncture or (2) stool slurry peritoneal injection. Wild-type and Toll-like receptor 7 knockout mice, both in C57BL/6J background, were used. The following endpoints were measured: mortality, acute kidney injury biomarkers, plasma and peritoneal cytokines, blood bacterial loading, peritoneal leukocyte counts, and neutrophil phagocytic function. RESULTS: The 11-day overall mortality was 81% in wild-type mice and 48% in Toll-like receptor 7 knockout mice after cecal ligation and puncture (N = 27 per group, P = 0.0031). Compared with wild-type septic mice, Toll-like receptor 7 knockout septic mice also had lower sepsis severity, attenuated plasma cytokine storm (wild-type vs. Toll-like receptor 7 knockout, interleukin-6: 43.2 [24.5, 162.7] vs. 4.4 [3.1, 12.0] ng/ml, P = 0.003) and peritoneal inflammation, alleviated acute kidney injury (wild-type vs. Toll-like receptor 7 knockout, neutrophil gelatinase-associated lipocalin: 307 ± 184 vs.139 ± 41-fold, P = 0.0364; kidney injury molecule-1: 40 [16, 49] vs.13 [4, 223]-fold, P = 0.0704), lower bacterial loading, and enhanced leukocyte peritoneal recruitment and phagocytic activities at 24 h. Moreover, stool slurry from wild-type and Toll-like receptor 7 knockout mice resulted in similar level of sepsis severity, peritoneal cytokines, and leukocyte recruitment in wild-type animals after peritoneal injection. CONCLUSIONS: Toll-like receptor 7 plays an important role in the pathogenesis of polymicrobial sepsis by mediating host innate immune responses and contributes to acute kidney injury and mortality.


Assuntos
Lesão Renal Aguda/mortalidade , Inflamação/mortalidade , Sepse/mortalidade , Receptor 7 Toll-Like/genética , Lesão Renal Aguda/genética , Animais , Modelos Animais de Doenças , Inflamação/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Sepse/genética
19.
J Am Soc Nephrol ; 30(3): 505-515, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31058607

RESUMO

BACKGROUND: Variable standards of care may contribute to poor outcomes associated with AKI. We evaluated whether a multifaceted intervention (AKI e-alerts, an AKI care bundle, and an education program) would improve delivery of care and patient outcomes at an organizational level. METHODS: A multicenter, pragmatic, stepped-wedge cluster randomized trial was performed in five UK hospitals, involving patients with AKI aged ≥18 years. The intervention was introduced sequentially across fixed three-month periods according to a randomly determined schedule until all hospitals were exposed. The primary outcome was 30-day mortality, with pre-specified secondary endpoints and a nested evaluation of care process delivery. The nature of the intervention precluded blinding, but data collection and analysis were independent of project delivery teams. RESULTS: We studied 24,059 AKI episodes, finding an overall 30-day mortality of 24.5%, with no difference between control and intervention periods. Hospital length of stay was reduced with the intervention (decreases of 0.7, 1.1, and 1.3 days at the 0.5, 0.6, and 0.7 quantiles, respectively). AKI incidence increased and was mirrored by an increase in the proportion of patients with a coded diagnosis of AKI. Our assessment of process measures in 1048 patients showed improvements in several metrics including AKI recognition, medication optimization, and fluid assessment. CONCLUSIONS: A complex, hospital-wide intervention to reduce harm associated with AKI did not reduce 30-day AKI mortality but did result in reductions in hospital length of stay, accompanied by improvements in in quality of care. An increase in AKI incidence likely reflected improved recognition.


Assuntos
Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Alarmes Clínicos , Pessoal de Saúde/educação , Pacotes de Assistência ao Paciente , Lesão Renal Aguda/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Creatinina/sangue , Cuidados Críticos/métodos , Progressão da Doença , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Reino Unido/epidemiologia , Adulto Jovem
20.
PLoS One ; 14(5): e0216412, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31063508

RESUMO

BACKGROUND: Most sepsis and acute kidney injury (AKI) cases are community acquired (CA). The aim of this study was to evaluate the characteristics of suspected community acquired infection (sCA-I) and CA-AKI and their impact upon patient outcomes. METHODS: All adult creatinine blood tests from non-elective, non-dialysis attendances to a single centre over a 29-month period were analysed retrospectively. We defined sCA-I and CA-AKI cases as antibiotic prescription and AKI alert within 48 hours of attendance respectively. Binary logistic regression models were created to determine associations with 30-day mortality, intensive care unit (ICU) admission and length of stay (LOS) dichotomised at median. RESULTS: Of 61,471 attendances 28.1% and 5.7% suffered sCA-I or CA-AKI in isolation respectively, 3.4% suffered both. sCA-I was present in 58.8% of CA-AKI cases and CA-AKI was present in 11.9% of CA-I cases. The combination of sCA-I and CA-AKI was associated with a higher risk for all outcomes compared to sCA-I or CA-AKI in isolation. The 30-day mortality was 8.1%, 11.8% and 26.2% in patients with sCA-I, CA-AKI and when sCA-I and CA-AKI occurred in combination respectively. The adjusted odds ratios (OR) and 95% confidence intervals (CI) for 30-day mortality, ICU admission and LOS for sCA-I combined with CA-AKI stage 1 were OR 6.09:CI: 5.21-7.12, OR 12.52 CI: 10.54-14.88 and OR 8.97 CI: 7.62-10.56, respectively, and for combined sCA-I and CA-AKI stage 3 were OR 9.23 CI: 6.91-12.33, OR 29.26 CI: 22.46-38.18 and OR 9.48 CI: 6.82-13.18 respectively. CONCLUSION: The combination of sCA-I and CA-AKI is associated with worse outcomes.


Assuntos
Lesão Renal Aguda , Infecções Comunitárias Adquiridas , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Adulto , Idoso , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/terapia , Intervalo Livre de Doença , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Sepse/mortalidade , Sepse/terapia , Taxa de Sobrevida
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