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Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery:A prospective observational study

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World Journal of Clinical Cases 2023年第16期11卷 3791-3801页

作者： Stavros Dimopoulos Georgios Zagkotsis Charalambia Kinti Niki Rouvali Magda Georgopoulou Mariantzela Mavraki Androniki Tasouli Efterpi Lyberopoulou Antonios Roussakis Ioannis Vasileiadis Serafim Nanas Andreas Karabinis Department of Cardiac Surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece Department of Clinical Ergospirometry Exercise and Rehabilitation LaboratoryNational and Kapodistrian University of AthensAthens 10676Greece

BACKGROUND Patients admitted to intensive care unit(ICU) after cardiac surgery develop acute kidney injury(AKI) immediately post-operation. We hypothesized that AKI occurs mainly due to perioperative risk factors and may affect *** To assess peri-operative risk factors for AKI post cardiac surgery and its relationship with clinical *** This was an observational single center, tertiary care setting study, which enrolled 206 consecutive patients, admitted to ICU after cardiac surgery. Patients were followed-up until ICU discharge or death, in order to determine the incidence of AKI, perioperative risk factors for AKI and its association with *** and multivariate logistic regression analysis was performed to assess predictor variables for AKI *** After ICU admission, 55 patients(26.7%) developed AKI within 48 h. From the logistic regression analysis performed, high EuroScore Ⅱ(OR: 1.18;95%CI: 1.06-1.31, P = 0.003), white blood cells(WBC) pre-operatively(OR: 1.0;95%CI: 1.0-1.0, P = 0.002) and history of chronic kidney disease(OR: 2.82;95%CI: 1.195-6.65, P = 0.018) emerged as independent predictors of AKI among univariate predictors. AKI that developed AKI had longer duration of mechanical ventilation [1113(777–2195) vs 714(511–1020) min, P = 0.0001] and ICU length of stay [70(28–129) vs 26(21–51) h, P = 0.0001], higher rate of ICU-acquired weakness(16.4% vs 5.3%, P =0.015), reintubation(10.9% vs 1.3%, P = 0.005), dialysis(7% vs 0%, P = 0.005), delirium(36.4% vs 23.8%, P = 0.001) and mortality(3.6% vs 0.7%, P = 0.046).CONCLUSION Patients present frequently with AKI after cardiac surgery. EuroScore Ⅱ, WBC count and chronic kidney disease are independent predictors of AKI development. The occurrence of AKI is associated with poor outcome.

关键词： acute kidney injury Renal failure Cardiac surgery Predisposing factors Prognosis Outcome

The duration of acute kidney injury is an additional parameter to predict1-year survival in very elderly patients

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Journal of Intensive Medicine 2023年第3期3卷 283-290页

作者： Qinglin Li Yan Wang Feihu Zhou Department of Critical Care Medicine The First Medical CenterChinese PLA General HospitalBeijing 100853China Department of Cardiology The Second Medical CenterChinese PLA General HospitalBeijing 100853China Chinese PLA General Hospital National Clinical Research Center for Geriatric Diseases Beijing 100853China Medical Engineering Laboratory of Chinese PLA General Hospital Beijing 100853China

Background:acute kidney injury(AKI)is primarily defined and classified according to the magnitude of theelevation of serum creatinine(Scr).We aimed to determine whether the duration of AKI adds prognostic valuein addition to that obtained from the magnitude of injury ***:This retrospective study enrolled very elderly inpatients(≥75 years)in the Chinese PLA General Hospitalfrom January 2007 to December *** was stratified by magnitude according to KDIGO stage(1,2,and 3)andduration(1–2 days,3–4 days,5–7 days,and>7 days).The primary outcome was the 1-year mortality after *** Cox regression analysis was performed to identify covariates associated with the 1-year *** probability of survival was estimated using the Kaplan–Meier method,and curves were compared using thelog-rank ***:In total,688 patients were enrolled,with the median age was 88(84–91)years,and the majority(652,94.8%)were *** to the KDIGO criteria,317 patients(46.1%)had Stage 1 AKI,169(24.6%)hadStage 2 AKI,and 202(29.3%)had Stage 3 *** the 688 study subjects,61(8.9%)with a duration of AKIlasted 1–2 days,104(15.1%)with a duration of AKI lasted 3–4 days,140(20.3%)with a duration of AKI lasted5–7 days,and 383(55.7%)with a duration of AKI lasted>7 *** each stage,a longer duration of AKIwas slightly associated with a higher rate of 1-year ***,within each of the duration categories,the stage of AKI was significantly associated with 1-year *** considered separately in multivariateanalyses,both the duration of AKI(3–4 days:HR=3.184;95%CI:1.733–5.853;P7 days:HR=1.766;95%CI:1.017–3.065;P=0.043)and more advanced AKIstage(Stage 2:HR=3.063;95%CI:2.207–4.252;P<0.001;Stage 3:HR=7.333;95%CI:5.274–10.197;P<0.001)were independently associated with an increased risk of 1-year ***:In very elderly AKI patients,both a higher stage and duration were independently associ

关键词： acute kidney injury Duration Very elderly 1-Year mortality

Value of urine IL-8, NGAL and KIM-1 for the early diagnosis of acute kidney injury in patients with ureteroscopic lithotripsy related urosepsis

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Chinese Journal of Traumatology 2022年第1期25卷 27-31页

作者： Dan Tan Liang Zhao Wei Peng Fang-Hao Wu Guo-Bin Zhang Bo Yang Wen-Qian Huo Department of Urology The General Hospital of Chongqing Steel CompanyChongqing400081China

Purpose::To investigate the clinical value of urine interleukin-18(IL-8),neutrophil gelatinase-associated lipocalin(NGAL)and kidney injury molecule-1(KIM-1)for the early diagnosis of acute kidney injury(AKI)in patients with ureteroscopic lithotripsy(URL)related ***::A retrospective study was carried out in 157 patients with urosepsis after *** patients were divided into AKI group and non-AKI group according to the Kidigo guideline and urine IL-8,NGAL and KIM-1 levels were detected by enzyme-linked immunosorbent assay at 0,4,12,24 and 48 h after the *** operating characteristic curve(ROC)was used to evaluate the diagnostic value of these three biomarkers for postoperative ***::The level of urine IL-8,NGAL and KIM-1 in AKI group was significantly higher than that in non-AKI group at 4,12,24 and 48 h(p<0.01).The ROC analysis showed the combined detection of urine IL-8,NGAL and KIM-1 at 12 h had a larger area under curve(AUC)than a single marker(0.997,95%CI:0.991-0.998),and the sensitivity and specificity were 98.2%and 96.7%,*** correlation analysis showed that the levels of urine NGAL at 4,12,24 and 48 h in AKI patients were positively correlated with the levels of urine KIM-1 and IL-18(p<0.01).Conclusion::AKI could be quickly recognized by the elevated level of urine IL-8,NGAL and KIM-1 in patients with URL-related *** detection of the three urine biomarkers at 12 h after surgery had a better diagnostic performance,which may be an important reference for the early diagnosis of AKI.

关键词： Urosepsis Ureteroscopic lithotripsy acute kidney injury Early diagnosis lnterleukin-18 Neutrophil gelatinase-associated lipocalin kidney injury molecule-1

Association of serum potassium level with early and late mortality in very elderly patients with acute kidney injury

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Journal of Intensive Medicine 2022年第1期2卷 50-55页

作者： Qinglin Li Yuru Li Feihu Zhou Department of Critical Care Medicine The First Medical CentreChinese PLA General HospitalBeijing 100853China Department of Laboratory Test The Second Medical CentreChinese PLA General HospitalBeijing 100853China Chinese PLA General Hospital National Clinical Research Center for Geriatric Diseases Beijing 100853China

Background:The kidneys play a central role in serum potassium(K+)homeostasis,and their dysfunction leads to electrolyte *** aimed to examine the relationship between different levels of K+and mortality among very elderly patients with acute kidney injury(AKI).Methods:We retrospectively enrolled very elderly patients(≥75 years)with AKI from the hospital information system of the Chinese PLA General Hospital from January 1,2007 to December 31,***-cause mortality was examined according to six predefined K+levels:<3.50 mmol/L,3.50-3.79 mmol/L,3.80-4.09 mmol/L,4.10-4.79 mmol/L,4.80-5.49 mmol/L,and≥5.50 mmol/*** estimated the risk of all-cause mortality using the multivariable adjusted Cox proportional hazard model with the normal K+level at 3.50-3.79 mmol/L as a ***:In total,747 patients were deemed suitable for the final *** median age of the 747 par-ticipants was 88(84-91)*** 90 days,the mortality rates in the six strata were 28.3%,21.9%,30.1%,35.4%,45.2%,and 58.3%,*** the multivariable adjusted analysis,patients with K+levels of 4.10-4.79 mmol/L(hazard ratio[HR]:1.638;95%confidence interval[CI]:1.016-2.642),4.80-5.49 mmol/L(HR:2.585;95%CI:1.524-4.384),and≥5.50 mmol/L(HR:2.587;95%CI:1.495-4.479)had an increased risk of all-cause *** 1 year,the mortality rates in the six strata were 44.8%,41.1%,45.1%,51.8%,63.1%,and 76.3%,*** the multivariable adjusted analysis,patients with K+levels of 4.10-4.79 mmol/L(HR:1.452;95%CI:1.014-2.079),4.80-5.49 mmol/L(HR:2.151;95%CI:1.427-3.241),and≥5.50 mmol/L(HR:2.341;95%CI:1.514-3.620)had an increased risk of all-cause ***:Increased serum K+levels,including levels of 4.10-5.49 mmol/L and≥5.50 mmol/L,were associated with a significantly increased short-and long-term risk of *** K+has the potential to be a marker of disease severity among very elderly patients with AKI.

关键词： Hyperkalemia Hypokalemia Serum potassium acute kidney injury Elderly Mortality

Literature review of the mechanisms of acute kidney injury secondary to acute liver injury

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World Journal of Nephrology 2022年第1期11卷 13-29页

作者： Esther Platt Enriko Klootwijk Alan Salama Brian Davidson Francis Robertson Division of Surgery and Interventional Science University College LondonLondon NW32QGUnited Kingdom Department of Renal Medicine University College LondonLondon NW32PFUnited Kingdom

People exposed to liver ischaemia reperfusion(IR)injury often develop acute kidney injury and the combination is associated with significant morbidity and *** mediators released by the liver in response to IR injury are the likely cause of acute kidney injury(AKI)in this setting,but the mediators have not yet been *** the mechanism of injury will allow the identification of therapeutic targets which may modulate both liver IR injury and AKI following liver IR injury.

关键词： Liver failure Liver transplantation Ischaemia-reperfusion injury acute kidney injury Liver

Duration of acute kidney injury predicts 90-day mortality and chronic kidney disease progression in elderly patients

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Journal of Intensive Medicine 2022年第2期2卷 110-117页

作者： Qinglin Li Yuru Li Feihu Zhou Department of Critical Care Medicine The First Medical CenterChinese PLA General HospitalBeijing 100853China Department of Laboratory Test The Second Medical CenterChinese PLA General HospitalBeijing 100853China Chinese PLA General Hospital National Clinical Research Center for Geriatric Diseases Beijing 100853China

Background:This study evaluated the prognostic impact of acute kidney injury(AKI)duration on 90-d mortality and new-onset chronic kidney disease(CKD)progression in elderly ***:We retrospectively enrolled elderly patients(≥75 years;n=693)from the Chinese PLA General Hospital between January 1,2007 and December 31,*** 2012 kidney Disease Improving Global Outcomes(KDIGO)defined serum creatinine(Scr)criteria were used to identify and classify *** were divided into transient AKI(T-AKI)and persistent AKI(P-AKI)groups based on whether Scr levels returned to baseline within 48 h *** further classified P-AKI based on AKI duration:(1)short duration:resolving AKI lasting 3–4 days;(2)medium duration:resolving AKI lasting 5–7 days;and(3)long duration:AKI lasting>7 ***:Among patients,62(9.0%)had T-AKI(1–2 days),104(15.0%)had short-duration,140(20.2%)had medium-duration,and 387(55.8%)had *** total,209(30.2%)died within 90 days;122(25.2%)developed *** adjusting for multiple covariates,duration of AKI(3–4 days:hazard ratio[HR]=2.512;P=0.045;5–7 days:HR=3.154;P=0.015;>7 days:HR=6.212;P7 days:OR=7.007;P<0.001)was significantly associated with new-onset CKD of ***:AKI duration is useful for predicting poorer clinical outcomes in elderly patients,emphasizing the importance of identifying an appropriate treatment window for early intervention.

关键词： acute kidney injury Duration Elderly Mortality Renal function

Predictors of Mortality at 28-days in Infection associated acute kidney injury in Cirrhosis

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World Journal of Hepatology 2022年第3期14卷 592-601页

作者： Tarana Gupta Naveen Ranga Sandeep Kumar Goyal Department of Medicine Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical SciencesRohtak 124001HaryanaIndia Independent Researcher Kangra 176056Himachal PradeshIndia

BACKGROUND acute kidney injury(AKI)in cirrhosis is important complication with poor *** infections are common cause for acute *** in cirrhosis lead to acute deterioration of hemodynamics leading to precipitation of *** To study predictors of mortality in patients with infection-associated AKI in *** This was a prospective,observational study conducted at Tertiary care centre from January 2018 till April *** 119 participants with cirrhosis of liver presenting with AKI were included into the *** was defined as per international club of Ascites-AKI criteria *** were grouped into infection AKI and non-infection ***-infection AKI included patients with diuretic induced AKI and pre-renal *** regression analysis was used to determine predictors of mortality at *** Out of 119 patients,alcohol(n=104)was most common etiology of *** infection AKI included 67(56%)patients and non-infection AKI(n=52)included pre-renal AKI in 36(30%)and diuretic-induced AKI in 16(14%)*** AKI had significantly higher bilirubin,higher international normalized ratio(INR),low serum sodium,higher total leukocyte count(TLC)and higher prevalence of hepatic encephalopathy(HE)as compared to non-infection *** AKI had higher progression of AKI(19/67 vs 2/52;P=0.01)and 28-d mortality(38/67 vs 4/5;P≤0.01)as compared to non-infection *** 28-d,non-survivors(n=42)had significantly higher bilirubin,higher INR,low serum sodium,higher TLC and higher prevalence of HE as compared to survivors(n=77).On subgroup analysis of Infection AKI group,on multivariate analysis,serum bilirubin as well as presence of HE were independent predictors of 28-d *** was no significant difference of mortality at 90-d between two *** Infection AKI in cirrhosis has a dismal prognosis with higher 28-d mortality as compared to noninfection *** bilirubin and presence of HE predict

关键词： Infection acute kidney injury Mortality Cirrhosis Bilirubin Hepatic encephalopathy

acute kidney injury in severely injured patients admitted to the Intensive Care Unit

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Military Medical Research 2021年第2期8卷 141-147页

作者： Alberto F.García Ramiro Manzano-Nunez Juan G.Bayona Maria P.Naranjo Dary Neicce Villa Manuel Moreno Sebastian Ossa Juan M.Martinez Nathalia Martinez Juan C.Puyana Division of Trauma and acute Care Surgery Department of SurgeryFundación Valle del LiliCaliColombia Clinical Research Center Fundación Valle del LiliCaliColombia Escuela de Medicina Ciencias de la SaludUniversidad del RosarioCarrera 98#18-49760001BogotaColombia Méderi Hospital Universitario Mayor Colombia School of Medicine Universidad ICESI(ICESI University)CaliColombia Department of Surgery University of PittsburghPittsburghPAUSA

Background:Our objective was to identify possible associations between clinical and laboratory variables and the risk of developing acute kidney injury(AKI)in severely injured patients admitted to the Intensive Care Unit(ICU)for whom creatine kinase(CK)levels were ***:For this retrospective observational study,we analyzed adult trauma patients admitted to the ICU from 2011 to 2015 at Fundación Valle del Lili(FVL)University *** primary outcome was the incidence of *** regression analysis was used to assess risk factors for this ***:A total of 315 patients were *** trauma mechanisms were blunt(n=130),penetrating(n=66)and blast(n=44)*** median[interquartile range,(IQR)of injury severity score(ISS)was 21(16–29).AKI developed in 75 patients(23.8%).Multivariate regression analysis revealed that the thoracic abbreviated injury scale(AIS)value(median(IQR)in the AKI group:3(0–4)],acute Physiology and Chronic Health Evaluation(APACHE Ⅱ)score[median(IQR)in the AKI group:18(10–27)],CK greater than 5000 U/L,lactic acid concentration at admission,and dobutamine administration were independently associated with ***:We found that age,APACHE Ⅱ score,thoracic trauma,lactic acidosis,and dobutamine administration were independently associated with *** surgeons need to be aware of the increased odds of AKI if one of these factors is identified during the evaluation and treatment of injured patients.

关键词： Rhabdomyolysis Wounds and injuries acute kidney injury Critical care Trauma

Risk factors and prediction of acute kidney injury after liver transplantation:Logistic regression and artificial neural network approaches

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World Journal of Hepatology 2022年第3期14卷 570-582页

作者： Luis Cesar Bredt Luis Alberto Batista Peres Michel Risso Leandro Cavalcanti de Albuquerque Leite Barros Department of Surgical Oncology and Hepatobilary Surgery UnioesteCascavel 85819-110ParanáBrazil Department of Nephrology UnioesteCascavel 85819-110ParanáBrazil Department of Internal Medicine Assis Gurgacz UniversityCascavel 85000ParanáBrazil Department of Hepatobiliary Surgery UnioesteCascavel 85819-110ParanáBrazil

BACKGROUND acute kidney injury(AKI)has serious consequences on the prognosis of patients undergoing liver ***,artificial neural network(ANN)was reported to have better predictive ability than the classical logistic regression(LR)for this postoperative *** To identify the risk factors of AKI after deceased-donor liver transplantation(DDLT)and compare the prediction performance of ANN with that of LR for this *** Adult patients with no evidence of end-stage kidney dysfunction(KD)who underwent the first DDLT according to model for end-stage liver disease(MELD)score allocation system was *** was defined according to the International Club of Ascites criteria,and potential predictors of postoperative AKI were identified by *** prediction performance of both ANN and LR was *** The incidence of AKI was 60.6%(n=88/145)and the following predictors were identified by LR:MELD score>25(odds ratio[OR]=1.999),preoperative kidney dysfunction(OR=1.279),extended criteria donors(OR=1.191),intraoperative arterial hypotension(OR=1.935),intraoperative massive blood transfusion(MBT)(OR=1.830),and postoperative serum lactate(SL)(OR=2.001).The area under the receiver-operating characteristic curve was best for ANN(0.81,95%confidence interval[CI]:0.75-0.83)than for LR(0.71,95%CI:0.67-0.76).The root-mean-square error and mean absolute error in the ANN model were 0.47 and 0.38,*** The severity of liver disease,pre-existing kidney dysfunction,marginal grafts,hemodynamic instability,MBT,and SL are predictors of postoperative AKI,and ANN has better prediction performance than LR in this scenario.

关键词： Logistic regression Liver transplantation acute kidney injury Machine learning Artificial neural network