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Peng Y, Wang Q, Jin F, Tao T, Qin Q. Assessment of urine CCL2 as a potential diagnostic biomarker for acute kidney injury and septic acute kidney injury in intensive care unit patients. Ren Fail 2024; 46:2313171. [PMID: 38345000 PMCID: PMC10863526 DOI: 10.1080/0886022x.2024.2313171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/27/2024] [Indexed: 02/15/2024] Open
Abstract
Acute kidney injury (AKI) is a prevalent and serious condition in the intensive care unit (ICU), associated with significant morbidity and mortality. Septic acute kidney injury (SAKI) contributes substantially to AKI cases in the ICU. However, current diagnostic methods have limitations, necessitating the exploration of novel biomarkers. In this study, we investigated the potential of plasma and urine CCL2 levels as diagnostic markers for AKI and SAKI in 216 ICU patients. Our findings revealed significant differences in plasma (p < 0.01) and urine CCL2 (p < 0.0001) levels between AKI and non-AKI patients in the ICU. Notably, urine CCL2 demonstrated promising predictive value for AKI, exhibiting high specificity and sensitivity (AUC = 0.8976; p < 0.0001). Furthermore, we observed higher urine CCL2 levels in SAKI compared to non-septic AKI (p < 0.001) and urine CCL2 could also differentiate SAKI from non-septic AKI (AUC = 0.7597; p < 0.0001). These results suggest that urine CCL2 levels hold promise as early biomarkers for AKI and SAKI, offering valuable insights for timely intervention and improved management of ICU patients.
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Affiliation(s)
- Yuan Peng
- Intensive Care Unit, The First People’s Hospital of Kunshan Affiliated to Jiangsu University, Kunshan, PR China
| | - Qin Wang
- Intensive Care Unit, The First People’s Hospital of Kunshan Affiliated to Jiangsu University, Kunshan, PR China
| | - Fang Jin
- Intensive Care Unit, The First People’s Hospital of Kunshan Affiliated to Jiangsu University, Kunshan, PR China
| | - Tao Tao
- Intensive Care Unit, The First People’s Hospital of Kunshan Affiliated to Jiangsu University, Kunshan, PR China
| | - Qihong Qin
- Department of Emergency, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou, PR China
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Baghdadi F, Evans BA, Goodacre S, John PA, Hettiarachchi T, John A, Lyons RA, Porter A, Safari S, Siriwardena AN, Snooks H, Watkins A, Williams J, Khanom A. Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries: the BE SURE study protocol. BMJ Open 2023; 13:e069596. [PMID: 37185177 PMCID: PMC10151843 DOI: 10.1136/bmjopen-2022-069596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Injuries are a major public health problem which can lead to disability or death. However, little is known about the incidence, presentation, management and outcomes of emergency care for patients with injuries among people from ethnic minorities in the UK. The aim of this study is to investigate what may differ for people from ethnic minorities compared with white British people when presenting with injury to ambulance and Emergency Departments (EDs). METHODS AND ANALYSIS This mixed methods study covers eight services, four ambulance services (three in England and one in Scotland) and four hospital EDs, located within each ambulance service. The study has five Work Packages (WP): (WP1) scoping review comparing mortality by ethnicity of people presenting with injury to emergency services; (WP2) retrospective analysis of linked NHS routine data from patients who present to ambulances or EDs with injury over 5 years (2016-2021); (WP3) postal questionnaire survey of 2000 patients (1000 patients from ethnic minorities and 1000 white British patients) who present with injury to ambulances or EDs including self-reported outcomes (measured by Quality of Care Monitor and Health Related Quality of Life measured by SF-12); (WP4) qualitative interviews with patients from ethnic minorities (n=40) and focus groups-four with asylum seekers and refugees and four with care providers and (WP5) a synthesis of quantitative and qualitative findings. ETHICS AND DISSEMINATION This study received a favourable opinion by the Wales Research Ethics Committee (305391). The Health Research Authority has approved the study and, on advice from the Confidentiality Advisory Group, has supported the use of confidential patient information without consent for anonymised data. Results will be shared with ambulance and ED services, government bodies and third-sector organisations through direct communications summarising scientific conference proceedings and publications.
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Affiliation(s)
| | | | - Steve Goodacre
- School of Health and Health Related Research, University of Sheffield, Sheffield, UK
| | - Paul Anthony John
- Research and Innovation Hub, Scottish Ambulance Service, Edinburgh, UK
| | | | - Ann John
- Medical School, Swansea University, Swansea, UK
| | | | | | - Solmaz Safari
- Public Contributor, c/o Medical School, Swansea University, Swansea, UK
| | | | | | | | - Julia Williams
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
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Stonko DP, Etchill EW, Giuliano KA, DiBrito SR, Eisenson D, Heinrichs T, Morrison JJ, Haut ER, Kent AJ. Failure to Rescue in Geriatric Trauma: The Impact of Any Complication Increases with Age and Injury Severity in Elderly Trauma Patients. Am Surg 2021; 87:1760-1765. [PMID: 34727744 DOI: 10.1177/00031348211054072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The interaction of increasing age, Injury Severity Score (ISS), and complications is not well described in geriatric trauma patients. We hypothesized that failure to rescue rate from any complication worsens with age and injury severity. METHODS The National Trauma Data Bank (NTDB) was queried for injured patients aged 65 years or older from January 1, 2013 through December 31, 2016. Demographics and injury characteristics were used to compare groups. Mortality rates were calculated across subgroups of age and ISS, and captured with heatmaps. Multivariable logistic regression was performed to identify independent predictors of mortality. RESULTS 614,496 geriatric trauma patients were included; 151,880 (24.7%) experienced a complication. Those with complications tended to be older, female, non-white, have non-blunt mechanism, higher ISS, and hypotension on arrival. Overall mortality was highest (19%) in the oldest (≥86 years old) and most severely injured (ISS ≥ 25) patients, with constant age increasing across each ISS group was associated with a 157% increase in overall mortality (P < .001, 95% CI: 148-167%). Holding ISS stable, increasing age group was associated with a 48% increase in overall mortality (P < .001, 95% CI: 44-52%). After controlling for standard demographic variables at presentation, the existence of any complication was an independent predictor of overall mortality in geriatric patients (OR: 2.3; 95% CI: 2.2-2.4). CONCLUSIONS Any complication was an independent risk factor for mortality, and scaled with increasing age and ISS in geriatric patients. Differences in failure to rescue between populations may reflect critical differences in physiologic vulnerability that could represent targets for interventions.
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Affiliation(s)
- David P Stonko
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Department of Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Eric W Etchill
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Department of Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Katherine A Giuliano
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Department of Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Sandra R DiBrito
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Department of Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Daniel Eisenson
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Department of Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | | | | | - Elliott R Haut
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Armstrong Institute for Patient Safety and Quality, 1501Johns Hopkins Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alistair J Kent
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Department of Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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Estimated glomerular filtration rate may be an independent predictor for clinical outcomes regardless of acute kidney injury complication in the emergency department. PLoS One 2021; 16:e0258665. [PMID: 34648576 PMCID: PMC8516290 DOI: 10.1371/journal.pone.0258665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/04/2021] [Indexed: 11/20/2022] Open
Abstract
Study objective Acute kidney injury (AKI), chronic kidney disease (CKD), and decreased estimated glomerular filtration rate (eGFR) are all associated with poor clinical outcomes among emergency department (ED) patients. This study aimed to evaluate the effect of different types of renal dysfunction and the degree of eGFR reduction on the clinical outcomes in a real-world ED setting. Methods Adult patients with an eGFR lower than 60 mL/min/1.73m2 in our ED, from October 1, 2016, to December 31, 2016, were enrolled in this retrospective observational study. Besides AKI and CKD, patients with unknown baseline renal function before an ED visit were categorized in the undetermined renal dysfunction (URD) category. Results Among 1495 patients who had eGFR evaluation at ED, this study finally enrolled 441 patients; 22 patients (5.0%) had AKI only, 32 (7.3%) had AKI on CKD, 196 (44.4%) had CKD only, 27 (6.1%) had subclinical kidney injury (those who met neither criteria for AKI nor CKD), and 164 (37.2%) had URD. There was a significant association between eGFR and critical illness defined as the composite outcome of death or intensive care unit (ICU) need, hospitalization, ICU need, death, and renal replacement therapy need (odds ratio [95% confidence interval]: 1.72 [1.45–2.05], 1.36 [1.16–1.59], 1.66 [1.39–2.00], 1.73 [1.32–2.28], and 2.71 [1.73–4.24] for every 10 mL/min/1.73m2 of reduction, respectively). Multivariate logistic regression analysis showed eGFR was an independent predictor of critical illness composite outcome (death or ICU need), hospitalization, and ICU need even after adjustment with AKI or URD. Conclusions Estimated GFR may be a sufficient predictor of clinical outcomes of ED patients regardless of AKI complication. Considerable ED patients were determined as URD, which might have a significant impact on the ED statistics regarding renal dysfunction.
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Peng JC, Wu T, Wu X, Yan P, Kang YX, Liu Y, Zhang NY, Liu Q, Wang HS, Deng YH, Wang M, Luo XQ, Duan SB. Development of mortality prediction model in the elderly hospitalized AKI patients. Sci Rep 2021; 11:15157. [PMID: 34312443 PMCID: PMC8313696 DOI: 10.1038/s41598-021-94271-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/30/2021] [Indexed: 12/29/2022] Open
Abstract
Acute kidney injury (AKI) correlates with increased health-care costs and poor outcomes in older adults. However, there is no good scoring system to predict mortality within 30-day, 1-year after AKI in older adults. We performed a retrospective analysis screening data of 53,944 hospitalized elderly patients (age > 65 years) from multi-centers in China. 944 patients with AKI (acute kidney disease) were included and followed up for 1 year. Multivariable regression analysis was used for developing scoring models in the test group (a randomly 70% of all the patients). The established models have been verified in the validation group (a randomly 30% of all the patients). Model 1 that consisted of the risk factors for death within 30 days after AKI had accurate discrimination (The area under the receiver operating characteristic curves, AUROC: 0.90 (95% CI 0.875–0.932)) in the test group, and performed well in the validation groups (AUROC: 0.907 (95% CI 0.865–0.949)). The scoring formula of all-cause death within 1 year (model 2) is a seven-variable model including AKI type, solid tumor, renal replacement therapy, acute myocardial infarction, mechanical ventilation, the number of organ failures, and proteinuria. The area under the receiver operating characteristic (AUROC) curves of model 2 was > 0.80 both in the test and validation groups. Our newly established risk models can well predict the risk of all-cause death in older hospitalized AKI patients within 30 days or 1 year.
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Affiliation(s)
- Jing-Cheng Peng
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Ting Wu
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xi Wu
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Ping Yan
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yi-Xin Kang
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yu Liu
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Ning-Ya Zhang
- Information Center, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Qian Liu
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Hong-Shen Wang
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Ying-Hao Deng
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Mei Wang
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xiao-Qin Luo
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Shao-Bin Duan
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Elsamadicy AA, Sandhu MRS, Freedman IG, Reeves BC, Koo AB, Hengartner A, Havlik J, Sherman J, Maduka R, Agboola IK, Johnson DC, Kolb L, Laurans M. Impact of Frailty on Morbidity and Mortality in Adult Patients Presenting with an Acute Traumatic Cervical Spinal Cord Injury. World Neurosurg 2021; 153:e408-e418. [PMID: 34224881 DOI: 10.1016/j.wneu.2021.06.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The aim of this study was to determine if baseline frailty was an independent predictor of adverse events (AEs) and in-hospital mortality in patients being treated for acute cervical spinal cord injury (SCI). METHODS A retrospective cohort study was performed using the National Trauma Database (NTDB) from 2017. Adult patients (>18 years old) with acute cervical SCI were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification diagnostic and procedural coding systems. Patients were categorized into 3 cohorts based on the criteria of the 5-item modified frailty index (mFI-5): mFI = 0, mFI = 1, or mFI≥2. Patient demographics, comorbidities, type of injury, diagnostic and treatment modality, AEs, and in-patient mortality were assessed. A multivariate logistic regression analysis was used to identify independent predictors of in-hospital AEs and mortality. RESULTS Of 8986 patients identified, 4990 (55.5%) were classified as mFI = 0, 2328 (26%) as mFI = 1, and 1668 (18.5%) as mFI≥2. On average, the mFI≥2 cohort was 5 years older than the mFI = 1 cohort and 22 years older than the mFI = 0 cohort (P < 0.001). Most patients in each cohort sustained either complete SCI or central cord syndrome after a fall or transport accident (mFI = 0, 77.31% vs. mFI = 1, 89.5% vs. mFI≥2, 93.65%). With respect to in-hospital events, the proportion of patients who experienced any AE increased significantly along with frailty score (mFI = 0, 30.42% vs. mFI = 1, 31.74% vs. mFI≥2, 34.95%; P < 0.001). In-hospital mortality followed a similar trend, increasing with frailty score (mFI = 0, 10.53% vs. mFI = 1, 11.33% vs. mFI≥2, 16.23%; P < 0.001). On multivariate regression analysis, both mFI = 1 1.21 (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.05-1.4; P = 0.008) and mFI≥2 (OR, 1.23; 95% CI, 1.05-1.45; P = 0.012) predicted AEs, whereas only mFI≥2 was found to be a predictor for in-hospital mortality (OR, 1.45; 95% CI, 1.14-1.83; P = 0.002). CONCLUSIONS Increasing frailty is associated with an increased risk of AEs and in-hospital mortality in patients undergoing treatment for cervical SCI.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA.
| | | | - Isaac G Freedman
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Astrid Hengartner
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - John Havlik
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Josiah Sherman
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Richard Maduka
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Isaac K Agboola
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dirk C Johnson
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Luis Kolb
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Maxwell Laurans
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
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Rashidi HH, Makley A, Palmieri TL, Albahra S, Loegering J, Fang L, Yamaguchi K, Gerlach T, Rodriquez D, Tran NK. Enhancing Military Burn- and Trauma-Related Acute Kidney Injury Prediction Through an Automated Machine Learning Platform and Point-of-Care Testing. Arch Pathol Lab Med 2021; 145:320-326. [PMID: 33635951 DOI: 10.5858/arpa.2020-0110-oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Delayed recognition of acute kidney injury (AKI) results in poor outcomes in military and civilian burn-trauma care. Poor predictive ability of urine output (UOP) and creatinine contribute to the delayed recognition of AKI. OBJECTIVE.— To determine the impact of point-of-care (POC) AKI biomarker enhanced by machine learning (ML) algorithms in burn-injured and trauma patients. DESIGN.— We conducted a 2-phased study to develop and validate a novel POC device for measuring neutrophil gelatinase-associated lipocalin (NGAL) and creatinine from blood samples. In phase I, 40 remnant plasma samples were used to evaluate the analytic performance of the POC device. Next, phase II enrolled 125 adults with either burns that were 20% or greater of total body surface area or nonburn trauma with suspicion of AKI for clinical validation. We applied an automated ML approach to develop models predicting AKI, using a combination of NGAL, creatinine, and/or UOP as features. RESULTS.— Point-of-care NGAL (mean [SD] bias: 9.8 [38.5] ng/mL, P = .10) and creatinine results (mean [SD] bias: 0.28 [0.30] mg/dL, P = .18) were comparable to the reference method. NGAL was an independent predictor of AKI (odds ratio, 1.6; 95% CI, 0.08-5.20; P = .01). The optimal ML model achieved an accuracy, sensitivity, and specificity of 96%, 92.3%, and 97.7%, respectively, with NGAL, creatinine, and UOP as features. Area under the receiver operator curve was 0.96. CONCLUSIONS.— Point-of-care NGAL testing is feasible and produces results comparable to reference methods. Machine learning enhanced the predictive performance of AKI biomarkers including NGAL and was superior to the current techniques.
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Affiliation(s)
- Hooman H Rashidi
- From the Department of Pathology and Laboratory Medicine (Rashidi, Albahra, Loegering, Tran), University of California, Davis, Sacramento
| | - Amy Makley
- The Department of Surgery, University of Cincinnati, Cincinnati, Ohio (Makley)
| | - Tina L Palmieri
- Department of Surgery (Palmieri), University of California, Davis, Sacramento
| | - Samer Albahra
- From the Department of Pathology and Laboratory Medicine (Rashidi, Albahra, Loegering, Tran), University of California, Davis, Sacramento
| | - Julia Loegering
- From the Department of Pathology and Laboratory Medicine (Rashidi, Albahra, Loegering, Tran), University of California, Davis, Sacramento
| | - Lei Fang
- Nanomix, Inc, Emeryville, California (Fang, Yamaguchi)
| | | | - Travis Gerlach
- The Department of Surgery, David Grant Medical Center, Travis Air Force Base, Fairfield, California (Gerlach)
| | - Dario Rodriquez
- The Department of Surgery, 711th Human Performance Wing, Wright-Patterson Air Force Base, Cincinnati, Ohio (Rodriquez Jr)
| | - Nam K Tran
- From the Department of Pathology and Laboratory Medicine (Rashidi, Albahra, Loegering, Tran), University of California, Davis, Sacramento
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Cerceo E, Rachoin JS, Gaughan J, Weisberg L. Association of gender, age, and race on renal outcomes and mortality in patients with severe sepsis and septic shock. J Crit Care 2020; 61:52-56. [PMID: 33080528 DOI: 10.1016/j.jcrc.2020.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/02/2020] [Accepted: 10/12/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND The association of age, gender and race with renal outcomes in patients with severe sepsis and septic shock (SEP) is not completely elucidated. We aimed to shed light on these relationships. METHODS We performed a retrospective cohort study of hospitalized patients in the USA discharged between January 1st, 2005 and December 31st, 2014 using the National Inpatient Sample. We adjusted analyses using the Charlson comorbidity index. RESULTS 65,772,607 records were included of which 1,064,790 had SEP. There were 60% female and 12% African American (AA). The incidence of SEP was 1.6% and patients with SEP were older, had more AA and less females. Acute kidney injury (AKI) and mortality among patients with SEP were 62% and 30.7% respectively. AA race was associated with increased risk of SEP, AKI and dialysis, (OR = 1.12, 1.25 and 1.7 respectively, all p < 0.001). Female gender was associated with lower risk of all measured outcomes with odds ratios ranging from 0.65 to 0.78 (p < 0.001). Increasing age was associated with a higher risk of all outcomes except for dialysis. CONCLUSION Female gender is associated with a lower risk of poor renal outcomes and death among patients with SEP, while AA race places patients at higher risk of poor outcomes in that setting. Increasing age is generally associated with adverse outcomes.
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Affiliation(s)
- Elizabeth Cerceo
- Division of Hospital Medicine, Cooper University Health Care, Camden, NJ, USA; Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Jean-Sebastien Rachoin
- Division of Hospital Medicine, Cooper University Health Care, Camden, NJ, USA; Cooper Medical School of Rowan University, Camden, NJ, USA; Division of Critical Care Medicine, Cooper University Health Care, Camden, NJ, USA.
| | - John Gaughan
- Cooper Research Institute, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Lawrence Weisberg
- Cooper Medical School of Rowan University, Camden, NJ, USA; Division of Nephrology, Cooper University Health Care, Camden, NJ 08103, USA
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