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Chen JJ, Lee TH, Lai PC, Chang CH, Wu CH, Huang YT. Prognostic nutritional index as a predictive marker for acute kidney injury in adult critical illness population: a systematic review and diagnostic test accuracy meta-analysis. J Intensive Care 2024; 12:16. [PMID: 38671543 PMCID: PMC11046764 DOI: 10.1186/s40560-024-00729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The prognostic nutritional index (PNI), integrating nutrition and inflammation markers, has been increasingly recognized as a prognostic predictor in diverse patient cohorts. Recently, its effectiveness as a predictive marker for acute kidney injury (AKI) in various clinical settings has gained attention. This study aims to assess the predictive accuracy of the PNI for AKI in critically ill populations through systematic review and meta-analysis. METHODS A systematic review was conducted using the databases MEDLINE, EMBASE, PubMed, and China National Knowledge Infrastructure up to August 2023. The included trials reported the PNI assessment in adult population with critical illness and its predictive capacity for AKI. Data on study characteristics, subgroup covariates, and diagnostic performance of PNI, including sensitivity, specificity, and event rates, were extracted. A diagnostic test accuracy meta-analysis was performed. Subgroup analyses and meta-regression were utilized to investigate the sources of heterogeneity. The GRADE framework evaluated the confidence in the meta-analysis's evidence. RESULTS The analysis encompassed 16 studies with 17 separate cohorts, totaling 21,239 patients. The pooled sensitivity and specificity of PNI for AKI prediction were 0.67 (95% CI 0.58-0.74) and 0.74 (95% CI 0.67-0.80), respectively. The pooled positive likelihood ratio was 2.49 (95% CI 1.99-3.11; low certainty), and the negative likelihood ratio was 0.46 (95% CI 0.37-0.56; low certainty). The pooled diagnostic odds ratio was 5.54 (95% CI 3.80-8.07), with an area under curve of summary receiver operating characteristics of 0.76. Subgroup analysis showed that PNI's sensitivity was higher in medical populations than in surgical populations (0.72 vs. 0.55; p < 0.05) and in studies excluding patients with chronic kidney disease (CKD) than in those including them (0.75 vs. 0.56; p < 0.01). Overall, diagnostic performance was superior in the non-chronic kidney disease group. CONCLUSION Our study demonstrated that PNI has practical accuracy for predicting the development of AKI in critically ill populations, with superior diagnostic performance observed in medical and non-CKD populations. However, the diagnostic efficacy of the PNI has significant heterogeneity with different cutoff value, indicating the need for further research.
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Affiliation(s)
- Jia-Jin Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung university, Taoyuan, 33305, Taiwan
| | - Tao-Han Lee
- Department of Nephrology, Chansn Hospital, Taoyuan City, 33305, Taiwan
| | - Pei-Chun Lai
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung university, Taoyuan, 33305, Taiwan
| | - Che-Hsiung Wu
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 231, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, 970, Taiwan.
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Shengli Road, Tainan, 701, Taiwan.
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Zhang X, Fu J, Feng Z, Li Y, Zhang L, Zhou X, Dai S, Qiu T, Zhou J, Chen S, Ji Y. High Serum Albumin Levels were Associated with Acute Kidney Injury in Pediatric Surgical Intensive Care Units. J Pediatr Surg 2024; 59:621-626. [PMID: 38182536 DOI: 10.1016/j.jpedsurg.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 01/07/2024]
Abstract
INTRODUCTION There are limited studies revealing the association between serum albumin concentrations and acute kidney injury (AKI) in critically ill children. METHODS This was a multicenter retrospective study. Children consecutively admitted to four pediatric surgical intensive care units (PSICUs) between January 2016 and December 2020 were screened for analysis. Patients without recorded albumin values during the PSICU stay were excluded. Data were extracted from the electronic medical records systems of the hospitals. AKI was defined according to the Kidney Disease Improving Global Outcome (KDIGO) guidelines. The associations between serum albumin levels and AKI were assessed by using logistic regression models. RESULTS A total of 7802 children were included in the analysis. The median age of the children was 1.0 (interquartile range (IQR), 0.0-4.0) years. There were 3214 (41.2 %) children who developed AKI. In the univariate logistic regression model, serum albumin levels were associated with AKI (odds ratio (OR) = 1.04, 95 % confidence interval (CI) 1.04-1.05). After adjusting for covariates, serum albumin showed an independent association with AKI (OR = 1.04, 95 % CI 1.03-1.05). Albumin levels above 39.43 g/L (OR = 1.036, 95 % CI 1.002-1.070) were associated with AKI in the unadjusted cubic spline. In the adjusted cubic spline, albumin levels above 40.41 g/L (OR = 1.061, 95 % CI 1.003-1.122) were associated with AKI. CONCLUSION High serum albumin was associated with AKI in critically ill children in the PSICU. Further studies are needed to validate our findings. TYPE OF STUDY Prognostic Study. LEVEL OF EVIDENCE LEVEL II.
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Affiliation(s)
- Xuepeng Zhang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China; Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jianlei Fu
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Zhongxue Feng
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yang Li
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Lifan Zhang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xinyue Zhou
- Department of Pediatric Critical Care Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu 610041, China
| | - Shiyi Dai
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China; Department of Pediatric Surgery, West China Women's and Children's Hospital, Sichuan University, Chengdu 610041, China
| | - Tong Qiu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jiangyuan Zhou
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Siyuan Chen
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China.
| | - Yi Ji
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
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Klimkiewicz J, Grzywacz A, Michałowski A, Gutowski M, Paryż K, Jędrych E, Lubas A. Acute Kidney Injury and Chronic Kidney Disease and Their Impacts on Prognosis among Patients with Severe COVID-19 Pneumonia: An Expert Center Case-Cohort Study. J Clin Med 2024; 13:1486. [PMID: 38592301 PMCID: PMC10932456 DOI: 10.3390/jcm13051486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Acute kidney injury (AKI) is associated with substantial mortality. In this case-control study, we analyzed the impacts of AKI and chronic kidney disease (CKD) on outcomes in a group of 323 patients with severe COVID-19. The correlation of clinical and laboratory data with AKI and CKD was also analyzed. Methods: A retrospective case-control study was conducted among AKI, CKD, and normal kidney function (NKF) groups hospitalized in a COVID-19 center in 2021. Results: AKI patients had higher in-hospital mortality (55.2 vs. 18.8%, p < 0.001), more frequent transfers from the HDU to ICU (57.5 vs. 12.9%, p < 0.001), and prolonged hospital stays (15.4 ± 10.7 vs. 10.7 ± 6.7 days, p < 0.001) compared to the NKF group. AKI was a predictor of death (OR 4.794, 95%CI: 2.906-7.906, p < 0.001). AKI patients also had broader lung parenchymal involvement and higher inflammatory markers compared to the NKF group. Patients with prior CKD had higher in-hospital mortality compared to the NKF group (64.0 vs. 18.8%, p < 0.001, OR 4.044, 95%CI: 1.723-9.490, p = 0.013); however, transfers from the HDU to ICU were not more frequent (16.0 vs. 12.9%, p = 0.753). Conclusions: AKI among COVID-19 patients was correlated with more ICU transfers, higher morbidity, and greater markers of severe disease. Patients with CKD had a higher mortality; however, the rate of ICU transfer was not substantially higher due to their poor prognosis.
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Affiliation(s)
- Jakub Klimkiewicz
- Department of Anesthesiology and Intensive Care, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.M.); (M.G.); (K.P.)
| | - Anna Grzywacz
- Department of Nephrology, Internal Diseases and Dialysis, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.G.); (E.J.); (A.L.)
| | - Andrzej Michałowski
- Department of Anesthesiology and Intensive Care, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.M.); (M.G.); (K.P.)
| | - Mateusz Gutowski
- Department of Anesthesiology and Intensive Care, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.M.); (M.G.); (K.P.)
| | - Kamil Paryż
- Department of Anesthesiology and Intensive Care, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.M.); (M.G.); (K.P.)
| | - Ewelina Jędrych
- Department of Nephrology, Internal Diseases and Dialysis, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.G.); (E.J.); (A.L.)
| | - Arkadiusz Lubas
- Department of Nephrology, Internal Diseases and Dialysis, COVID-19 Hospital, Military Institute of Medicine-National Research Institute, Szaserów 128 Str., 04-141 Warsaw, Poland; (A.G.); (E.J.); (A.L.)
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Matsuura Y, Fune J, Ngai L. Navigating Multiple Challenges: Malnutrition and Nephrotoxic Drug Effects in a Non-verbal Child With Autism Spectrum Disorder Requiring Dialysis. Cureus 2024; 16:e56951. [PMID: 38665731 PMCID: PMC11044742 DOI: 10.7759/cureus.56951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Acute kidney injury (AKI) is a common medication adverse event, particularly in patients with pre-existing medical conditions taking nephrotoxic medications. However, little is known about the differences in the risk of nephrotoxic medication-related complications in children with autism spectrum disorder (ASD) compared to the general pediatric population. A nine-year-old non-verbal boy with ASD was hospitalized for scrotal cellulitis requiring vancomycin and piperacillin/tazobactam due to a lack of clinical response to cephalosporins. His history is significant for being an extremely selective eater, and his appetite decreased over four months prior to presentation. Poorly controlled scrotal pain, despite acetaminophen use, was suspected based on his facial expressions and maternal assessment, especially considering his non-verbal status. Consequently, a non-steroidal anti-inflammatory drug was initiated. The hospital course was complicated by the development of a scrotal abscess, minimal enteral intake, hypoalbuminemia-induced intravascular dehydration, oliguria, and generalized edema. His creatinine increased to 5.11 mg/dL from 0.51 mg/dL despite early discontinuation of nephrotoxic medications and fluid resuscitation, which led to hemodialysis due to worsening AKI. Subsequently, urinary output and edema improved. Creatinine improved to <1 mg/dL with careful creatinine monitoring and concomitant furosemide and albumin infusion in the pediatric intensive care unit. Children with comorbidities, such as malnutrition, who require nephrotoxic medications, need extra attention. Implementing clinical decision support tools or quality improvement programs can promote the prevention of nephrotoxic medication exposure and decrease the incidence of AKI. An alert within an electronic health record system for multiple nephrotoxic drugs and daily multidisciplinary huddles during patient-centered rounds could help reduce and eliminate adverse events. In particular, for non-verbal patients or those with limited communication skills, such as children with ASD, rigorous and close monitoring of vital signs, physical condition, pain, medication intake, and lab results, in addition to a nephrotoxic medication screening and notification system, should be key to optimizing patient care.
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Affiliation(s)
- Yusuke Matsuura
- Pediatrics, Mount Sinai Hospital, New York, USA
- Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jan Fune
- Pediatrics/Hospital Medicine, Mount Sinai Hospital, New York, USA
- Pediatrics/Hospital Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Lena Ngai
- Pharmacy, Mount Sinai Hospital, New York, USA
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Huang X, Mulasihan M, Tudi M, Li S. A single-center clinical study of acute kidney injury associated with acute myocardial infarction. Int Urol Nephrol 2024; 56:325-334. [PMID: 37368084 DOI: 10.1007/s11255-023-03676-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To investigate the risk factors of acute kidney injury (AKI) patients with acute myocardial infarction (AMI) and establish potential microRNA (miRNA) biomarkers in the peripheral blood of AMI-AKI patients. METHODS Patients hospitalized from 2016 to 2020 and diagnosed with AMI (with AKI or without AKI groups) were recruited. The data of the two groups were compared and the risk factors of AMI-AKI were analyzed by logistic regression. The receiver operator characteristics (ROC) curve was drawn and the predictive value of risk factors in AMI-AKI was evaluated. Six AMI-AKI patients were selected and six healthy subjects were enrolled as the control. The peripheral blood samples of the two groups were collected for miRNA high-throughput sequencing. RESULTS A total of 300 AMI patients were collected, including 190 patients with AKI and 110 patients without AKI. Multivariate logistic regression analysis indicated that diastolic pressure (68-80 mmHg), urea nitrogen, creatinine, serum uric acid (SUA), aspartate aminotransferase (AST), and left ventricular ejection fraction were the dependent risk factors of AMI-AKI patients (P < 0.05). ROC curve showed that the incidence of AMI-AKI patients was most correlated with urea nitrogen, creatinine, and SUA. In addition, 60 differentially expressed miRNAs were identified between AMI-AKI and controls. Then, hsa-miR-2278, hsa-miR-1827, and hsa-miR-149-5p were more corrected with predictors. Twelve of them targeted 71 genes involved in phagosome, oxytocin signaling pathway, and microRNAs in cancer pathways. CONCLUSION Urea nitrogen, creatinine, and SUA were the dependent risk factors and important predictors for AMI-AKI patients. Three miRNAs may be considered as biomarkers for AMI-AKI.
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Affiliation(s)
- Xuan Huang
- Nephrology Center, The First Affiliated Hospital of Xinjiang Medical University, No. 137 Xinshi Area, Urumqi, 830000, China
| | - Muhuyati Mulasihan
- Heart Center, The First Affiliated Hospital of Xinjiang Medical University, No. 137 Xinshi Area, Urumqi, 830000, China
| | - Mireayi Tudi
- The First People's Hospital of Kashi Region, Yingbin Road, Kashi, 844099, China
| | - Suhua Li
- Nephrology Center, The First Affiliated Hospital of Xinjiang Medical University, No. 137 Xinshi Area, Urumqi, 830000, China.
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Huang X, Huang Y, Chen M, Liao L, Lin F. Association between total bilirubin/Albumin ratio and all-cause mortality in acute kidney injury patients: A retrospective cohort study. PLoS One 2023; 18:e0287485. [PMID: 37910573 PMCID: PMC10619791 DOI: 10.1371/journal.pone.0287485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/06/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The association between the total bilirubin/albumin (B/A) and the all-cause mortality of critically ill patients with acute kidney injury (AKI) remains unclear. This retrospective study aimed to investigate the relationship between B/A ratio and mortality in patients with AKI. METHODS The clinical data of AKI patients in the Medical Information Mart for Intensive Care III (MIMIC-III) database were retrospectively analyzed. Patients were divided into the low and high B/A groups (B/A ≤ 0.25 and B/A > 0.25, respectively). The primary outcome was 28-day all-cause mortality, and the secondary outcomes were 60-day, 1-year and 4-year all-cause mortality. Kaplan-Meier survival curves and Cox proportional risk models were constructed to evaluate the effect of B/A on survival outcomes. RESULTS The 28-day mortality rates were 18.00% and 25.10% in the low and high B/A groups, respectively (P < 0.001). The Kaplan-Meier analysis showed that patients with higher B/A values had higher all-cause mortality risk (log-rank P < 0.0001). The multivariate Cox proportional risk analysis showed that B/A was an independent risk predictor for death at 28 days, 60 days, 1 year, and 4 years. CONCLUSION B/A is an independent risk factor for increased mortality in patients with AKI and may be used as a predictor of clinical outcomes in AKI.
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Affiliation(s)
- Ximei Huang
- Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yunhua Huang
- Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, China
| | - Min Chen
- Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, China
| | - Lin Liao
- Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, China
| | - Faquan Lin
- Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, China
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Xu Y, Qi W. Association between red cell distribution width to albumin ratio and acute kidney injury in patients with sepsis: a MIMIC population-based study. Int Urol Nephrol 2023; 55:2943-2950. [PMID: 37014490 DOI: 10.1007/s11255-023-03572-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE To investigate the association between red cell distribution width (RDW) to albumin (ALB) ratio and acute kidney injury (AKI) in sepsis. METHODS This was a retrospective cohort study. Data were collected from the Medical Information Mart for Intensive Care Database IV (MIMIC-IV) from 2008 to 2019. The incidence of AKI was the primary outcome, which was defined based on the improving Global Outcomes (KDIGO). The association of RDW/ALB ratio with AKI in sepsis was assessed by multivariate logistic regression analysis using relative risk (RR) and a 95% confidence interval (CI). Subgroup group analyses were applied according to age, use of ventilation, and use of vasopressor, SAPS II, and SOFA. RESULTS Of 1810 sepsis patients involved in this study, 563 (31.10%) sepsis patients developed AKI after ICU admission. The results suggested an increase in RDW/ALB was associated with a rise in the risk of AKI in sepsis (RR 1.09, 95% CI 1.02 to 1.16, P = 0.013).Based on the subgroup analysis, RDW/ALB ratio was significantly associated with the risk of AKI in sepsis patients using the treatment of ventilation (RR: 1.07, 95% CI 1.01 to 1.14, P = 0.041)) and in patients with SAPS II < 43 (RR: 1.16, 95% CI 1.04 to 1.29, P = 0.007). CONCLUSION RDW/ALB ratio was independently associated with the risk of AKI in sepsis patients.
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Affiliation(s)
- Yang Xu
- Department of Emergency Medicine, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, No. 188, Lingshan North Road, Qixia District, Nanjing, 210046, People's Republic of China
- Department of Emergency Medicine, Taikang Xianlin Drum Tower Hospital Clinical College of Wuhan University, Nanjing, 210046, People's Republic of China
| | - Wei Qi
- Department of Emergency Medicine, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, No. 188, Lingshan North Road, Qixia District, Nanjing, 210046, People's Republic of China.
- Department of Emergency Medicine, Taikang Xianlin Drum Tower Hospital Clinical College of Wuhan University, Nanjing, 210046, People's Republic of China.
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Alfieri F, Ancona A, Tripepi G, Rubeis A, Arjoldi N, Finazzi S, Cauda V, Fagugli RM. Continuous and early prediction of future moderate and severe Acute Kidney Injury in critically ill patients: Development and multi-centric, multi-national external validation of a machine-learning model. PLoS One 2023; 18:e0287398. [PMID: 37490482 PMCID: PMC10368244 DOI: 10.1371/journal.pone.0287398] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/05/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Acute Kidney Injury (AKI) is a major complication in patients admitted to Intensive Care Units (ICU), causing both clinical and economic burden on the healthcare system. This study develops a novel machine-learning (ML) model to predict, with several hours in advance, the AKI episodes of stage 2 and 3 (according to KDIGO definition) acquired in ICU. METHODS A total of 16'760 ICU adult patients from 145 different ICU centers and 3 different countries (US, Netherland, Italy) are retrospectively enrolled for the study. Every hour the model continuously analyzes the routinely-collected clinical data to generate a new probability of developing AKI stage 2 and 3, according to KDIGO definition, during the ICU stay. RESULTS The predictive model obtains an auROC of 0.884 for AKI (stage 2/3 KDIGO) prediction, when evaluated on the internal test set composed by 1'749 ICU stays from US and EU centers. When externally tested on a multi-centric US dataset of 6'985 ICU stays and multi-centric Italian dataset of 1'025 ICU stays, the model achieves an auROC of 0.877 and of 0.911, respectively. In all datasets, the time between model prediction and AKI (stage 2/3 KDIGO) onset is at least of 14 hours after the first day of ICU hospitalization. CONCLUSIONS In this study, a novel ML model for continuous and early AKI (stage 2/3 KDIGO) prediction is successfully developed, leveraging only routinely-available data. It continuously predicts AKI episodes during ICU stay, at least 14 hours in advance when the AKI episode happens after the first 24 hours of ICU admission. Its performances are validated in an extensive, multi-national and multi-centric cohort of ICU adult patients. This ML model overcomes the main limitations of currently available predictive models. The benefits of its real-world implementation enable an early proactive clinical management and the prevention of AKI episodes in ICU patients. Furthermore, the software could be directly integrated with IT system of the ICU.
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Affiliation(s)
| | | | - Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Andrea Rubeis
- Department of Applied Science and Technology, Politecnico di Torino, Turin, Italy
| | - Niccolò Arjoldi
- Department of Applied Science and Technology, Politecnico di Torino, Turin, Italy
| | - Stefano Finazzi
- Dipartimento di Salute Pubblica, Laboratorio di Clinical Data Science, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Valentina Cauda
- U-Care Medical srl, Torino, Italy
- Department of Applied Science and Technology, Politecnico di Torino, Turin, Italy
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Wu M, Jiang X, Du K, Xu Y, Zhang W. Ensemble machine learning algorithm for predicting acute kidney injury in patients admitted to the neurointensive care unit following brain surgery. Sci Rep 2023; 13:6705. [PMID: 37185782 PMCID: PMC10130041 DOI: 10.1038/s41598-023-33930-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/20/2023] [Indexed: 05/17/2023] Open
Abstract
Acute kidney injury (AKI) is a common postoperative complication among patients in the neurological intensive care unit (NICU), often resulting in poor prognosis and high mortality. In this retrospective cohort study, we established a model for predicting AKI following brain surgery based on an ensemble machine learning algorithm using data from 582 postoperative patients admitted to the NICU at the Dongyang People's Hospital from March 1, 2017, to January 31, 2020. Demographic, clinical, and intraoperative data were collected. Four machine learning algorithms (C5.0, support vector machine, Bayes, and XGBoost) were used to develop the ensemble algorithm. The AKI incidence in critically ill patients after brain surgery was 20.8%. Intraoperative blood pressure; postoperative oxygenation index; oxygen saturation; and creatinine, albumin, urea, and calcium levels were associated with the postoperative AKI occurrence. The area under the curve value for the ensembled model was 0.85. The accuracy, precision, specificity, recall, and balanced accuracy values were 0.81, 0.86, 0.44, 0.91, and 0.68, respectively, indicating good predictive ability. Ultimately, the models using perioperative variables exhibited good discriminatory ability for early prediction of postoperative AKI risk in patients admitted to the NICU. Thus, the ensemble machine learning algorithm may be a valuable tool for forecasting AKI.
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Affiliation(s)
- Muying Wu
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Jinhua, Dongyang, Zhejiang, People's Republic of China
| | - Xuandong Jiang
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Jinhua, Dongyang, Zhejiang, People's Republic of China.
| | - Kailei Du
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Jinhua, Dongyang, Zhejiang, People's Republic of China
| | - Yingting Xu
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Jinhua, Dongyang, Zhejiang, People's Republic of China
| | - Weimin Zhang
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Jinhua, Dongyang, Zhejiang, People's Republic of China
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Gao C, Peng L. Association and prediction of red blood cell distribution width to albumin ratio in all-cause mortality of acute kidney injury in critically ill patients. Front Med (Lausanne) 2023; 10:1047933. [PMID: 36968820 PMCID: PMC10034203 DOI: 10.3389/fmed.2023.1047933] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
AimThe progression of acute kidney injury (AKI) might be associated with systemic inflammation. Our study aims to explore the association and predictive value of the red blood cell distribution width (RDW) to human serum albumin (ALB) ratio (RDW/ALB ratio), an inflammation-related indicator, in the risk of all-cause mortality and renal replacement therapy (RRT) in AKI patients admitted in intensive care units (ICU).MethodsA retrospective cohort study was designed, and data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III). The primary outcome was the risk of all-cause mortality (1-month, 3-month, and 12-month), and the secondary outcome was the risk of RRT. The association between the RDW/ALB ratio and the risk of all-cause mortality and RRT was assessed using the Cox regression analysis, with results shown as hazard ratio (HR) and 95% confidence intervals (CIs). The relationship between the RDW/ALB ratio and crude probability of all-cause mortality or RRT was assessed using restricted cubic splines (RCS). The concordance index (C-index) was used to assess the discrimination of the prediction model.ResultsA total of 13,856 patients were included in our study. In the fully adjusted Cox regression model, we found that a high RDW/ALB ratio was associated with an increased risk of 1-month, 3-month, and 12-month all-cause mortality and RRT (all p < 0.05). Moreover, RCS curves showed the linear relationship between the RDW/ALB ratio and the probability of all-cause mortality and RRT, and the probability was elevated with the increase of the ratio. In addition, the RDW/ALB ratio showed a good predictive performance in the risk of 1-month all-cause mortality, 3-month all-cause mortality, 12-month all-cause mortality, and RRT, with a C-index of 0.728 (95%CI: 0.719–0.737), 0.728 (95%CI: 0.721–0.735), 0.719 (95%CI: 0.713–0.725), and 0.883 (95%CI: 0.876–0.890), respectively.ConclusionThe RDW/ALB ratio performed well to predict the risk of all-cause mortality and RRT in critically ill patients with AKI, indicating that this combined inflammatory indicator might be effective in clinical practice.
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Nada A, Askenazi D, Kupferman JC, Mhanna M, Mahan JD, Boohaker L, Li L, Griffin RL. Low albumin levels are independently associated with neonatal acute kidney injury: a report from AWAKEN Study Group. Pediatr Nephrol 2022; 37:1675-1686. [PMID: 34657971 PMCID: PMC9986677 DOI: 10.1007/s00467-021-05295-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/09/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Data from adult and pediatric literature have shown an association between albumin levels and AKI. Whether hypoalbuminemia and neonatal AKI are associated has not been studied. METHODS We evaluated the association of albumin with early (during the first postnatal week) and late (after the first postnatal week) AKI for 531 neonates from the Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN) database and for 3 gestational age (GA) subgroups: < 29, 29 to < 36, and ≥ 36 weeks GA. RESULTS Low albumin levels were associated with increased odds of neonatal AKI; for every 0.1 g/dL decrease in albumin, the odds of late AKI increased by 12% on continuous analysis. After adjustment for potential confounders, neonates with albumin values in the lowest quartiles (< 2.2 g/dL) had an increased odds of early [Adjusted Odd Ratio (AdjOR) 2.5, 95% CI = 1.1-5.3, p < 0.03] and late AKI [AdjOR 13.4, 95% CI = 3.6-49.9, p < 0.0001] compared to those with albumin in the highest quartile (> 3.1 g/dL). This held true for albumin levels 2.3 to 2.6 g/dL for early [AdjOR 2.5, 95% CI = 1.2-5.5, p < 0.02] and late AKI [AdjOR 6.4, 95% CI = 1.9-21.6, p < 0.01]. Albumin quartiles of (2.7 to 3.0 g/dL) were associated with increased odds of late AKI. Albumin levels of 2.6 g/dL and 2.4 g/dL best predicted early (AUC = 0.59) and late AKI (AUC = 0.64), respectively. Analysis of albumin association with AKI by GA is described. CONCLUSIONS Low albumin levels are independently associated with early and late neonatal AKI. Albumin could be a potential modifiable risk factor for neonatal AKI.
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Affiliation(s)
- Arwa Nada
- Department of Pediatrics, Division of Nephrology & Hypertension, Le Bonheur Children's Hospital, The University of Tennessee Health Science Center, 49 North Dunlap St FOB 326, Memphis, TN, 38105, USA.
| | - David Askenazi
- Department of Pediatrics, Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Juan C Kupferman
- Department of Pediatrics, Division of Pediatric Nephrology & Hypertension, Maimonides Medical Center, Brooklyn, NY, USA
| | - Maroun Mhanna
- Department of Pediatrics, Division of Neonatology, Louisiana State University Health in Shreveport, Shreveport, LA, USA
| | - John D Mahan
- Department of Pediatrics, Division of Nephrology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Louis Boohaker
- Department of Pediatrics, Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Linzi Li
- Department of Pediatrics, Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Russell L Griffin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Acute kidney injury secondary to urinary tract infection in kidney transplant recipients. Sci Rep 2022; 12:10858. [PMID: 35760823 PMCID: PMC9237017 DOI: 10.1038/s41598-022-15035-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/16/2022] [Indexed: 12/29/2022] Open
Abstract
Acute kidney injury (AKI) in kidney transplant recipients (KTRs) is a common, yet poorly investigated, complication of urinary tract infections (UTI) and urosepsis. A retrospective comparative analysis was performed, recruiting 101 KTRs with urosepsis, 100 KTRs with UTI, and 100 KTRs without history of UTI or sepsis. The incidences of AKI in the urosepsis and UTI groups were 75.2% and 41%, respectively. The urosepsis group has also presented with a significantly higher prevalence of AKI stage 2 and 3 than the UTI group. The rates of recovery from AKI stages 1, 2 and 3, were 75,6%, 55% and 26.1%, respectively. Factors independently associated with renal recovery from AKI were: AKI severity grade (AKI stage 2 with OR = 0.25 and AKI stage 3 with OR = 0.1), transfusion of red blood cells (RBC) (OR = 0.22), and the use of steroid bolus in the acute phase of treatment (OR = 4). The septic status (urosepsis vs UTI) did not influence the rates of renal recovery from AKI after adjustment for the remaining variables. The dominant cause of RBC transfusions in the whole population was upper GI-bleeding. In multivariable analyses, the occurrence of AKI was also independently associated with a greater decline of eGFR at 1-year post-discharge and with a greater risk of graft loss. In KTRs with both urosepsis and UTI, the occurrence of AKI portends poor transplantation outcomes. The local transfusion policy, modulation of immunosuppression and stress ulcer prophylaxis (which is not routinely administered in KTRs) in the acute setting may be modifiable factors that significantly impact long-term transplantation outcomes.
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YEŞİLTAŞ S, GÜZEL C, SÜMER İ, UYSAL H, DAŞKAYA H, TÜRKAY M, KARAASLAN K. The Effect of Exogenous Human Albumin Administration on Acute Kidney Injury Development in Hypoalbuminemic Patients in the Intensive Care Unit. BEZMIALEM SCIENCE 2022. [DOI: 10.14235/bas.galenos.2021.6113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Association of the serum albumin level with prognosis in chronic kidney disease patients. Int Urol Nephrol 2022; 54:2421-2431. [PMID: 35230608 DOI: 10.1007/s11255-022-03140-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Chronic kidney disease (CKD) is an important contributor to the overall morbidity and mortality due to noncommunicable diseases. We investigated the relationship between serum albumin and the clinical prognosis in patients with stage G2-G5 CKD who were not undergoing dialysis. METHODS This was a post hoc analysis of 1138 patients enrolled from 2010 to 2011 in the Chronic Kidney Disease Research of Outcomes in Treatment and Epidemiology (CKD-ROUTE) study. The primary endpoints were CKD progression, cardiovascular disease (CVD) development, and all-cause mortality. Cox proportional hazards models were used. RESULTS During a median follow-up time of 35 months, the number of patients who experienced CKD progression, CVD development, and all-cause mortality was 278 (24.7%), 116 (10.3%), and 78 (6.9%), respectively. In multivariable-adjusted Cox proportional hazards models, the adjusted hazard ratios (HRs) for CKD progression, CVD development, and all-cause mortality in patients with the highest quartile of serum albumin concentrations compared to those with the lowest quartile of serum albumin concentrations were 0.13 (P < 0.0001), 0.29 (P = 0.0002), and 0.27 (P = 0.0009), respectively, in the model adjusted for demographic factors, hypertension, diabetes, and a history of CVD. After further adjustment for the estimated glomerular filtration rate (eGFR), urinary protein/creatinine ratio (UPCR), and systolic blood pressure (SBP), the results remained significant (HR for CKD progression 0.37, P < 0.0001; HR for CVD development 0.41, P = 0.0120; HR for all-cause mortality 0.37, P = 0.0158). CONCLUSION Serum albumin levels were inversely associated with the risks of CKD progression, CVD development, and all-cause mortality among patients with stage G2-G5 CKD who were not undergoing dialysis.
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Marques F, Gameiro J, Oliveira J, Fonseca JA, Duarte I, Bernardo J, Branco C, Costa C, Carreiro C, Braz S, Lopes JA. Acute Kidney Disease and Mortality in Acute Kidney Injury Patients with COVID-19. J Clin Med 2021; 10:4599. [PMID: 34640618 PMCID: PMC8509682 DOI: 10.3390/jcm10194599] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/26/2021] [Accepted: 10/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The incidence of AKI in coronavirus disease 2019 (COVID-19) patients is variable and has been associated with worse prognosis. A significant number of patients develop persistent kidney damage defined as Acute Kidney Disease (AKD). There is a lack of evidence on the real impact of AKD on COVID-19 patients. We aim to identify risk factors for the development of AKD and its impact on mortality in COVID-19 patients. METHODS Retrospective analysis of COVID-19 patients with AKI admitted at the Centro Hospitalar Universitário Lisboa Norte between March and August of 2020. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. AKD was defined by presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. RESULTS In 339 COVID-19 patients with AKI, 25.7% patients developed AKD (n = 87). The mean age was 71.7 ± 17.0 years, baseline SCr was 1.03 ± 0.44 mg/dL, and the majority of patients were classified as KDIGO stage 3 AKI (54.3%). The in-hospital mortality was 18.0% (n = 61). Presence of hypertension (p = 0.006), CKD (p < 0.001), lower hemoglobin (p = 0.034) and lower CRP (p = 0.004) at the hospital admission and nephrotoxin exposure (p < 0.001) were independent risk factors for the development of AKD. Older age (p = 0.003), higher serum ferritin at admission (p = 0.008) and development of AKD (p = 0.029) were independent predictors of in-hospital mortality in COVID-19-AKI patients. CONCLUSIONS AKD was significantly associated with in-hospital mortality in this population of COVID-19-AKI patients. Considering the significant risk of mortality in AKI patients, it is of paramount importance to identify the subset of higher risk patients.
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Affiliation(s)
- Filipe Marques
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisbon, Portugal; (J.G.); (J.O.); (J.A.F.); (I.D.); (J.B.); (C.B.); (C.C.); (C.C.); (S.B.); (J.A.L.)
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Lv J, Wang H, Sun B, Gao Y, Zhang Z, Pei H. Serum Albumin Before CRRT Was Associated With the 28- and 90-Day Mortality of Critically Ill Patients With Acute Kidney Injury and Treated With Continuous Renal Replacement Therapy. Front Nutr 2021; 8:717918. [PMID: 34513902 PMCID: PMC8425552 DOI: 10.3389/fnut.2021.717918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Although low serum albumin (ALB) may worsen acute kidney injury (AKI), additional study is needed to establish the connection between ALB and the prognosis of critically ill patients with AKI and treated with continuous renal replacement therapy (CRRT). Methods:A secondary analysis of a bi-center, retrospective, and observational study, such as critically ill patients with AKI and treated with CRRT from January 2009 to September 2016. The univariate analysis, multi-factor regression analysis, sensitivity analysis, and curve-fitting analysis were applied to explore the association of ALB with the 28 and 90 days mortality of critically ill patients with AKI and treated with CRRT, and the removal efficiency of serum phosphorus. Results: From January 2009 to September 2016, 1,132 cases with AKI and treated with CRRT met the inclusion criteria and enrolled in this study. We found that the higher ALB before CRRT, the lower the 28- and 90-day mortality of patients with AKI and treated with CRRT, the higher removal efficiency of serum phosphorus, the adjusted hazard ratio (HR) value for 28-day mortality in the four models were separately 0.92 (0.90, 0.95), 0.91 (0.89, 0.94), 0.92 (0.89, 0.95), and 0.92 (0.89, 0.95); the adjusted HR value for 90 day mortality in the four models were 0.91 (0.89, 0.94), 0.92 (0.89, 0.95), 0.92 (0.89, 0.95), and 0.92 (0.89, 0.96); the adjusted OR value for the removal efficiency of serum phosphorus in the four models were separately -0.04 (-0.07, -0.01), -0.05 (-0.08, -0.01), -0.04 (-0.08, -0.01), and -0.04 (-0.08, -0.01). The sensitivity analysis and curve-fitting analysis also showed that ALB before CRRT was correlated with the 28 and 90 days mortality of critically ill patients with AKI and treated with CRRT and the removal efficiency of serum phosphorus. Conclusion: The higher the serum ALB before CRRT, the lower the mortality of critically ill patients with AKI and treated with CRRT, and the higher the clearance efficiency of serum phosphorus.
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Affiliation(s)
- Junhua Lv
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hai Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Baoni Sun
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanxia Gao
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhenglinag Zhang
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Honghong Pei
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Zheng LJ, Jiang W, Pan L, Pan J. Reduced serum albumin as a risk factor for poor prognosis in critically ill patients receiving renal replacement therapy. BMC Nephrol 2021; 22:305. [PMID: 34496793 PMCID: PMC8427850 DOI: 10.1186/s12882-021-02512-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/27/2021] [Indexed: 01/17/2023] Open
Abstract
Background Albumin is the primary body protein, which can predict the poor prognosis of several critical diseases. However, there are a few scientific studies on the relationship between albumin and the prognosis of dialysis patients. This study aims to explore the impact of hypoalbuminemia on the prognosis of critically ill patients with acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT). Methods This was a secondary study. Clinical, biochemical, and 28-day and 90-day mortality rates for critical patients with AKI who received CRRT between 2009 and 2016 were searched from the database to determine the effect of hypoalbuminemia on poor outcomes by univariate, multivariate, smooth curve fitting, and subgroup analysis. Results A total of 837 participants were enrolled in this study. Multivariate Cox proportional hazard regression analysis showed that hypoalbuminemia was associated with both 28-day and 90-day mortality risks after full adjustment for confounding variables, with an adjusted hazard ratio (95% confidence interval) of 0.63 (0.50–0.80) and 0.63 (0.51–0.78), respectively for each 1 g/dL increase of albumin. Stratified analysis showed that hypoalbuminemia was not associated with poor prognosis in oliguria. Conclusion Hypoalbuminemia is associated with poor prognosis in critically ill AKI patients with CRRT; therefore, measuring albumin may be helpful for predicting the prognosis. However, in those with oliguria, this conclusion is not valid.
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Affiliation(s)
- Lang Jing Zheng
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People's Republic of China
| | - Weiming Jiang
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People's Republic of China
| | - Lingling Pan
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People's Republic of China
| | - Jingye Pan
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People's Republic of China.
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Cobeñas CJ, Lombardi LL, Pereyra P, De Rose E, Gogorza MJ, Spizzirri AP, Ruscasso JD, Ferradas SL, Suárez ÁDC, Amoreo OR, Zalba JH, Risso P. Hypoalbuminemia: a risk factor in patients with STEC-associated hemolytic uremic syndrome. Pediatr Nephrol 2021; 36:2739-2746. [PMID: 33712864 DOI: 10.1007/s00467-021-05017-8] [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] [Received: 03/06/2020] [Revised: 01/30/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to determine the prevalence of hypoalbuminemia in STEC-HUS patients with hemorrhagic colitis (HC) and whether serum albumin level (SAL), leukocyte count, hematocrit and serum sodium level (SSL) are prognostic markers of HC, central nervous system disease (CNSd) and/or dialysis requirement and evaluate if hypoalbuminemia is associated with fecal protein losses. METHODS We prospectively evaluated STEC-HUS patients treated at our institution from 9/2011 to 2/2019, analyzing the presence of HC, CNSd and dialysis requirement and SAL, SSL, leukocytes, hematocrit and α1-antitrypsin clearance. RESULTS We evaluated 98 patients, with mean age of 33.3 months. SAL ≤ 29.5 g/l, > 24,600 leukocytes/mm3 and hematocrit > 30% behave as independent prognostic markers for HC. SAL ≤ 28 g/l, > 25,200 leukocytes/mm3 and hematocrit > 30% behave as prognostic markers for CNSd. SAL ≤ 31.6 g/l, > 13,800 leukocytes/mm3, hematocrit > 18.9% and hyponatremia (≤ 132 mEq/l) behave as prognostic markers for dialysis requirement. However, in multivariate logistic regression models, only hypoalbuminemia behaved as a risk factor for HC, CNSd and dialysis. α1-antitrypsin clearance was performed in 69 patients and was high in 9/69 (13%), only 4 with HC. No significant association was observed between α1-antitrypsin clearance and albuminemia (χ2 = 0.1076, p = 0.7429) as well as α1-antitrypsin clearance and HC (χ2 = 1.7892, p = 0.1810). CONCLUSIONS Almost all patients with HC had hypoalbuminemia, which behaves as a risk factor for HC, CNSd and dialysis requirement. No significant association was observed between elevated α1-antitrypsin clearance and hypoalbuminemia nor between elevated α1-antitrypsin clearance and HC. These findings could be related to the small number of evaluated patients.
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Affiliation(s)
- Carlos J Cobeñas
- Nephrology Department, Hospital de Niños "Sup. Sor María Ludovica", La Plata, Argentina.
| | - Laura L Lombardi
- Nephrology Department, Hospital de Niños "Sup. Sor María Ludovica", La Plata, Argentina
| | - Priscila Pereyra
- Nephrology Department, Hospital de Niños "Sup. Sor María Ludovica", La Plata, Argentina
| | - Emanuel De Rose
- Nephrology Department, Hospital de Niños "Sup. Sor María Ludovica", La Plata, Argentina
| | - María José Gogorza
- Nephrology Department, Hospital de Niños "Sup. Sor María Ludovica", La Plata, Argentina
| | - Ana Paula Spizzirri
- Nephrology Department, Hospital de Niños "Sup. Sor María Ludovica", La Plata, Argentina
| | - Javier D Ruscasso
- Nephrology Department, Hospital de Niños "Sup. Sor María Ludovica", La Plata, Argentina
| | | | | | - Oscar R Amoreo
- Nephrology Department, Hospital de Niños "Sup. Sor María Ludovica", La Plata, Argentina
| | - Javier H Zalba
- Nephrology Department, Hospital de Niños "Sup. Sor María Ludovica", La Plata, Argentina
| | - Paula Risso
- Cátedra de Bioestadística Bayesiana y Clásica, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina
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Özgür Y, Akın S, Yılmaz NG, Gücün M, Keskin Ö. Uric acid albumin ratio as a predictive marker of short-term mortality in patients with acute kidney injury. Clin Exp Emerg Med 2021; 8:82-88. [PMID: 34237812 PMCID: PMC8273677 DOI: 10.15441/ceem.20.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/30/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE We aimed to investigate uric acid and albumin ratio (UA/A) as a marker of short-term mortality in acute kidney injury (AKI). Both uric acid and albumin are strongly correlated with the development and mortality of AKI. METHODS The patients hospitalized from May 2019 to September 2019 for AKI were included in this study. The diagnostic odds ratio (DOR), Youden index (J), and the area under a receiver operating characteristic curve (AUROC) determined a cut-off UA/A ratio for mortality. Cox-regression analysis was performed to identify UA/A as a prognostic marker of the 30-day mortality rate. RESULTS A total of 171 patients with an average age of 69.20±13.0 (45.6% women) were included in the study. The average UA/A ratio was 3.3±1.5 mg/g and 2.5±1.0 mg/g in the non-survivor and survivor groups, respectively (P=0.001). The best cut-off UA/A ratio associated with mortality was determined as 2.4 mg/g with a specificity of 52% and a sensitivity of 77% (DOR, 3.6; J, 28.8; AUROC, 0.644). Thirty-day cumulative survival rates of the low and high UA/A ratio groups were 85.9±4.0% and 63.7±5.0%, respectively. The estimated survival times of the low and high UA/A ratio groups were 27.7 days (95% confidence interval [CI], 26.2-29.3) and 23.9 days (95% Cl, 22.0-25.9), respectively. CONCLUSION We found a direct correlation between 30-day mortality and UA/A ratio at initial presentation in AKI patients regardless of age, comorbidities, and clinical and laboratory findings, including albuminuria.
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Affiliation(s)
- Yasemin Özgür
- Department of Internal Medicine, Dr. Lutfi Kırdar Kartal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Seydahmet Akın
- Department of Internal Medicine, Dr. Lutfi Kırdar Kartal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nuran Gamze Yılmaz
- Department of Internal Medicine, Dr. Lutfi Kırdar Kartal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Gücün
- Department of Nephrology, Kartal Koşuyolu High Speciality Educational and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özcan Keskin
- Department of Internal Medicine, Dr. Lutfi Kırdar Kartal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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AKMAN C, BAKİRDOGEN S, DAŞ M, BALCI S, AYKAN ON. Comparison of serum corrected and ionized calcium levels in patients with acute kidney injury. FAMILY PRACTICE AND PALLIATIVE CARE 2021. [DOI: 10.22391/fppc.854694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Liu L, Lun Z, Wang B, Lei L, Sun G, Liu J, Guo Z, He Y, Song F, Liu B, Chen G, Chen S, Chen J, Liu Y. Predictive Value of Hypoalbuminemia for Contrast-Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis. Angiology 2021; 72:616-624. [PMID: 33525920 DOI: 10.1177/0003319721989185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Contrast-associated acute kidney injury (CA-AKI) is a major adverse complication of intravascular administration of contrast medium. Current studies have shown that hypoalbuminemia might be a novel risk factor of CA-AKI. This systematic review and meta-analysis was performed to evaluate the predictive value of hypoalbuminemia for CA-AKI. Relevant studies were identified in Ovid-Medline, PubMed, Embase, and Cochrane Library up to December 31, 2019. Two authors independently screened studies, consulting with a third author when necessary to resolve discrepancies. The pooled odds ratio (OR) was calculated to assess the association between hypoalbuminemia and CA-AKI using a random-effects model or fixed-effects model. Eight relevant studies involving a total of 18 687 patients met our inclusion criteria. The presence of hypoalbuminemia was associated with an increased risk of CA-AKI development (pooled OR: 2.59, 95% CI: 1.80-3.73). Hypoalbuminemia is independently associated with the occurrence of CA-AKI and may be a potentially modifiable factor for clinical intervention. This systematic review and meta-analysis was registered in PROSPERO (CRD42020168104).
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Affiliation(s)
- Liwei Liu
- The Second School of Clinical Medicine, 70570Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,89346Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, Guangdong, People's Republic of China.,Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 36721Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Zhubin Lun
- Department of Cardiology, Dongguan People's Hospital, Dongguan, People's Republic of China
| | - Bo Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 36721Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Li Lei
- The Second School of Clinical Medicine, 70570Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,89346Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, Guangdong, People's Republic of China
| | - Guoli Sun
- 89346Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, Guangdong, People's Republic of China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 36721Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Zhaodong Guo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 36721Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Yibo He
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 36721Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Feier Song
- Department of Emergency and Critical Care Medicine, 89346Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Bowen Liu
- 89346Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, People's Republic of China
| | - Guanzhong Chen
- 89346Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, People's Republic of China
| | - Shiqun Chen
- 89346Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, Guangdong, People's Republic of China
| | - Jiyan Chen
- The Second School of Clinical Medicine, 70570Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,89346Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, Guangdong, People's Republic of China.,Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 36721Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Yong Liu
- The Second School of Clinical Medicine, 70570Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,89346Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, Guangdong, People's Republic of China.,Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 36721Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
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Calabrese V, Scuto M, Salinaro AT, Dionisio G, Modafferi S, Ontario ML, Greco V, Sciuto S, Schmitt CP, Calabrese EJ, Peters V. Hydrogen Sulfide and Carnosine: Modulation of Oxidative Stress and Inflammation in Kidney and Brain Axis. Antioxidants (Basel) 2020; 9:antiox9121303. [PMID: 33353117 PMCID: PMC7767317 DOI: 10.3390/antiox9121303] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
Emerging evidence indicates that the dysregulation of cellular redox homeostasis and chronic inflammatory processes are implicated in the pathogenesis of kidney and brain disorders. In this light, endogenous dipeptide carnosine (β-alanyl-L-histidine) and hydrogen sulfide (H2S) exert cytoprotective actions through the modulation of redox-dependent resilience pathways during oxidative stress and inflammation. Several recent studies have elucidated a functional crosstalk occurring between kidney and the brain. The pathophysiological link of this crosstalk is represented by oxidative stress and inflammatory processes which contribute to the high prevalence of neuropsychiatric disorders, cognitive impairment, and dementia during the natural history of chronic kidney disease. Herein, we provide an overview of the main pathophysiological mechanisms related to high levels of pro-inflammatory cytokines, including interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and neurotoxins, which play a critical role in the kidney–brain crosstalk. The present paper also explores the respective role of H2S and carnosine in the modulation of oxidative stress and inflammation in the kidney–brain axis. It suggests that these activities are likely mediated, at least in part, via hormetic processes, involving Nrf2 (Nuclear factor-like 2), Hsp 70 (heat shock protein 70), SIRT-1 (Sirtuin-1), Trx (Thioredoxin), and the glutathione system. Metabolic interactions at the kidney and brain axis level operate in controlling and reducing oxidant-induced inflammatory damage and therefore, can be a promising potential therapeutic target to reduce the severity of renal and brain injuries in humans.
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Affiliation(s)
- Vittorio Calabrese
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95125 Catania, Italy; (M.S.); (S.M.); (M.L.O.); (V.G.); (S.S.)
- Correspondence: (V.C.); (A.T.S.)
| | - Maria Scuto
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95125 Catania, Italy; (M.S.); (S.M.); (M.L.O.); (V.G.); (S.S.)
| | - Angela Trovato Salinaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95125 Catania, Italy; (M.S.); (S.M.); (M.L.O.); (V.G.); (S.S.)
- Correspondence: (V.C.); (A.T.S.)
| | - Giuseppe Dionisio
- Department of Molecular Biology and Genetics, Research Center Flakkebjerg, Aarhus University, Forsøgsvej 1, 4200 Slagelse, Denmark;
| | - Sergio Modafferi
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95125 Catania, Italy; (M.S.); (S.M.); (M.L.O.); (V.G.); (S.S.)
| | - Maria Laura Ontario
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95125 Catania, Italy; (M.S.); (S.M.); (M.L.O.); (V.G.); (S.S.)
| | - Valentina Greco
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95125 Catania, Italy; (M.S.); (S.M.); (M.L.O.); (V.G.); (S.S.)
| | - Sebastiano Sciuto
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95125 Catania, Italy; (M.S.); (S.M.); (M.L.O.); (V.G.); (S.S.)
| | - Claus Peter Schmitt
- Centre for Pediatric and Adolescent Medicine, University of Heidelberg, 69120 Heidelberg, Germany; (C.P.S.); (V.P.)
| | - Edward J. Calabrese
- Department of Environmental Health Sciences, Morrill I, N344, University of Massachusetts, Amherst, MA 01003, USA;
| | - Verena Peters
- Centre for Pediatric and Adolescent Medicine, University of Heidelberg, 69120 Heidelberg, Germany; (C.P.S.); (V.P.)
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Chen HC, Lai MJ, Wu WC, Lee CY, Lin HJ, Lin CC, Chang CT, Wang CCN, Chou CY. Association of diabetes, education level, and care dependency with use of temporary vascular access in patients with chronic kidney disease. Semin Dial 2020; 34:130-136. [PMID: 33103809 DOI: 10.1111/sdi.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Temporary vascular access (TVA) is frequently used during the first dialysis in patients with chronic kidney disease (CKD), and it is associated with an increased risk of infection, central vein stenosis, and mortality. Here, factors associated with TVA in patients with CKD were explored. METHODS This study included patients in a single-center CKD care program who initiated long-term renal replacement therapy. The primary outcome was TVA use at first dialysis. Factors possibly associated with TVA use were analyzed using Cox regression. RESULTS Temporary vascular access was used in 53.2% of the patients at first dialysis. In total, 73.2% (n = 865) and 26.8% (n = 317) of the patients were on hemodialysis and peritoneal dialysis, respectively. Multivariate Cox regression analysis showed that TVA use in patients with CKD was associated with diabetes (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.28-1.81, p < 0.001), lower albumin (HR 0.82, 95% CI 0.75-0.91, p < 0.001), lower education level (HR 0.75, 95% CI 0.56-1.00, p = 0.055), and total care dependency (HR 1.92, CI 1.44-3.43, p = 0.003). CONCLUSION Diabetes, education level, and care dependency are associated with TVA at dialysis initiation in patients with CKD.
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Affiliation(s)
- Hung-Chih Chen
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Meng-Jie Lai
- Institute of Nursing, China Medical University, Taichung, Taiwan
| | - Wan-Chen Wu
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan
| | - Chi-Yu Lee
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan
| | - Hsuan-Jen Lin
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Chung-Chih Lin
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan
| | - Chiz-Tzung Chang
- Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Charles C N Wang
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Che-Yi Chou
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan.,Department of Post-baccalaureate Veterinary Medicine, Asia University, Wufeng, Taichung, Taiwan
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Padkins M, Breen T, Anavekar N, Barsness G, Kashani K, Jentzer JC. Association Between Albumin Level and Mortality Among Cardiac Intensive Care Unit Patients. J Intensive Care Med 2020; 36:1475-1482. [PMID: 33016174 DOI: 10.1177/0885066620963875] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To study the effect of hypoalbuminemia on short- and long-term mortality in Cardiac Intensive Care Unit (CICU) patients. METHODS We reviewed 12,418 unique CICU patients from 2007 to 2018. Hypoalbuminemia was defined as an admission albumin level <3.5 g/dL. Predictors of hospital mortality were identified using multivariable logistic regression. RESULTS We included 2,680 patients (22%) with a measured admission albumin level. The median age was 68 (39% females). Admission diagnoses included acute coronary syndrome, heart failure, cardiac arrest, and cardiogenic shock. The median albumin level was 3.4 g/dL and 55% of patients had hypoalbuminemia. Hospital mortality occurred in 16%, and patients with hypoalbuminemia had higher hospital mortality (21% vs. 9%, adjusted OR 2.64, 95% CI 2.09-3.34, p < 0.001). Albumin level was inversely associated with hospital mortality (adjusted OR 0.60 per 1 g/dL higher albumin level, 95% CI 0.47-0.75, p <0.001), with a stepwise increase in the hospital mortality at lower albumin levels. Post-discharge mortality was higher in hospital survivors with hypoalbuminemia, and increased as a function of lower albumin levels. CONCLUSION Hypoalbuminemia is common in CICU patients and associated with higher short- and long-term mortality. Progressively lower serum albumin was incrementally associated with higher hospital and post-discharge mortality.
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Affiliation(s)
- Mitchell Padkins
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic, Rochester, MN, USA
| | - Thomas Breen
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic, Rochester, MN, USA
| | - Nandan Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Gregory Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kianoush Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Hypoalbuminemia and Obesity in Orthopaedic Trauma Patients: Body Mass Index a Significant Predictor of Surgical Site Complications. Sci Rep 2020; 10:1953. [PMID: 32029855 PMCID: PMC7004978 DOI: 10.1038/s41598-020-58987-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/23/2020] [Indexed: 01/31/2023] Open
Abstract
The purpose of this investigation was to identify the prevalence of hypoalbuminemia and obesity in orthopaedic trauma patients with high-energy injuries and to investigate their impact on the incidence of surgical site complications. Patients 18 years of age and older undergoing intramedullary nail fixation of their femoral shaft fractures at a university-based level-1 trauma centre were assessed. Malnutrition was measured using serum markers (albumin <3.5 g/dL) as well as body mass index (BMI) as a marker of obesity (BMI > 30 kg/m2). The primary outcome measure was surgical wound complications. A total of 249 patients were included in this study. Ninety-eight patients (39.4%) presented with hypoalbuminaemia and 80 patients (32.1%) were obese. The overall incidence of wound complications in our study population was 9.65% (n = 25/259). A logistic regression model showed that non-obese patients (BMI < 30 kg/m2) were at significantly reduced risk for perioperative wound complications (Odds Ratio 0.400 [95% confidence interval 0.168, 0.954], p = 0.039). This study demonstrated a substantial prevalence of hypoalbuminemia and obesity among orthopaedic trauma patients with high-energy injuries. Obesity may increase the risk of surgical site complications. Future studies are required to further define malnutrition and its correlation with surgical site complications in orthopaedic trauma patients.
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Gong Y, Ding F, Gu Y. Can Serum Nutritional Related Biomarkers Predict Mortality Of Critically Ill Older Patients With Acute Kidney Injury? Clin Interv Aging 2019; 14:1763-1769. [PMID: 31695346 PMCID: PMC6811773 DOI: 10.2147/cia.s218973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/09/2019] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Yu Gong
- Department of Internal Medicine, Division of Nephrology, Shanghai Municipal Eighth People's Hospital, Shanghai, People's Republic of China
| | - Feng Ding
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yong Gu
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
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Konigsfeld HP, Viana TG, Pereira SC, Santos TOCD, Kirsztajn GM, Tavares A, de Souza Durão Junior M. Acute kidney injury in hospitalized patients who underwent percutaneous kidney biopsy for histological diagnosis of their renal disease. BMC Nephrol 2019; 20:315. [PMID: 31409299 PMCID: PMC6693282 DOI: 10.1186/s12882-019-1514-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Performing a kidney biopsy is necessary to accurately diagnose diseases such as glomerulonephritis and tubulointerstitial nephritis, among other such conditions. These conditions predispose patients to chronic kidney disease, as well as acute kidney injury (AKI). Notably, most epidemiological studies describing AKI have not investigated this patient population. METHODS Included patients admitted to the nephrology ward of a tertiary hospital who underwent percutaneous kidney biopsy. AKI was diagnosed based on the Kidney Disease: Improving Global Outcomes criteria. RESULTS Of the 223 patients investigated, 140 (62.8%) showed AKI. Of these, 91 (65%), 19 (13.6%), and 30 (21.4%) presented with AKI classified as stages 1, 2, and 3, respectively. The primary indication for performing biopsy was nephrotic syndrome or nephrotic proteinuria (73 [52.1%] in the AKI vs. 51 [61.4%] in the non-AKI group, p = 0.048). Focal segmental glomerulosclerosis was the most prevalent primary disease (24 [17.1%] in the AKI vs. 15 [18.0%] in the non-AKI group, p = 0.150). Multivariate analysis of risk factors associated with AKI showed hemoglobin levels (odds ratio [OR] 0.805, 95% confidence interval [CI] 0.681-0.951, p = 0.011), serum high-density lipoprotein cholesterol levels (HDL-c, OR 0.970, 95% CI 0.949-0.992, p = 0.008), and baseline serum creatinine levels (OR 2.703, 95% CI 1.471-4.968, p = 0.001) were significantly associated with AKI. CONCLUSIONS We observed a high prevalence of AKI in hospitalized patients who underwent kidney biopsy to investigate their renal disease, particularly glomerulonephritis. Higher levels of hemoglobin and serum HDL-c were associated with a lower risk of AKI.
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Affiliation(s)
| | | | | | | | | | - Agostinho Tavares
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marcelino de Souza Durão Junior
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, SP, Brazil. .,Kidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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YETER HH, YILDIRIM T, EYÜPOĞLU D, PAŞAYEV T, ASLAN A, ÇETİK S, AKÇAY Ö, TOPELİ A, ARICI M. Mild to moderate proteinuria is a heralding sign for acute kidney injury and mortality for intensive care unit patients. Turk J Med Sci 2019; 49:543-550. [PMID: 30997790 PMCID: PMC7018325 DOI: 10.3906/sag-1802-183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background/aim Lack of early predictors of acute kidney injury is currently delaying timely diagnosis.This study was done to evaluate the relationship between mild to moderate proteinuria and incidence of acute kidney injury (AKI) and 28-day mortality in intensive care unit (ICU) patients. Materials and methods This observational, retrospective study was conducted in the internal medicine ICU. A total of 796 patients were screened and 525 patients were used for this analysis. Proteinuria was measured by urine dipstick test. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Results Patients with dipstick urine protein positivity on admission had higher proportion of AKI and 28-day mortality compared to dipstick urine protein negative group [164 (59.6%) vs. 111 (44.4%) and 101 (36.7%) vs. 54 (21.6%), P = 0.01 and P < 0.01, respectively]. Urine dipstick protein positivity was also a significant predictor of 28-day mortality in patients with GFR > 60 mL/min (hazard ratio: 1.988, 95% confidence interval 1.380–2.862). Conclusion Proteinuria before ICU admission is a risk factor for development of AKI within seven days of ICU stay and also is a risk factor for 28-day mortality, even in patients with GFR > 60 mL/min.
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Affiliation(s)
- Hasan H. YETER
- Department of Nephrology, Faculty of Medicine, Gazi University, AnkaraTurkey
| | - Tolga YILDIRIM
- Department of Nephrology, Faculty of Medicine, Hacettepe University, AnkaraTurkey
| | - Damla EYÜPOĞLU
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, AnkaraTurkey
| | - Tural PAŞAYEV
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, AnkaraTurkey
| | - Abdullah ASLAN
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, AnkaraTurkey
| | - Sıla ÇETİK
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, AnkaraTurkey
| | - Ömer AKÇAY
- Department of Internal Medicine, Zekai Tahiri Burak Hospital, AnkaraTurkey
| | - Arzu TOPELİ
- Intensive Care Unit, Faculty of Medicine, Hacettepe University, AnkaraTurkey
| | - Mustafa ARICI
- Department of Nephrology, Faculty of Medicine, Hacettepe University, AnkaraTurkey
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Tang Y, Liu Z, Liang J, Zhang R, Wu K, Zou Z, Zhou C, Zhang F, Lu Y. Early post-operative serum albumin level predicts survival after curative nephrectomy for kidney cancer: a retrospective study. BMC Urol 2018; 18:111. [PMID: 30522461 PMCID: PMC6282248 DOI: 10.1186/s12894-018-0427-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 11/28/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Previous studies have shown that albumin-related systemic inflammation is associated with the long-term prognosis of cancer, but the clinical significance of an early (≤ 7 days) post-operative serum albumin level has not been well-documented as a prognostic factor in patients with renal cell cancer. METHODS We retrospectively included patients hospitalized for kidney cancer from January 2009 to May 2014. First, the receiver operating characteristic analysis was used to define the best cut-off of an early post-operative serum albumin level in determining the prognosis, from which survival analysis was performed. RESULTS A total of 329 patients were included. The median duration of follow-up was 54.8 months. Patients with an early post-operative serum albumin level < 32 g/L had a significantly shorter median recurrence-free survival (RFS; 49.1 versus 56.5 months, P = 0.001) and median overall survival (OS; 52.2 versus 57.0 months, P = 0.049) than patients with an early post-operative serum albumin level ≥ 32 g/L. After adjusting for age, BMI, tumor stage, post-operative hemoglobin concentration, and pre-operative albumin, globulin, and hemoglobin levels, multivariate Cox regression showed that an early post-operative serum albumin level < 32 g/L was an independent prognostic factor associated with a decreased RFS (HR = 3.60; 95% CI,1.05-12.42 [months], P = 0.042) and decreased OS (HR = 9.95; 95% CI, 1.81-54.80 [months], P = 0.008). CONCLUSION An early post-operative serum albumin level < 32 g/L is an independent prognostic factor leading to an unfavorable RFS and OS. Prospective trials and further studies involving additional patients are warranted.
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Affiliation(s)
- Yongquan Tang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, No. 37 of Guoxue Xiang, Chengdu, 610041 China
| | - Zhihong Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayu Liang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ruochen Zhang
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Kan Wu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zijun Zou
- Department of Urology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuan Zhou
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Fuxun Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yiping Lu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Single Graft Utilization From Donors With Severe Acute Kidney Injury After Circulatory Death. Transplant Direct 2018; 4:e355. [PMID: 29707626 PMCID: PMC5908460 DOI: 10.1097/txd.0000000000000768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/29/2017] [Indexed: 12/21/2022] Open
Abstract
Chronic shortages of organs for transplantation have led to the use of marginal kidneys from donors after circulatory death with acute kidney injury (AKI), but the utilization of kidneys with severe AKI is not well established. We retrospectively analyzed eight kidney transplantation (KTx) cases from donation after circulatory death (DCD) with terminal creatinine (t-Cr) concentrations higher than 10.0 mg/dL and/or oliguria for more than 5 days (AKI network criteria: stage III). Although all patients showed delayed graft function, no cases of primary nonfunction (PNF) were found. Five patients maintained stable renal function for approximately 15.5, 10, 10, 5, and 0.5 years after KTx. Only 1 patient showed biopsy-proven acute rejection. Also, 2 patients developed graft failure: one attributable to chronic antibody mediated rejection at 11.3 years after KTx, and one attributable to recurrence of IgA nephropathy at 4.6 years after KTx. Kidneys with AKI stage III yielded great outcomes without the risk of primary nonfunction and rejection. Although the AKI kidneys were associated with delayed graft function, these results suggest that even the most severe kidneys with AKI stage III from DCD donors can be considered a valid alternative for recipients on a waiting list for KTx.
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Wada H, Dohi T, Miyauchi K, Shitara J, Endo H, Doi S, Konishi H, Naito R, Tsuboi S, Ogita M, Kasai T, Hassan A, Okazaki S, Isoda K, Suwa S, Daida H. Long-term clinical impact of serum albumin in coronary artery disease patients with preserved renal function. Nutr Metab Cardiovasc Dis 2018; 28:285-290. [PMID: 29289574 DOI: 10.1016/j.numecd.2017.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Low serum albumin level is reportedly associated with worse clinical outcomes in patients with chronic kidney disease (CKD). However, associations between decreased serum albumin level and outcomes in non-CKD patients with coronary artery disease (CAD) remain unclear. Therefore, we aimed to evaluate the prognostic value of serum albumin concentrations in stable CAD patients with preserved renal function. METHODS AND RESULTS We studied 1316 patients with CAD and preserved renal function (estimated glomerular filtration rate ≥60 mL/min/1.73 m2) who underwent their first PCI between 2000 and 2011 and had data available for pre-procedural serum albumin. Patients were assigned to quartiles based on pre-procedural albumin concentrations. The incidence of major adverse cardiac events (MACE), including all-cause death and non-fatal myocardial infarction, was evaluated. Mean albumin concentration was 4.1 ± 0.4 g/dL. During the median follow-up of 7.5 years, 181 events occurred (13.8%). Kaplan-Meier curves revealed that patients with decreased serum albumin concentrations showed a higher event rate for MACE (log-rank, p < 0.0001). Using the highest tertiles (>4.3 g/dL) as reference, adjusted hazard ratios were 1.97 (95% CI, 1.12-3.55), 1.77 (95% CI, 0.99-3.25), and 1.19 (95% CI, 0.68-2.15) for serum albumin concentrations of <3.9, 3.9-4.0, and 4.1-4.3 g/dL, respectively. Decreased serum albumin concentration was associated with MACE even after adjusting for other independent variables (HR, 2.21 per 1-g/dL decrease; 95% CI, 1.37-3.56, p = 0.001). CONCLUSION Decreased serum albumin concentration independently predicted worse long-term prognosis in non-CKD patients after PCI. Pre-procedural serum albumin concentration could offer a useful predictor for patients with CAD and preserved renal function.
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Affiliation(s)
- H Wada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - T Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - K Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - J Shitara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - H Endo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - S Doi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - H Konishi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - R Naito
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - S Tsuboi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - M Ogita
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - T Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - A Hassan
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Cardiology, Suez Canal University, Ismailia, Egypt
| | - S Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - K Isoda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - S Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - H Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Bufarah MNB, Costa NA, Losilla MPRP, Reis NSC, Silva MZC, Balbi AL, Ponce D. Low caloric and protein intake is associated with mortality in patients with acute kidney injury. Clin Nutr ESPEN 2018; 24:66-70. [PMID: 29576366 DOI: 10.1016/j.clnesp.2018.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/17/2017] [Accepted: 01/19/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Acute renal injury (AKI) interferes greatly with nutritional status, affecting the metabolism of all macronutrients and increased mortality rates in hospitalized patients. Our objective was to evaluate the association of nutritional parameters (albumin, cholesterol, caloric and protein intake and nitrogen balance (NB)) with mortality in patients with AKI. METHODS This is a prospective observational study that evaluated 595 consecutive patients over the age of 18 years with AKI, requiring enteral or parenteral feeding. At the time of the patient's enrollment, demographic and laboratorial data, caloric and protein supply and NB were recorded on the first day of referral to the nephrologist. All patients were followed throughout the hospital stay and mortality rate was also recorded. RESULTS The medium age of patients with AKI was 64 (54-75) years, 64.5% male, 62% admitted to intensive care unit (ICU), 52% on dialysis and the majority (48%) were at stage 3 by AKIN. Length of stay and hospital mortality were 18 (10-31) days and 46%, respectively. Superior age, AKI severity, lower body weight and body mass index (BMI), higher need for dialysis, ICU admission and shorter hospital stay were associated with higher mortality. At logistic regression, caloric (OR: 0.946; CI:95%: 0.901-0.994; p:0.029) and protein intake (OR: 0.947; CI:95%: 0.988-0.992; p = 0.028) and serum albumin (OR: 0.545; CI:95%: 0.401-0741; p < 0.001) were associated with hospital mortality. Cholesterol (OR: 0.995; CI:95%: 0.991-1.000; p = 0.052) was not associated with increased mortality in the adjusted analysis. Analysis of the receiver operating characteristic (ROC) curve showed that calorie intake < 12 kcal/kg (AUC: 0.745; CI:95%: 0.684-0.765; p < 0.001) and protein intake < 0.5 g/kg (AUC: 0.726; CI:95%: 0.686-0.767; p < 0.001) were predictors of hospital mortality, as well as a negative NB < -6.47 g N/day (AUC: 0.745; CI:95%: 0.704-0.786; p < 0.001). CONCLUSIONS In conclusion, low caloric and protein intake, negative NB and low albumin value are conditions associated with higher hospital mortality in patients with AKI.
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Affiliation(s)
- M N B Bufarah
- Department of Internal Medicine, Botucatu Medical School, UNESP -São Paulo State University, Botucatu, Brazil.
| | - N A Costa
- Department of Internal Medicine, Botucatu Medical School, UNESP -São Paulo State University, Botucatu, Brazil.
| | | | - N S C Reis
- Department of Internal Medicine, Botucatu Medical School, UNESP -São Paulo State University, Botucatu, Brazil.
| | - M Z C Silva
- Department of Internal Medicine, Botucatu Medical School, UNESP -São Paulo State University, Botucatu, Brazil.
| | - A L Balbi
- Department of Internal Medicine, Botucatu Medical School, UNESP -São Paulo State University, Botucatu, Brazil.
| | - D Ponce
- Department of Internal Medicine, Botucatu Medical School, UNESP -São Paulo State University, Botucatu, Brazil.
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HYPOALBUMINEMIA AS A MARKER OF ADVERSE OUTCOME IN CHILDREN ADMITTED TO PEDIATRIC INTENSIVE CARE UNIT. ACTA ACUST UNITED AC 2018. [DOI: 10.32677/ijch.2018.v05.i01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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