Renal dysfunction and fluid and electrolyte disturbances

Estimates of 30-day postoperative pulmonary complications after gastrointestinal endoscopic procedures: A retrospective cohort analysis of a health system population

The incidence of 30-day postoperative pulmonary complications (PPC) of gastrointestinal endoscopic procedures (GIEP) are not well characterized in the literature. The primary aim of this study was to identify the incidence of 30-day PPC after GIEP within a large healthcare system. We conducted a retrospective cohort study of 5377 patients presenting for GIEP between January 2013 and January 2022. Our primary outcome was the Agency for Healthcare Research and Quality PPC composite (AHRQ-PPC). Secondary outcomes were sub-composites derived from the AHRQ-PPC; including pneumonia (AHRQ-PNA), respiratory failure (AHRQ-RF), aspiration pneumonia/ pneumonitis (AHRQ-ASP) and pulmonary emboli (AHRQ-PE). We performed propensity score matching (PSM) followed by multivariable logistic regression to analyze primary and secondary outcomes. Inpatients had higher 30-day AHRQ-PPC (6.0 vs. 1.2%, p<0.001), as well as sub-composite AHRQ-PNA (3.2 vs. 0.7%, p<0.001), AHRQ-RF (2.4 vs. 0.5%, p<0.001), and AHRQ-ASP (1.9 vs. 0.4%, p<0.001). After PSM adjustment, pre-procedural comorbidities of electrolyte disorder [57.9 vs. 31.1%, ORadj: 2.26, 95%CI (1.48, 3.45), p<0.001], alcohol abuse disorder [16.7 vs. 6.8%, ORadj: 2.66 95%CI (1.29, 5.49), p = 0.01], congestive heart failure (CHF) [22.3 vs. 8.7%, ORadj: 2.2 95%CI (1.17, 4.15), p = 0.02] and pulmonary circulatory disorders [21 vs. 16.9%, ORadj: 2.95, 95%CI (1.36, 6.39), p = 0.01] were associated with 30-day AHRQ-PPC. After covariate adjustment, AHRQ-PPC was associated with upper endoscopy more than lower endoscopy [5.9 vs. 1.0%, ORadj: 3.76, 95%CI (1.85, 7.66), p<0.001]. When compared to gastroenterologist-guided conscious sedation, anesthesia care team presence was protective against AHRQ-PPC [3.7 vs. 8.4%, ORadj: 0.032, 95%CI (0.01, 0.22), p<0.001] and AHRQ-ASP [1.0 vs. 3.37%, ORadj: 0.002, 95%CI (0.00, 0.55), p<0.001]. In conclusion, we report estimates of 30-day PPC after GIEP across inpatient and outpatient settings. Upper endoscopic procedures confer a higher risk, while the presence of an anesthesia care team may be protective against 30-day PPC.

A prediction model for 30-day mortality of sepsis patients based on intravenous fluids and electrolytes

To establish a prediction model for the 30-day mortality in sepsis patients. The data of 1185 sepsis patients were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) and all participants were randomly divided into the training set (n = 829) and the testing set (n = 356). The model was established in the training set and verified in the testing set. After standardization of the data, age, gender, input, output, and variables with statistical difference between the survival group and the death group in the training set were involved in the extreme gradient boosting (XGBoost) model. Subgroup analysis was performed concerning age and gender in the testing set. In the XGBoost model with variables related to intravenous (IV) fluid management and electrolytes for the 30-day mortality of sepsis patients, the area under the curve (AUC) was 0.868 (95% confidence interval [CI]: 0.867-0.869) in the training set and 0.781 (95% CI: 0.779-0.782) in the testing set. The sensitivity was 0.815 (95% CI: 0.774-0.857) in the training set and 0.755 (95% CI: 0.686-0.825) in the testing set. The specificity was 0.761 (95% CI: 0.723-0.798) in the training set, and 0.737 (95% CI: 0.677-0.797) in the testing set. In the XGBoost forest model without variables related to IV fluid management and electrolytes for the 30-day mortality of sepsis patients, in the training set, the AUC was 0.830 (95% CI: 0.829-0.831), the sensitivity was 0.717 (95% CI: 0.669-0.765), the specificity was 0.797 (95% CI: 0.762-0.833), and the accuracy was 0.765 (95% CI: 0.736-0.794). In the testing set, the AUC was 0.751 (95% CI: 0.750-0.753), the sensitivity was 0.612 (95% CI: 0.533-0.691), the specificity was 0.756 (95% CI: 0.698-0.814), and the accuracy was 0.697(95% CI: 0.649-0.744). The prediction model including variables associated with IV fluids and electrolytes had good predictive value for the 30-day mortality of sepsis patients.

Fluid and Electrolyte Disturbances in COVID-19 and Their Complications

The novel coronavirus disease 2019 (COVID-19) is the cause of an acute respiratory illness which has spread around the world. The virus infects the host by binding to the angiotensin-converting enzyme 2 (ACE2) receptors. Due to the presence of ACE2 receptors in the kidneys and gastrointestinal (GI) tract, kidneys and GI tract damage arising from the virus can be seen in patients and can cause acute conditions such as acute kidney injury (AKI) and digestive problems for the patient. One of the complications of kidneys and GI involvement in COVID-19 is fluid and electrolyte disturbances. The most common ones of these disorders are hyponatremia, hypernatremia, hypokalemia, hypocalcemia, hypochloremia, hypervolemia, and hypovolemia, which if left untreated, cause many problems for patients and even increase mortality. Fluid and electrolyte disturbances are more common in hospitalized and intensive care patients. Children are also at greater risk for fluid and electrolyte disturbances complications. Therefore, clinicians should pay special attention to the fluid and electrolyte status of patients. Changes in fluid and electrolyte levels can be a good indicator of disease progression.

Renal effects of general anesthesia from old to recent studies

Various types of anesthesia are being utilized to maintain physiologically secured surgical conditions. Nearly all categories of general anesthesia are characterized by various perioperative and postoperative complications. These shortcomings are important aspects that need to be considered by the anesthesiologist and surgeon before administration of these compounds. The renal effects of anesthesia play an important role in understanding possible systemic changes due to the fact that the kidney has a direct or indirect impact on nearly all the systems of the body. Various studies have been conducted to find out changes in renal parameters and its systemic effects upon administration of the anesthesia and its postoperative repercussions. Besides that, the impaired renal function might have an impact on the excretion of anesthetic metabolites, which can lead to long-term dysfunction. Patients with a previous history of disease ought to be brought under consideration because these chemicals can ameliorate pre-existent symptoms. This review is intended to discuss the early and latest studies based on the effects of general anesthesia on the renal system.