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Yu G, Cheng K, Liu Q, Wu W, Hong H, Lin X. Clinical outcomes of severe sepsis and septic shock patients with left ventricular dysfunction undergoing continuous renal replacement therapy. Sci Rep 2022; 12:9360. [PMID: 35672436 PMCID: PMC9174253 DOI: 10.1038/s41598-022-13243-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022] Open
Abstract
Baseline left ventricular (LV) dysfunction is associated with subsequent risks of acute kidney injury (AKI) and mortality in patients with sepsis. This study investigated the therapeutic effects of continuous renal replacement therapy (CRRT) in hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction. In this multicenter retrospective study, severe sepsis and septic shock patients with LV dysfunction were classified into one of two groups according to the timing of CRRT: the early group (before AKI was detected) or the control group (patients with AKI). Patients from the control group received an accelerated strategy or a standard strategy of CRRT. The primary outcome was all-cause intensive care unit (ICU) mortality. Patients were weighted by stabilized inverse probability of treatment weights (sIPTW) to overcome differences in baseline characteristics. After sIPTW analysis, the ICU mortality was significantly lower in the early group than the control group (27.7% vs. 63.5%, p < 0.001). Weighted multivariable analysis showed that early CRRT initiation was a protective factor for the risk of ICU mortality (OR 0.149; 95% CI 0.051–0.434; p < 0.001). The ICU mortality was not different between the accelerated- and standard-strategy group (52.5% vs. 52.9%, p = 0.970). Early CRRT in the absence of AKI is suggested for hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction since it benefits survival outcomes.
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Affiliation(s)
- Guangwei Yu
- Department of Emergency, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.,Fujian Key Laboratory of Vascular Aging, Fujian Medical University, 29 Xinquan Rd., Fuzhou, 350001, Fujian, China
| | - Kun Cheng
- Department of Intensive Care Unit, Fujian Provincial Hospital, Fuzhou, Fujian, China.,Fujian Critical Care Medicine Center, Fuzhou, Fujian, China.,Fujian Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Qing Liu
- Department of Emergency, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Wenwei Wu
- Department of Emergency, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Huashan Hong
- Department of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, Fujian, China. .,Fujian Key Laboratory of Vascular Aging, Fujian Medical University, 29 Xinquan Rd., Fuzhou, 350001, Fujian, China.
| | - Xiaohong Lin
- Department of Emergency, Fujian Medical University Union Hospital, Fuzhou, Fujian, China. .,Fujian Key Laboratory of Vascular Aging, Fujian Medical University, 29 Xinquan Rd., Fuzhou, 350001, Fujian, China.
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La disfunción diastólica es un predictor independiente de eventos cardiovasculares tras un fracaso renal agudo. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Ozrazgat-Baslanti T, Loftus TJ, Ren Y, Ruppert MM, Bihorac A. Advances in artificial intelligence and deep learning systems in ICU-related acute kidney injury. Curr Opin Crit Care 2021; 27:560-572. [PMID: 34757993 PMCID: PMC8783984 DOI: 10.1097/mcc.0000000000000887] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) affects nearly 60% of all patients admitted to ICUs. Large volumes of clinical, monitoring and laboratory data produced in ICUs allow the application of artificial intelligence analytics. The purpose of this article is to assimilate and critically evaluate recently published literature regarding artificial intelligence applications for predicting, diagnosing and subphenotyping AKI among critically ill patients. RECENT FINDINGS Among recent studies regarding artificial intelligence implementations for predicting, diagnosing and subphenotyping AKI among critically ill patients, there are many promising models, but few had external validation, clinical interpretability and high predictive performance. Deep learning techniques leveraging multimodal clinical data show great potential to provide continuous, accurate, early predictions of AKI risk, which could be implemented clinically to optimize preventive and early therapeutic management strategies. SUMMARY Use of consensus criteria, standard definitions and common data models could facilitate access to machine learning-ready data sets for external validation. The lack of interpretability, explainability, fairness and transparency of artificial intelligence models hinder their entrustment and clinical implementation; compliance with standardized reporting guidelines can mitigate these challenges.
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Affiliation(s)
- Tezcan Ozrazgat-Baslanti
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, USA
| | - Tyler J. Loftus
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, USA
| | - Yuanfang Ren
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, USA
| | - Matthew M. Ruppert
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, USA
| | - Azra Bihorac
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, USA
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