Soluble FcγRIA expressed on monocytes (sCD64): A new serum biomarker of acute kidney injury in patients with suspected infection at emergency department admission

Abstract Background and Aims Acute kidney injury (AKI) is a major health problem associated with considerable mortality and morbidity. The epidemiology of AKI in hospitalized and critically ill patients at the Intensive Care Unit with severe infection and sepsis has been well described, however data on mortality and clinical outcomes of AKI at the emergency department in patients with suspected infection are scarce. In this study, we investigated the incidence, mortality and renal outcomes after AKI up to one year after initial AKI-episode patients with suspected infection at the emergency department. Method We used data from the SPACE-cohort (SePsis in the ACutely ill patients in the Emergency department), which consisted of all consecutive patients that presented to the emergency department of the internal medicine with suspected infection in the period between 2016 and 2018 at the University Medical Center Utrecht. Clinical and laboratory data were prospectively collected of all patients. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Outcomes were 1-year all-cause mortality and renal function. Hazards ratios were assessed using Cox regression to investigate the association between AKI, 1-year mortality and renal function decline after AKI. HRs were adjusted for potential confounders including age, gender, Charlson Comorbidity Index, immune status, smoking status, medication use (diuretics, proton-pump inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs) and angiotensin converting enzyme inhibitors (ACEi)), disease severity, diagnosis in the emergency department. Decline of renal function after AKI episode at emergency department visit was defined as Serum Creatinine (SCr) level ≥30% above baseline. Survival in patients with and without AKI was assessed using Kaplan-Meier analyses. Results Of the 3105 patients in the SPACE-cohort with suspected infection, we included 1716, who fulfilled the inclusion criteria and had a baseline SCr measurement. Patients without SCr at baseline (401 patients), at emergence department visit (113 patients), during follow-up (33 patients), on renal replacement therapy (66 patients) or had a repeated emergency department visit (776 patients) were excluded. Of the 1716 patients presenting with suspected infection patients (median age 62y, 52.9% male), 185 patients (10.8%) had an AKI episode. Mortality was 23.8% for the AKI group and 20.4% for the non-AKI group. The adjusted HR for all-cause mortality at 1-year after presentation at the emergency department in AKI patients was 2.1 (95% CI 1.5 – 3.1). Moreover, the cumulative incidence of renal function decline was 69.8% for patients with AKI and 39.3% for patients without AKI. Patients with an episode of AKI had higher risks of developing renal function decline (adjusted HR 3.3, 95% CI 2.4-4.5) at one year after initial AKI-episode at the emergency department. Conclusion Acute kidney injury is common in patients with suspected infection in the emergency department and is significantly associated with mortality and renal function decline one year after AKI.

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The incidence, mortality and renal outcomes of acute kidney injury in patients with suspected infection at the emergency department

PLoS ONE ◽

10.1371/journal.pone.0260942 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260942

Author(s):

Meriem Khairoun ◽

Jan Willem Uffen ◽

Gurbey Ocak ◽

Romy Koopsen ◽

Saskia Haitjema ◽

...

Keyword(s):

Emergency Department ◽

Acute Kidney Injury ◽

Renal Function ◽

Cox Regression ◽

Kidney Injury ◽

Major Health Problem ◽

Renal Function Decline ◽

Suspected Infection ◽

Renal Outcomes ◽

One Year

Background Acute kidney injury (AKI) is a major health problem associated with considerable mortality and morbidity. Studies on clinical outcomes and mortality of AKI in the emergency department are scarce. The aim of this study is to assess incidence, mortality and renal outcomes after AKI in patients with suspected infection at the emergency department. Methods We used data from the SPACE-cohort (SePsis in the ACutely ill patients in the Emergency department), which included consecutive patients that presented to the emergency department of the internal medicine with suspected infection. Hazard ratios (HR) were assessed using Cox regression to investigate the association between AKI, 30-days mortality and renal function decline up to 1 year after AKI. Survival in patients with and without AKI was assessed using Kaplan-Meier analyses. Results Of the 3105 patients in the SPACE-cohort, we included 1716 patients who fulfilled the inclusion criteria. Of these patients, 10.8% had an AKI episode. Mortality was 12.4% for the AKI group and 4.2% for the non-AKI patients. The adjusted HR for all-cause mortality at 30-days in AKI patients was 2.8 (95% CI 1.7–4.8). Moreover, the cumulative incidence of renal function decline was 69.8% for AKI patients and 39.3% for non-AKI patients. Patients with an episode of AKI had higher risk of developing renal function decline (adjusted HR 3.3, 95% CI 2.4–4.5) at one year after initial AKI-episode at the emergency department. Conclusion Acute kidney injury is common in patients with suspected infection in the emergency department and is significantly associated with 30-days mortality and renal function decline one year after AKI.

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Faculty Opinions recommendation of Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1116099.573927 ◽

2008 ◽

Author(s):

Ravindra Mehta

Keyword(s):

Emergency Department ◽

Acute Kidney Injury ◽

Sensitivity And Specificity ◽

Kidney Injury ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

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113 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Elderly Hip Fracture Patients

Age and Ageing ◽

10.1093/ageing/afab030.74 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

C McCann ◽

A Hall ◽

J Min Leow ◽

A Harris ◽

N Hafiz ◽

...

Keyword(s):

Emergency Department ◽

Acute Kidney Injury ◽

Hip Fracture ◽

Length Of Stay ◽

Kidney Injury ◽

Ward Round ◽

Fluid Administration ◽

Ward Staff ◽

Intravenous Fluid Therapy ◽

Significant Difference

Abstract Background Acute kidney injury (AKI) in hip fracture patients is associated with morbidity, mortality, and increased length of stay. To avoid this our unit policy recommends maintenance crystalloid IV fluids of >62.5 mL/Hr for hip fracture patients. However, audits have shown that many patients still receive inadequate IV fluids. Methods Three prospective audits, each including 100 consecutive acute hip fracture patients aged >55, were completed with interventional measures employed between each cycle. Data collection points included details of IV fluid administration and pre/post-operative presence of AKI. Interventions between cycles included a revised checklist for admissions with a structured ward round tool for post-take ward round and various educational measures for Emergency Department, nursing and admitting team staff with dissemination of infographic posters, respectively. Results Cycle 1: 64/100 (64%) patients received adequate fluids. No significant difference in developing AKI post operatively was seen in patients given adequate fluids (2/64, 3.1%) compared to inadequate fluids (4/36, 11.1%; p = 0.107). More patients with pre-operative AKI demonstrated resolution of AKI with appropriate fluid prescription (5/6, 83.3%, vs 0/4, 0%, p < 0.05) Cycle 2: Fewer patients were prescribed adequate fluids (54/100, 54%). There was no significant difference in terms of developing AKI post operatively between patients with adequate fluids (4/54, 7.4%) or inadequate fluids (2/46, 4.3%; p = 0.52). Resolution of pre-operative AKI was similar in patients with adequate or inadequate fluid administration (4/6, 67% vs 2/2, 100%). Cycle 3: More patients received adequate fluids (79/100, 79%, p < 0.05). Patients prescribed adequate fluids were less likely to develop post-operative AKI than those receiving inadequate fluids (2/79, 2.5% vs 3/21, 14.3%; p < 0.05). Discussion This audit demonstrates the importance of administering appropriate IV fluid in hip fracture patients to avoid AKI. Improving coordination with Emergency Department and ward nursing/medical ward staff was a critical step in improving our unit’s adherence to policy.

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FP285LEUCINE RICH α-2 GLYCOPROTEIN IS A NOVEL URINALY AND SERUM BIOMARKER FOR ACUTE KIDNEY INJURY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz106.fp285 ◽

2019 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Yoshio Terada ◽

Nishikawa Hirofumi ◽

Matsumoto Tatsuki ◽

Shimamura Yoshiko ◽

Taniguchi Yoshinori ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Serum Biomarker

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Risk of acute kidney injury after contrast-enhanced computed tomography in emergency department

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920913397 ◽

2020 ◽

pp. 102490792091339

Author(s):

Seda Dağar ◽

Emine Emektar ◽

Hüseyin Uzunosmanoğlu ◽

Şeref Kerem Çorbacıoğlu ◽

Özge Öztekin ◽

...

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Acute Kidney Injury ◽

Intensive Care ◽

Contrast Media ◽

Kidney Injury ◽

Intravenous Contrast ◽

Contrast Enhanced ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

Background: Despite its risks associated with renal injury, intravenous contrast media increases diagnostic efficacy and hence the chance of early diagnosis and treatment, which leaves clinicians in a dilemma regarding its use in emergency settings. Objective: The aim of this study was to determine the risk and predictors of contrast-induced acute kidney injury following intravenous contrast media administration for computed tomography in the emergency department. Methods: All patients aged 18 years and older who had a basal creatinine measurement within the last 8 h before contrast-enhanced computed tomography and a second creatinine measurement within 48–72 h after computed tomography scan between 1 January 2015 and 31 December 2017 were included in the study. Characteristics of patients with and without contrast-induced acute kidney injury development were compared. Multivariate regression analysis was used to assess the predictors for contrast-induced acute kidney injury. Results: A total of 631 patients were included in the final statistical analysis. After contrast media administration, contrast-induced acute kidney injury developed in 4.9% ( n = 31) of the patients. When the characteristics of patients are compared according to the development of contrast-induced acute kidney injury, significant differences were detected for age, initial creatinine, initial estimated glomerular filtration rate, and all acute illness severity indicators (hypotension, anemia, hypoalbuminemia, and need for intensive care unit admission). A multivariate logistic regression analysis was performed. The need for intensive care unit admission (odds ratio: 6.413 (95% confidence interval: 1.709–24.074)) and hypotension (odds ratio: 5.575 (95% confidence interval: 1.624–19.133)) were the main factors for contrast-induced acute kidney injury development. Conclusion: Our study results revealed that hypotension, need for intensive care, and advanced age were associated with acute kidney injury in patients receiving contrast media. Therefore, we believe that to perform contrast-enhanced computed tomography in emergency department should not be decided only by checking for renal function tests and that these predictors should be taken into consideration.

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Risk factors, mortality and acute kidney injury outcomes in cirrhotic patients in the emergency department

BMC Nephrology ◽

10.1186/s12882-018-1061-8 ◽

2018 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Paulo Ricardo Gessolo Lins ◽

Wallace Stwart Carvalho Padilha ◽

Carolina Frade Magalhaes Giradin Pimentel ◽

Marcelo Costa Batista ◽

Aécio Flávio Teixeira de Gois

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Cirrhotic Patients ◽

Injury Outcomes

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Urinary Nitrate Might Be an Early Biomarker for Pediatric Acute Kidney Injury in the Emergency Department

Pediatric Research ◽

10.1203/pdr.0b013e31822188b4 ◽

2011 ◽

Vol 70 (2) ◽

pp. 203-207 ◽

Cited By ~ 14

Author(s):

Asad I Mian ◽

Yue Du ◽

Harsha K Garg ◽

A Chantal Caviness ◽

Stuart L Goldstein ◽

...

Keyword(s):

Emergency Department ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Pediatric Acute Kidney Injury ◽

Early Biomarker

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Cochrane meta-analysis: teicoplanin versus vancomycin for proven or suspected infection

Einstein (São Paulo) ◽

10.1590/s1679-45082011ao2020 ◽

2011 ◽

Vol 9 (3) ◽

pp. 265-282 ◽

Cited By ~ 2

Author(s):

Diogo Diniz Gomes Bugano ◽

Alexandre Biasi Cavalcanti ◽

Anderson Roman Goncalves ◽

Claudia Salvini de Almeida ◽

Eliézer Silva

Keyword(s):

Acute Kidney Injury ◽

Adverse Events ◽

Data Extraction ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Kidney Injury ◽

Serum Levels ◽

Suspected Infection ◽

Red Man Syndrome

ABSTRACT Objective: To compare efficacy and safety of vancomycin versus teicoplanin in patients with proven or suspected infection. Methods: Data Sources: Cochrane Renal Group's Specialized Register, CENTRAL, MEDLINE, EMBASE, nephrology textbooks and review articles. Inclusion criteria: Randomized controlled trials in any language comparing teicoplanin to vancomycin for patients with proven or suspected infection. Data extraction: Two authors independently evaluated methodological quality and extracted data. Study investigators were contacted for unpublished information. A random effect model was used to estimate the pooled risk ratio (RR) with 95% confidence interval (CI). Results: A total of 24 studies (2,610 patients) were included. The drugs had similar rates of clinical cure (RR: 1.03; 95%CI: 0.98-1.08), microbiological cure (RR: 0.98; 95%CI: 0.93-1.03) and mortality (RR: 1.02; 95%CI: 0.79-1.30). Teicoplanin had lower rates of skin rash (RR: 0.57; 95%CI: 0.35-0.92), red man syndrome (RR: 0.21; 95%CI: 0.08-0.59) and total adverse events (RR: 0.73; 95%CI: 0.53-1.00). Teicoplanin reduced the risk of nephrotoxicity (RR: 0.66; 95%CI: 0.48-0.90). This effect was consistent for patients receiving aminoglycosides (RR: 0.51; 95%CI: 0.30-0.88) or having vancomycin doses corrected by serum levels (RR: 0.22; 95%CI: 0.10-0.52). There were no cases of acute kidney injury needing dialysis. Limitations: Studies lacked a standardized definition for nephrotoxicity. Conclusions: Teicoplanin and vancomycin are equally effective; however the incidence of nephrotoxicity and other adverse events was lower with teicoplanin. It may be reasonable to consider teicoplanin for patients at higher risk for acute kidney injury.

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