Vancomycin with concomitant piperacillin/tazobactam vs. cefepime or meropenem associated acute kidney injury in the critically ill: A multicenter propensity score-matched study

2022 ◽  
Vol 67 ◽  
pp. 134-140
Author(s):  
Mitchell S. Buckley ◽  
Ivan A. Komerdelj ◽  
Paul A. D'Alessio ◽  
Pooja Rangan ◽  
Sumit K. Agarwal ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Propensity Score ◽  
Critically Ill ◽  
Kidney Injury ◽  
Matched Study

Incidence Evaluation of Acute Kidney Injury and Pharmacoeconomic Analysis Among Critically Ill Patients With Use of Antipseudomonal β-Lactams and Vancomycin

2021 ◽  
Author(s):  
Yalin Dong ◽  
Ying Zhang ◽  
Yan Wang ◽  
Jiangping Lian ◽  
Ruixia Yang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Treatment Cost ◽  
Independent Predictor ◽  
Pharmacoeconomic Analysis ◽  
Kidney Injury ◽  
Decision Analytic Model ◽  
Combination Therapies ◽  
Matched Study

Abstract Background: Whether vancomycin (VAN) plus piperacillin-tazobactam (PTZ) could increase the risk of acute kidney injury (AKI) is still controversial in critically ill patients. The purpose of this study was to compare the risk of developing AKI and risk of developing AKI and treatment cost among this population receiving VAN/PTZ to a matched group receiving VAN/other antipseudomonal β-lactams. Methods: This multicenter, retrospective, matched study included 700 critically ill patients who received ≥48 hours of VAN/PTZ or VAN/other antipseudomonal β-lactams. The risk of developing AKI was compared between these two combination therapies using propensity-adjusted analysis. Furthermore, a pharmacoeconomic decision-analytic model was performed.Results: According to three AKI-defined criteria, VAN/PTZ was associated with significantly higher incidence of than VAN/other antipseudomonal β-lactams (all P < 0.001). In multivariate analysis, regardless of any VAN/other antipseudomonal β-lactams, VAN/PTZ was an independent predictor for stage 2 or 3 AKI. In the empiric treatment, the incremental cost-effectiveness ratios per additional nephrotoxic episode of 1147.35$, 1845.11$, and 3989.95$ were found for VAN/PTZ relative to, vancomycin plus imipenem-cilastatin, vancomycin plus meropenem, and vancomycin plus cefoperazone-sulbactam, respectively. Conclusion: In critically ill patients, VAN/PTZ was associated with both higher AKI risk and treatment cost when considering AKI occurence compared to VAN/other antipseudomonal β-lactams.Trial registration: retrospectively registered, ClinicalTrials.gov number: NCT03776409.

scholarly journals SO040A SIMPLE CARE BUNDLE FOR USE IN ACUTE KIDNEY INJURY - A PROPENSITY SCORE MATCHED STUDY

2016 ◽  
Vol 31 (suppl_1) ◽  
pp. i18-i18
Author(s):  
Nitin Kolhe ◽  
Timothy Reilly ◽  
Janson C. H. Leung ◽  
Kirtsy Swinscoe ◽  
Richard J. Fluck ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Propensity Score ◽  
Kidney Injury ◽  
Care Bundle ◽  
Matched Study

Association between Obstructive Sleep Apnea and Acute Kidney Injury in Critically Ill Patients: A Propensity-Matched Study

Nephron ◽  
2016 ◽  
Vol 135 (2) ◽  
pp. 137-146 ◽  
Author(s):  
Lin Dou ◽  
Haitao Lan ◽  
Daniel J. Reynolds ◽  
Tina M. Gunderson ◽  
Rahul Kashyap ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Obstructive Sleep ◽  
Matched Study

MO837IMPACT OF DOWNTIME ON CLINICAL OUTCOMES IN CRITICALLY ILL PATIENTS WITH ACUTE KIDNEY INJURY RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY: A RETROSPECTIVE STUDY USING PROPENSITY SCORE-MATCHED ANALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Jungho Shin ◽  
Hyun Chul Song ◽  
Jin Ho Hwang ◽  
Su Hyun Kim
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Propensity Score ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Quality Indicator ◽  
Kidney Injury

Abstract Background and Aims Continuous renal replacement therapy (CRRT) is essential in treating critically ill patients with acute kidney injury, and circuit downtime is considered a quality indicator. However, it remains uncertain whether CRRT downtime affects outcomes such as mortality and renal recovery. This study investigated the impact of downtime on various clinical outcomes in critically ill patients undergoing CRRT. Method A total of 216 patients who underwent CRRT were retrospectively recruited. Downtime was calculated over 4 days from CRRT initiation, and patients were classified as downtime &lt;20% or ≥20% of potential operative time. Patients with ≥20% downtime were matched to those with &lt;20% downtime using 1:2 propensity score matching, adjusting for age, sex, comorbidity index, and severity score. Results There were 88 patients with &lt;20% downtime and 44 patients with ≥20% downtime. The cumulative volume and median flow rate of effluent in patients with ≥20% downtime were lower than those in patients with &lt;20% downtime (P&lt;0.001 and 0.062, respectively). Daily fluid balance differed on days 2 and 3 (P=0.046 and 0.031, respectively), and the difference in levels of urea and creatinine widened over time (P=0.004 and &lt;0.001, day 4). The levels of total carbon dioxide were lower in those with ≥20% downtime (P=0.038 and 0.020 at days 2 and 3). Based on our results, ≥20% downtime was not associated with increased 28-day mortality (P=0.944). On the other hand, a subgroup analysis showed the interaction between downtime and daily fluid balance on mortality (P=0.004). In this study, downtime was not related to renal recovery. Conclusion Increased downtime could impair fluid and uremic control and acidosis management in patients undergoing CRRT. Moreover, the adverse effect of downtime on fluid control may increase mortality rate. Further studies are needed to verify the value of downtime as a quality indicator and its impact on outcomes in critically ill patients requiring CRRT.

scholarly journals Effects of Dexmedetomidine Administration on Outcomes in Critically Ill Patients with Acute Kidney Injury: A Propensity Score-Matching Analysis

2021 ◽  
Author(s):  
Aixiang Yang ◽  
Jing Yang ◽  
Biying Zhou ◽  
Jinxian Qian ◽  
Liyang Jiang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Information ◽  
Kidney Injury ◽  
Cox Proportional Hazards Model

Abstract Background Dexmedetomidine (DEX) had organ protection effects and could decrease mortality in animal models, but its association with mortality and length of stay (LOS) in ICU and hospital in critically ill patients was conflicting. Whether acute kidney injury (AKI) subgroup of critically ill patients could benefit from DEX was unknown. The present study aimed to evaluate the effects of DEX on clinical outcomes of critically ill patients with AKI. Methods Data were extracted from the Medical Information Mart for Intensive Care Ⅲ database (MIMIC Ⅲ). Propensity score matching (PSM) analysis (1:3), cox proportional hazards model, linear regression and logistic regression model were used to assess the effect of DEX on clinical outcomes. Results After PSM, 324 pairs of patients were matched between the patients with DEX administration and those without. DEX administration was associated with decreased in-hospital mortality [hazard ratio (HR) 0.287; 95% CI 0.151–0.542; P < 0.001] and 90-day mortality [HR 0.344; 95% CI 0.221–0.534; P < 0.001], and it was also associated with reduced length of stay (LOS) in ICU [4.54(3.13,7.72) versus 5.24(3.15,10.91), P < 0.001] and LOS in hospital [11.63(8.02,16.79) versus 12.09(7.83,20.44), P = 0.002]. Subgroup analysis showed the above associations existed only in mild and moderate AKI subgroups, but not in severe AKI subgroup. Nevertheless, DEX administration was not associated with the recovery of renal function [HR 1.199; 95% CI 0.851–1.688; P = 0.300]. Conclusions DEX administration improved outcomes in critically ill patients with mild and moderate AKI and could be a good choice of sedation.

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