scholarly journals LO05: In patients presenting to the ED with STEMI, is the provision of morphine associated with worse patient outcomes?

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S28-S29
Author(s):  
D. Barbic ◽  
F.X. Scheuermeyer ◽  
Q. Salehmohamed ◽  
B. Kim ◽  
S. Barbic ◽  
...  
Keyword(s):  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Binary Logistic Regression ◽  
Primary Objective ◽  
Charlson Score ◽  
Risk Of Death ◽  
Increased Risk ◽  
Primary Investigator ◽  
Comorbidity Scores ◽  
St Elevation

Introduction: ST-elevation myocardial infarction (STEMI) presenting to the ED is a significant health burden. The provision of IV morphine with doses titrated to provide comfort is recommended in the AHA STEMI Guidelines, yet there is limited evidence of safety in this setting. The primary objective of this study was to measure potential harm associated with the provision of IV morphine in STEMI patients presenting to the ED. Methods: This was a two centre retrospective chart review from an urban, inner city, academic ED with an annual census of 85,000 visits, and an affiliated community hospital with 35,000 annual visits. Consecutive patients from April 2009 to January 2015 presenting to the 2 EDs with a diagnosis of STEMI were identified in the ED database. Eight trained research assistants, blinded to the study hypothesis, used standardized data collection templates. The primary investigator double collected 20% of all data to ensure completeness and accuracy. Results: We included 311 patients with STEMI (124 received morphine [M]; 187 no morphine [nM]). The ages of the two groups were similar (mean 64 yrs [M] & 67 yrs [nM]; median 63 yrs [M] & 66 yrs [nM]; IQR 45-81 [M] and 45.5-86.5 [nM]); as were the proportion of female patients (21.0% [M] & 23.5% [nM]. The pre-STEMI Charlson comorbidity scores (mean 2.6), median time to first ECG (11 min [M] & 16 min [nM]), and mean time-to-needle for PCI (96.8 min [M] & 92.0 min [nM]) were similar between groups. The mean CCU length of stay (LOS) (9.3 days vs 6.3 days) and hospital LOS (7.4 days vs 4.6 days) were longer for patients receiving morphine than those not receiving morphine. Rates of congestive heart failure, acute kidney injury and cardiac arrest in hospital were unchanged between the groups. Unadjusted mortality was similar (10.5% [M] vs 13.3% [nM]) between groups. Binary logistic regression controlling for age, Charlson score, first and peak troponin values demonstrated an association between receiving morphine in the ED and an increased risk of death at 30 days (OR 8.1; 95% CI 7.1.-9.1). Conclusion: The provision of morphine to patients with STEMI in the ED may be associated with increased CCU and hospital LOS. When controlling for age, pre-STEMI Charlson score, first and peak troponin values, receiving morphine was associated with an increased risk of death at 30 days. Further research to elucidate this association is warranted.

scholarly journals Acute Kidney Injury in Patients With Acute Chemical Poisoning: the Experience of the Toxicological Center in Ryazan

2021 ◽  
Vol 9 (4) ◽  
pp. 639-645
Author(s):  
N. V. Shatrova ◽  
M. N. Rudakova ◽  
L. G. Zaytseva ◽  
Zh. A. Varenova
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Acute Poisoning ◽  
Annual Reports ◽  
Infusion Therapy ◽  
Chi Square ◽  
Exact Test ◽  
Risk Of Death ◽  
Increased Risk ◽  
Microsoft Office

Relevance. Acute kidney injury (AKI) is one of the leading causes of death worldwide. However, the epidemiology of AKI is not well understood. In Russia, toxic kidney damage plays a significant role in the nosological structure of AKI — 12.2%.Aim of study. To study the features of AKI in patients with acute chemical poisoning.Material and methods. We analyzed 26 case histories of patients with acute chemical poisoning with AKI (according to KDIGO). The comparison group included 25 patients with acute chemical poisoning without AKI. All patients were hospitalized in a toxicological center on the basis of the emergency department of the Ryazan Region State Budgetary Institution “City Clinical Emergency Hospital” (SBI RR “CCH EMC”) in 2016–2018. The analysis of the annual reports of the chief toxicologist of the Ministry of Health of the Ryazan Region for 2016–2018 was carried out. Data processing was performed using Microsoft Office Excel 2013 and on the website medstatistic.ru (Pearson’s chi-square test and Fisher’s exact test).Results. In most patients AKI developed during poisoning with cauterizing action substances - 38.4% (23% - vinegar essence, 15.4% - unidentified cauterizing action substance). The poisoning with alcohol substitutes (12%) took the 2nd place, with narcotic substances (8%) – the 3 rd place. Also, isolated cases of AKI (4% each) were reported in case of poisoning with pregabalin, tramadol, ketorol and ethanol. Poisoning with an unknown toxicant was noted in 29.6% of cases. Most patients (69.2%.) had stage 3 AKI. The second stage was registered in 7.7% of patients, the first — in 23.1%. Proteinuria was detected in all patients who underwent common urine test (CUT). Infusion therapy using crystalloids was performed in 100% of cases.Conclusion. Acute renal injury most often develops in acute poisoning with cauterizing poisons. The development of acute kidney injury in acute chemical poisoning leads to an increased risk of death. Acute kidney injury is the second most common immediate cause of death in acute chemical poisoning. Infusion therapy is an integral part of the management of toxicological patients with acute kidney injury.

507 Outcomes After the Administration of Hydroxocobalamin

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S90-S90
Author(s):  
Kaitlin A Pruskowski ◽  
Leopoldo C Cancio
Keyword(s):  
Hospital Mortality ◽  
Hospital Stay ◽  
Hospital Setting ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Lactate Clearance ◽  
Inhalation Injury ◽  
Icu Admission ◽  
Increased Risk ◽  
Lactate Levels

Abstract Introduction Hydroxocobalamin is administered to patients after injures sustained during structure fires or fires in enclosed spaces. It is unknown how the administration of hydroxocobalamin affects patient outcomes, however, there have been reports of increased risk of acute kidney injury (AKI). The purpose of this study was to determine the population in which hydroxocobalamin is administered and to assess outcomes in patients who receive this medication in the ICU setting. Methods This was a retrospective chart review that included all patients admitted to the burn ICU between July 2016 and April 2019. Patients were included if they received hydroxocobalamin after ICU admission. Patients who received hydroxocobalamin in the pre-ICU or pre-hospital setting were not included in this analysis. Data collected included demographic information, number of hydroxocobalamin doses administered, burn size (% TBSA), presence of inhalation injury (II), lactate levels during the first 72 hours of hospitalization, carboxyhemoglobin levels, need for continuous renal replacement therapy (CRRT), and in-hospital mortality. Results Thirty-five patients received hydroxocobalamin after ICU admission. Patients were, on average, 48 ± 19 years old with a 25.5 ± 24.8% TBSA burn. Twenty-nine patients (82.9%) who received hydroxocobalamin in the ICU were diagnosed with II via bronchoscopy. The median 24-hour fluid resuscitation requirement was 7.4 mL/kg/% TBSA (IQR 4.6, 12.7). Twenty-two patients (63%) who received hydroxocobalamin developed AKI during the first 72 hours of admission. Twenty-one patients (60%) required CRRT during their hospital stay; 42.8% of patients were started on CRRT during the resuscitation period. The mean admission lactate level was 4.4 ± 2.3 mmol/L. On average, lactate clearance occurred in 34.6 hours; 11 (31.4%) patients did not clear lactate within 72 hours. One patient had a carboxyhemoglobin level greater than 10% on admission. Ten (28.9%) patients died during their hospital stay. Conclusions Most patients who receive hydroxocobalamin after ICU admission developed AKI within the first 72 hours. Further studies on the relationship between the administration of hydroxocobalamin and the development of AKI and in-hospital mortality are warranted. Applicability of Research to Practice The use of hydroxocobalamin may carry an increased risk of AKI. Providers should be aware of this risk when prescribing this medication.

scholarly journals Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19

2020 ◽  
Vol 45 (6) ◽  
pp. 1018-1032
Author(s):  
Imran Chaudhri ◽  
Richard Moffitt ◽  
Erin Taub ◽  
Raji R. Annadi ◽  
Minh Hoai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Hospital Death ◽  
Study Cohort ◽  
Icu Admission ◽  
Risk Of Death ◽  
Increased Risk

<b><i>Introduction:</i></b> Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. <b><i>Methods:</i></b> This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, <i>t</i> test, χ<sup>2</sup> test, and Fisher’s exact test for bivariate analyses and logistic regression for multivariable analysis. <b><i>Results:</i></b> Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28–17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12–18.64), IMV (OR 8.79, 95% CI 2.08–37.00), and death (OR 18.03, 95% CI 2.84–114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19–114.4, <i>p</i> = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44–240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001–0.06). <b><i>Conclusion:</i></b> Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

Use of Pamidronate for Hypercalcemia of Malignancy in Renal Dysfunction

2019 ◽  
pp. 089719001988316 ◽  
Author(s):  
Sarah J. Norman ◽  
David J. Reeves ◽  
Lindsay M. Saum
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Chart Review ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Limited Impact ◽  
Hypercalcemia Of Malignancy ◽  
Baseline Renal Function ◽  
Community Teaching

Background: Few studies have been conducted investigating the use of bisphosphonates in hypercalcemia of malignancy (HCM) in the setting of renal dysfunction. Objective: The primary objective was to compare the incidence of acute kidney injury (AKI) within 7 days of receiving pamidronate for the treatment of HCM with pre-existing renal dysfunction versus normal renal function at the time of pamidronate administration. The secondary objectives explored the effects of pamidronate doses and infusion rates on the safety and efficacy in those with pre-existing renal dysfunction for the treatment of HCM. Methods: A retrospective chart review was conducted on patients who received pamidronate for the treatment of HCM at a community teaching hospital in Indianapolis, Indiana, from January 1, 2013, to May 31, 2017. Results: A total of 141 pamidronate administrations were included (116 patients had normal baseline renal function, and 25 patients had pre-existing renal dysfunction before pamidronate administration for the treatment of HCM). Two (8%) patients developed AKI in the pre-existing renal dysfunction group, compared with 4 (3.4%) patients in those without pre-existing renal dysfunction ( P = .288). For those with pre-existing renal dysfunction, the incidence of AKI did not differ based on the dosage of pamidronate given ( P = .762) or infusion rates ( P = .373). Conclusion: Pamidronate appears to have limited impact on renal function at doses up to 90 mg in the setting of pre-existing renal dysfunction for the treatment of HCM.

Clostridium Difficile-Associated Disease in Allogeneic Transplant Patients.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5095-5095
Author(s):  
Justin S. Sadhu ◽  
Erik R. Dubberke ◽  
Robert Gatti ◽  
Steven M. Devine ◽  
Victoria J. Fraser
Keyword(s):  
Clostridium Difficile ◽  
Retrospective Chart Review ◽  
Adverse Outcomes ◽  
Allogeneic Transplant ◽  
Risk Of Death ◽  
Transplant Patients ◽  
Increased Risk ◽  
One Year ◽  
Gastric Acid Suppression ◽  
Underlying Diseases

Abstract Allogeneic transplant (allo) patients (pts) are at high risk for Clostridium difficile-associated disease (CDAD), yet there are few studies evaluating CDAD in allo pts. We carried out a retrospective chart review of all allo pts who had CDAD on a transplant (tx) unit between 8/01 and 7/03. 37 pts were identified who had CDAD during tx hospitalization (hosp) or after tx during the study period. 17 (46%) were admitted for initial tx, 13 (35%) for infection, and 7 (19%) for other reasons. 15 (40%) had acute leukemia, 6 (16%) lymphoma, 4 (11%) myelodisplastic syndrome, and 12 (32%) other underlying diseases. On admission, 17 (46%) pts were in complete remission, 4 (11%) in partial remission, 7 (19%) in relapse, and 9 (24%) presented with refractory disease. 5 pts (14%) had CDAD before day 0 (median d-2, range d-9 to d-1) and 32 pts (86%) had CDAD after tx (median d+49, d0 to d+3185). In the 60 days prior to CDAD, pts had median 1 (0–4) prior hosp and 15 days (1–50) hospitalized; 36 pts (97%) received antibiotics, 35 (95%) immunosuppressants, 33 (89%) antimotility/narcotic agents, 31 (84%) gastric acid suppression, 23 (62%) chemo, and 14 (38%) TBI. Within 48 hours of CDAD, 31 (86%) pts had diarrhea, 12 (33%) fever, 10 (28%) abdominal tenderness, 7 (19%) abdominal distention, and 7 (19%) hypothermia. 22 pts (59%) had either moderate or severe CDAD. 25 (68%) pts were treated for their primary episode of CDAD with metronizadole (met), 2 (5%) with vancomycin (vanc), 8 (22%) with met and vanc, and 2 (5%) were not treated for CDAD. 32 (86%) pts responded to therapy (median 2 days, range 0–25 days). Of the 32 pts who had CDAD post allo, 3 (9%) had gut graft-versus-host disease (GVHD) before CDAD and 8/29 (28%) developed gut GVHD after CDAD. Those 8 pts developed CDAD median d+114 (range +1 to +278) and gut GVHD d+131 (+1 to +454), with gut GVHD coming median 11 days (0 to 176) after CDAD. 7 pts (19%) died before discharge. The median survival time for all pts was 79 days after CDAD and 205 days after tx. Of the 30 (81%) pts discharged alive, 10 (33%) had recurrent CDAD episodes (median 1, range 1–3). When compared to mild CDAD, patients with severe CDAD had an increased risk of death at one year after CDAD (OR 3.3; CI 1.4–7.6). CDAD in allo pts may be associated with an increased risk of gut GVHD, death, and other adverse outcomes.

Incidence and prediction of checkpoint inhibitor immune-related nephrotoxicity.

2020 ◽  
Vol 38 (5_suppl) ◽  
pp. 91-91
Author(s):  
Jonathan D Sorah ◽  
Tracy L. Rose ◽  
Roshni Radhakrishna ◽  
Vimal Derebail ◽  
Matthew I. Milowsky
Keyword(s):  
Autoimmune Disease ◽  
Adverse Events ◽  
Checkpoint Inhibitors ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Tumor Type ◽  
True Incidence ◽  
Platinum Based Chemotherapy ◽  
Increased Risk ◽  
Clinically Significant

91 Background: Immune checkpoint inhibitors (ICIs), through inhibition of self-tolerance, have the potential to cause immune-related adverse events that can affect any organ, including the kidneys. Our study aimed to better characterize the incidence of and predictive characteristics for immune-related nephrotoxicity. Methods: All patients at the University of North Carolina (UNC) who received ICIs between April 2014 and December 2018 for any malignancy were identified. Patients on dialysis or those who received concurrent platinum-based chemotherapy were excluded. Any patient who subsequently had a clinically significant acute kidney injury (AKI), defined as a doubling or more of baseline creatinine, was included for analysis. A retrospective chart review was performed to determine the cause of AKI. Any uncertain cases were reviewed by two nephrologists for expert consensus (R.R. and V.D.). Results: 1766 patients received an ICI during the study period. 123 (7%) patients had AKI within one year of the first ICI dose. 14 were due to immune-related nephrotoxicity (11% of patients with AKI and 0.8% of all ICI patients). Pre-existing autoimmune disease was more likely in patients with immune-related nephrotoxicity than in those with non-immune AKI (14% vs 3%, p = 0.04). Similarly, concurrent or prior other immune-related adverse events were more common in patients with immune-related AKI (57% vs 6%, p = 0.01). Patients with immune-related AKI were more likely to see a nephrologist (57% vs 23%, p = 0.007) and had a more profound increase in creatinine from baseline (median 2.6 vs 1.6, p = 0.02). Age, sex, urinalysis findings, and primary tumor type were not associated with increased risk. Conclusions: The true incidence of ICI related nephrotoxicity is difficult to ascertain due to the many confounders that contribute to AKI in this population. Severe immune-related nephrotoxicity is rare, but patients with preexisting autoimmune disease or history of immune-related adverse events are at increased risk.

scholarly journals Complications and risk factors regarding the outcomes of canine babesiosis in Central Europe – A retrospective analysis of 240 cases

2020 ◽  
Vol 68 (2) ◽  
pp. 160-168
Author(s):  
Anja Strobl ◽  
Frank Künzel ◽  
Alexander Tichy ◽  
Michael Leschnik
Keyword(s):  
Medical Records ◽  
Biochemical Analysis ◽  
Complete Blood Count ◽  
Renal Involvement ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Serum Biochemical ◽  
Severity Of The Disease

AbstractThe purpose of this study was to investigate retrospectively the prevalence of the complicated and uncomplicated forms of babesiosis and to evaluate various laboratory and clinical parameters of dogs infected with Babesia canis in order to assess their prognostic value regarding the outcomes of the disease. Medical records, complete blood count and serum biochemical analysis from the animal hospital information system of 240 dogs were reviewed and evaluated retrospectively. Binary logistic regression analysis was used to ascertain correlations between alterations in the obtained parameters and survival probability. The results showed that creatinine levels of more than 5 mg/dL and phosphate levels of more than 3 mmol/L have a highly significant link to death (P ≤ 0.001). Albumin levels of <2.2 g/dL (P = 0.003) and a rectal body temperature below 38 °C (P ≤ 0.001) may also serve as prognostic markers for the severity of the disease. If renal involvement was present, 33.9% of the dogs died, while 40.0% of the dogs died in the presence of pancreatitis. The parameters creatinine, phosphate, albumin and rectal temperature serve as reliable predictive markers of an increased risk of death in the case of an infection with B. canis.

scholarly journals DIAGNOSTIC AND PROGNOSTIC VALUE OF RENAL TUBULAR INJURY BIOMARKERS NGAL, KIM-1, L-FABP IN CHRONIC KIDNEY DISEASE PATIENTS

2017 ◽  
Vol 21 (2) ◽  
pp. 24-32 ◽  
Author(s):  
O. B. Kuzmin ◽  
V. V. Zhezha ◽  
V. V. Belaynin ◽  
N. V. Buchneva ◽  
L. N. Landar ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Kidney Injury ◽  
Diabetes Type 2 ◽  
Cardiovascular Complications ◽  
Diabetes Type ◽  
Fatty Acid Binding ◽  
Risk Of Death ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Diagnostic And Prognostic Value

The review summarized data on the diagnostic and prognostic value of biomarkers of kidney injury NGAL (neutrophil gelatinaseassociated lipocalin), KIM-1 (kidney injury molecule-1) and L-FABP (liver type fatty acid-binding protein) in patients with CKD. The most studied of these is NGAL, increase of its level in urine reflects the severity of CKD. Elevated levels of urinary NGAL evaluated also as a prognostic criterion which allows identifying patients with high risk of unfavorable course of disease. Elevated levels of urinary KIM-1 inpatients with CHF can detect individuals with tubulointerstitial kidney injury, having an adverse prognostic value, and to assess their risk of death or rehospitalization about CHF. Data obtained in large populations of patients with diabetes type 1 and 2 with CKD show that high levels of urinary L-FABP is associated with an increased risk of diabetic nephropathy progression. High levels of this biomarker in urine of patients with diabetes type 2 and stage1-2 CKD is also unfavorable prognostic marker of increased risk of coronary heart disease and other cardiovascular complications. In general, diagnostic and prognostic value of urine KIM-1 and L-FABP in CKD patients with varying severity poorly understood and needs further clinical studies. 

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