Risk Factors for Adverse Maternal Outcomes following Expectantly Managed Preterm Prelabor Rupture of Membranes

Author(s):  
Alice J. Darling ◽  
Hailey M. Harris ◽  
Gregory E. Zemtsov ◽  
Maria Small ◽  
Matthew R. Grace ◽  
...  

Objective We sought to characterize the incidence and risk factors associated with developing maternal morbidity following preterm prelabor rupture of membranes. Study Design Retrospective case–control study of patients with preterm prelabor rupture of membranes at a single institution from 2013 to 2019 admitted at ≥23 weeks gestational age. The primary outcome was a composite of maternal morbidity which included: death, sepsis, intensive care unit (ICU) admission, acute kidney injury, postpartum dilation and curettage, postpartum hysterectomy, venous thromboembolism, postpartum hemorrhage, postpartum wound complication, postpartum endometritis, pelvic abscess, postpartum pneumonia, readmission, and/or need for blood transfusion were compared with patients without above morbidities. Severe morbidity was defined as: death, ICU admission, venous thromboembolism, acute kidney injury, postpartum hysterectomy, sepsis, and/or transfusion >2 units. Demographics, antenatal, and delivery characteristics were compared between patients with and without maternal morbidity. Bivariate statistics and regression models were used to compare outcomes and calculate adjusted odd ratios. Results Of 361 included patients, 64 patients (17.7%) experienced maternal morbidity and nine (2.5%) had severe morbidity. Patients who experienced maternal morbidity were significantly (p < 0.05) more likely to be older, have private insurance, have BMI ≥40, have chorioamnionitis at delivery, and undergo cesarean or operative vaginal delivery when compared with patients who did not experience morbidity. After controlling for confounders, cesarean delivery (aOR 2.38, 95% CI[1.30,4.39]), body mass index ≥40 at admission (aOR 2.54, 95% CI[1.12,5.79]), private insurance (aOR 3.08, 95% CI[1.54,6.16]), and tobacco use (aOR 3.43, 95% CI[1.58,7.48]) were associated with increased odds of maternal morbidity. Conclusion In this cohort, maternal morbidity occurred in 17.7% of patients with preterm prelabor rupture of membranes. Private insurance, body mass index ≥40, tobacco use, and cesarean delivery were associated with higher odds of morbidity. These data can be used in counseling and to advocate for smoking cessation. Key Points

2021 ◽  
Author(s):  
Lei Wang ◽  
Guodong Zhong ◽  
Xiaochai Lv ◽  
Dong Yi ◽  
Yanting Hou ◽  
...  

Abstract Background Acute kidney injury (AKI) is one of the most common complications after Stanford type A aortic dissection (TAAD) repair surgery, but its risk factors are inconsistent in different studies. So this meta-analysis was conducted to systematically analyze the risk factors for AKI after TAAD repair surgery, so as to early identify the therapeutic targets for preventing AKI and to improve the outcomes. Methods Studies on risk factors for AKI after TAAD repair surgery were searched from PubMed, Embase, Cochrane library and Web of science from inception of databases to June 2021. The meta-analysis was performed by Stata 16.0 software. The combined incidence and risk factors of AKI and its impact on mortality after TAAD repair surgery were calculated. Results A total of 11 studies and 4156 patients were included. The combined incidence of postoperative AKI was 56.0%. The advanced age [odds ratio (OR)=1.32, 95% confidence interval (CI) (1.19, 1.47), P<0.001], cardiopulmonary bypass time > 180 minutes [OR=4.88, 95% CI (2.05, 11.59), P<0.001], red blood cell (RBC) volume transfused perioperatively [OR=1.13, 95% CI (1.03, 1.24), P<0.01], high body mass index [OR=1.22, 95% CI (1.18, 1.27), P<0.001] and preoperative renal malperfusion [OR= 5.32, 95% CI (2.92, 9.71), P<0.001] were risk factors for AKI after TAAD repair surgery. The in-hospital mortality [rate ratio (RR)=2.50, 95% CI (1.82, 3.44), P<0.001] and 30-day mortality [RR=2.81, 95% CI (1.95, 4.06), P<0.001] were higher in patients with postoperative AKI than that without AKI. Conclusions The incidence of AKI after TAAD repair surgery was high, and it increased the in-hospital and 30-day mortality. Reducing cardiopulmonary bypass time and RBC transfusions perioperatively, especially in elderly or patients with high body mass index, or patients with renal malperfusion preoperatively were important to prevent AKI after TAAD repair surgery.Systematic review registration number: INPLASY 202060100.


2018 ◽  
Vol 33 (3) ◽  
pp. 283-290 ◽  
Author(s):  
Areg Grigorian ◽  
Viktor Gabriel ◽  
Ninh T. Nguyen ◽  
Brian R. Smith ◽  
Sebastian Schubl ◽  
...  

2019 ◽  
Vol 71 (5) ◽  
Author(s):  
Rita Ladeiras ◽  
Filipa Flor-De-Lima ◽  
Henrique Soares ◽  
Bárbara Oliveira ◽  
Hercília Guimarães

2018 ◽  
Vol 22 (5) ◽  
pp. 17-24 ◽  
Author(s):  
E. V. Burnasheva ◽  
Y. V. Shatokhin ◽  
I. V. Snezhko ◽  
A. A. Matsuga

Кidney injury is a frequent and significant complication of cancer and cancer therapy. The kidneys are susceptible to injury from malignant infiltration, damage by metabolites of malignant cells, glomerular  injury, nephrotoxic drugs including chemotherapeutic agents. Also  bone marrow transplantation complications, infections with immune  suppression (including septicemia), tumor lysis syndrome should be  taken into account. Chemotherapeutic agents are a common cause  of acute kidney injury but can potentially lead to chronic kidney  disease development in cancer patients. This article summarizes risk  factors of acute kidney injury in cancer patients. Risk factors are  divided into two groups. The systemic are decrease of total  circulating blood volume, infiltration of kidney tissue by tumor cells,  dysproteinemia, electrolyte disturbances. The local (renal) risk  factors are microcirculation disturbances, drugs biotransformation  with formation of reactive oxygen intermediates, high concentration of nephrotoxic agents in proximal tubules and its  sensitivity to ischemia. Drug-related risk factors include: drugs  combination with cytotoxic effect high doses long term use necessity, direct cytotoxic effect of not only chemotherapeutic agents but also its metabolites, mean solubility forming intratubular  precipitates. Early diagnosis, timely prevention and treatment of  these complications provide significantly improve nononcologic results of treatment.


2020 ◽  
Author(s):  
Yong Liu ◽  
Shiqun Chen ◽  
Edmund Y. M. Chung ◽  
Li Lei ◽  
Yibo He ◽  
...  

Author(s):  
Xiaoqi Wei ◽  
Hanchuan Chen ◽  
Zhebin You ◽  
Jie Yang ◽  
Haoming He ◽  
...  

Abstract Background This study aimed to investigate the connection between malnutrition evaluated by the Controlling Nutritional Status (CONUT) score and the risk of contrast-associated acute kidney injury (CA-AKI) in elderly patients who underwent percutaneous coronary intervention (PCI). Methods A total of 1308 patients aged over 75 years undergoing PCI was included. Based on the CONUT score, patients were assigned to normal (0–1), mild malnutrition (2–4), moderate-severe malnutrition group (≥ 5). The primary outcome was CA-AKI (an absolute increase in ≥ 0.3 mg/dL or ≥ 50% relative serum creatinine increase 48 h after contrast medium exposure). Results Overall, the incidence of CA-AKI in normal, mild, moderate-severe malnutrition group was 10.8%, 11.0%, and 27.2%, respectively (p < 0.01). Compared with moderate-severe malnutrition group, the normal group and the mild malnutrition group showed significant lower risk of CA-AKI in models adjusting for risk factors for CA-AKI and variables in univariate analysis (odds ratio [OR] = 0.48, 95% confidence interval [CI]: 0.26–0.89, p = 0.02; OR = 0.46, 95%CI: 0.26–0.82, p = 0.009, respectively). Furthermore, the relationship were consistent across the subgroups classified by risk factors for CA-AKI except anemia. The risk of CA-AKI related with CONUT score was stronger in patients with anemia. (overall interaction p by CONUT score = 0.012). Conclusion Moderate-severe malnutrition is associated with higher risk of CA-AKI in elderly patients undergoing PCI.


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