281Impact of complications on VA-ECMO support for cardiopulmonary support: analysis of 8,351 adult patients in Germany from 2007 to 2015

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P M Becher ◽  
B Schrage ◽  
B Schmack ◽  
C Sinning ◽  
N Fluschnik ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Major Bleeding ◽  
Kidney Injury ◽  
Ecmo Support ◽  
Bleeding Complications ◽  
Complication Rates ◽  
Cardiopulmonary Support ◽  
Ischemic Complications ◽  
Va Ecmo ◽  
Over Time

Abstract Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for treatment of patients with critical cardiopulmonary failure. However, utilization of VA-ECMO support must be carefully weighed against possible complications. Therefore, we investigated the incidence and impact of complications on VA-ECMO support in one of the largest datasets of VA-ECMO therapy. Material and methods We analyzed complications and outcomes of all VA-ECMO procedures performed in Germany from 2007 to 2015 by using administrative data from the German Federal Health Monitoring System. For the present analyses all cases treated with VA-ECMO between 2007 and 2015 were identified and selected by the primary procedural code (OPS) for VA-ECMO (OPS code 8852.3). Results Among 8,351 patients undergoing VA-ECMO between 2007 and 2015, there were significant changes in complication rates over time such as increase in acute kidney injury (from 35.9% in 2007–2012 to 44.6% in 2013–2015), major bleeding (from 11.3% in 2007–2012 to 19.5% in 2013–2015 and abdominal ischemia (from 4.5% in 2007–2009 to 7.2% in 2013–2015). The incidence of stroke and limb ischemia did not differ over time. Procedure-related and ischemic complications were more frequently observed in non-survivors as compared to survivors (12.2% versus 15.3%, p<0.001) except for major bleeding (20.9% in survivors versus 15.0% in non-survivors, p<0.001). Multivariate analyses retained stroke and acute kidney injury as being significantly associated with 30-day in-hospital mortality, with respective OR [95% CI] of 1.7 [1.0–2.9] and 1.2 [1.1–1.3]. Conclusion In one of the largest registries, major bleeding and ischemic events are the most common complications on VA-ECMO support. Ischemic complications seem to influence outcome more than bleeding complications. However, only stroke and acute kidney injury were independently associated with higher mortality rates. These findings should be incorporated in risk-benefit stratification when initiation of VA-ECMO and in prevention of complications to avoid additional morbidity and mortality in these critically ill patients.

scholarly journals Clinical features and major bleeding predictors for 161 fatal cases of COVID-19: A retrospective observational study

2021 ◽  
Author(s):  
Gokhan Alici ◽  
Hasan Ali Barman ◽  
Ramazan Asoglu ◽  
Adem Atici ◽  
Atike Nazli Akciger ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Major Bleeding ◽  
Myocardial Injury ◽  
Kidney Injury ◽  
Patient Characteristics ◽  
International Normalized Ratio ◽  
Bleeding Complications ◽  
Reactive Protein ◽  
Logistics Regression ◽  
D Dimer

The aim of this study was to investigate the patient characteristics and laboratory parameters for COVID-19 non-survivors as well as to find risk factors for major bleeding complications. For this retrospective study, the data of patients who died with COVID-19 in our intensive care unit were collected in the period of March 20 - April 30, 2020. D-dimer, platelet count, C-reactive protein (CRP), troponin, and international normalized ratio (INR) levels were recorded on the 1st, 5th, and 10th days of hospitalization in order to investigate the possible correlation of laboratory parameter changes with in-hospital events. A total of 161 non-survivors patients with COVID-19 were included in the study.  The median age was 69.8±10.9 years, and 95 (59%) of the population were male. Lung-related complications were the most common in-hospital complications. Patients with COVID-19 had in-hospital complications such as major bleeding (39%), hemoptysis (14%), disseminated intravascular coagulation (13%), liver failure (21%), ARDS (85%), acute kidney injury (40%), and myocardial injury (70%). A multiple logistics regression analysis determined that age, hypertension, diabetes mellitus, use of acetylsalicylic acid (ASA) or low molecular weight heparin (LMWH), hemoglobin, D-dimer, INR, and acute kidney injury were independent predictors of major bleeding. Our results showed that a high proportion of COVID-19 non-survivors suffered from major bleeding complications.

scholarly journals Temporal Trends in COVID-19 associated AKI from March to December 2020 in New York City

2021 ◽  
Author(s):  
Sergio Dellepiane ◽  
Akhil Vaid ◽  
Suraj K Jaladanki ◽  
Ishan Paranjpe ◽  
Steven Coca ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
Acute Kidney Injury ◽  
New York City ◽  
Renal Replacement Therapy ◽  
York City ◽  
Temporal Trends ◽  
Kidney Injury ◽  
Clinical Approach ◽  
Over Time

AbstractAcute Kidney Injury (AKI) is among the most common complications of Coronavirus Disease 2019 (COVID-19). Throughout 2020 pandemic, the clinical approach to COVID-19 has progressively improved, but it is unknown how these changes have affected AKI incidence and severity. In this retrospective analysis, we report the trend over time of COVID-19 associated AKI and need of renal replacement therapy in a large health system in New York City, the first COVID-19 epicenter in United States.

P0643PROGNOSTIC IMPACT OF THROMBOCYTOPENIA IN THE RISK OF INTRAHOSPITAL BLEEDING IN ACUTE KIDNEY INJURY (AKI) PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Zorica Dimitrijevic ◽  
Branka Mitic ◽  
Danijela Tasic ◽  
Goran Paunovic ◽  
Karolina Paunovic ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Platelet Count ◽  
Major Bleeding ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Bleeding Risk ◽  
Prognostic Impact ◽  
Care Hospital ◽  
Ulcer Disease ◽  
Post Surgery

Abstract Background and Aims Low platelet count is a marker of adverse events in acute kidney injury (AKI) patients. Thrombocytopenia has often been reported as an indicator of underlying disease severity and worse patient outcomes; however, it’s role in the prediction of the risk of bleeding is not well defined. Our study aimed to assess the prognostic impact of admission thrombocytopenia in the risk of major bleeding in non-septic, non-post surgery AKI patients. Method This retrospective study enrolled patients with AKI hospitalized at tertiary care hospital during the three years. Admission thrombocytopenia was defined as a platelet count &lt; 150x103/mL. The primary endpoint was major bleeding, as defined by the International Society on Thrombosis and Haemostasis. Results Of 178 included patients (age 61.7±11.1 years; 68.3% males), 26 (14.6%) had thrombocytopenia. These patients had more comorbidities: cancer (19.4 vs 9.6%; p=0.05); previous ulcer disease (17.6 vs. 8.8; p=0.04) and bleeding history (7.4% vs. 2.0%;p=0.04). While in a hospital, there was a trend for the use of more blood transfusions (7.4% vs. 2.7%; p=0.03) and more concomitant medications (12.7 vs. 5.1; p&lt;0.05) in patients with thrombocytopenia. During a hospital stay (IQR: 7-29 days), 19 patients (10.7%) died), 22 (12.35%) had major bleeding, and 5 (2.8%) intracranial bleeding. After adjusting for age, presence of cancer, and use of oral anticoagulant medications, patients with thrombocytopenia had a higher risk of major bleeding (HR 3.34 95%CI: 1.57-7.26; p &lt; 0.001). Conclusion Thrombocytopenia is a predictor of major intrahospital bleeding in the non-septic, non-post surgery AKI patients. It should be regarded in bleeding risk estimation and therapeutic strategy decisions.

Acute kidney injury in pregnancy

2018 ◽  
Author(s):  
Duska Dragun ◽  
Björn Hegner
Keyword(s):  
Acute Kidney Injury ◽  
Placental Abruption ◽  
Hyperemesis Gravidarum ◽  
Kidney Injury ◽  
Late Pregnancy ◽  
Bleeding Complications ◽  
Volume Depletion ◽  
Cortical Necrosis ◽  
Renal Deterioration ◽  
Obstetric Haemorrhage

Any kind of acute renal deterioration that occurs in young women may, besides typical pregnancy-related disorders, account for pregnancy-related acute kidney injury (PR-AKI). Incidence of PR-AKI is continuously decreasing, yet still represents a significant cause of fetomaternal morbidity and mortality. Hyperemesis gravidarum causing volume depletion and septic shock with renal cortical necrosis upon septic abortion are major causes of PR-AKI during early pregnancy. Pre-eclampsia and bleeding complications associated with placental abruption or other causes of obstetric haemorrhage are responsible for the majority of cases during late pregnancy (after week 35) and puerperium. Haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura disorders are less common than pre-eclampsia, yet represent a diagnostic and therapeutic challenge due to similar features to severe pre-eclampsia cases.

scholarly journals P06 Improving renal function monitoring during chemotherapy- a role for cystatin C?

2020 ◽  
Vol 105 (9) ◽  
pp. e8.2-e9
Author(s):  
Rachel Boys
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Kidney Injury ◽  
Estimating Equations ◽  
Transformation Factor ◽  
Over Time

AimRenal toxicity causes major morbidity following chemotherapy- abnormal iGFRs may be detected in up to 73.7% of patients.1 Creatinine is universally used as a biomarker to track fluctuating function and to calculate surrogate glomerular filtration rate (GFR) in the form of estimating equations.2 There is concern regarding the suitability of creatinine as a biomarker in this population, and it is proposed that cystatin C as a biomarker alone and also included in estimating equations may offer improved clinical suitability and accuracy.3MethodsIn this prospective, longitudinal study over a period of 18 months, 132 combined isotope GFR (iGFR), creatinine and cystatin C measurements were taken from 48 paediatric oncology patients at a Northern Children’s Hospital. Correlation and agreement analysis was performed for both individual biomarkers and estimating equations. Sensitivity data, along with ROC curve analysis was performed for all biomarkers and estimating equations. Data from three identified patients was isolated to examine individual patient variation over time.ResultsCreatinine identified only 1/32 patients with an abnormal iGFR (<90 ml/min/1.73 m2) compared to cystatin C which identified 12/32. Creatinine values and both estimating equations failed to change significantly over a period of declining iGFR though cystatin C did show a significant inverse increase (p<0.05). Bland Altman analysis for both the creatinine and combined equation showed poor agreement (mean difference -64 ml/min/1.3 m2 and -20 ml/min/1.73 m2 respectively). All biomarkers and equations showed poor sensitivity to detect an abnormal iGFR either below 70 ml/min/1.73 m2 or 90 ml/min/1.73 m2. A transformation factor applied to the equations significantly improved the sensitivity and clinical applicability of all equations. The data from three individual patients failed to reveal any significant intra-patient relationships.ConclusionData from this study cannot support the use of creatinine or cystatin C as a single biomarker to monitor renal function in children undergoing chemotherapy. Newer cystatin C and creatinine combined equations, whilst offering statistical superiority, do not offer the clinical superiority to replace iGFR or provide a tool for accurate dose calculations. A transformation factor can be applied to the results gained from the estimating equations to significantly improve the detection of abnormal iGFR, though work in other patient cohorts is needed to support this. Previous work also supported the use of a transformation factor, though application of their transformation factor to this current cohort failed to replicate the 100% sensitivity findings previously demonstrated4. Three patients were identified from the cohort and their paired iGFR and estimated GFR were monitored prospectively, over a period of approximately a year. Significant variation was observed between iGFR and eGFR at each time point for all three patients and therefore personalisation of GFR estimation from baseline iGFR and demographic data could not be proposed. This requires exploration in a larger cohort with the possible inclusion of additional baseline variables.ReferencesCRUK Survival trends over time in Children’s Cancers. 1.2015. https://www.cancerresearchuk.org/health-professional/cancer-statistics/childrens-cancers/survival#heading-Two Accessed 28th March 2019.NICE ( 2013) CG169 Acute kidney injury: Prevention, detection and management of acute kidney injury up to the point of renal replacement therapy.Barnfield, MC, Burniston, MT, Reid, U, et al. Cystatin C in assessment of glomerular filtration rate in children and young adults suffering from cancer. Nuclear Medicine Communications 2013;34:609–614.Dodgshun, AJ, Quinlan, C, Sullivan, MJ. Cystatin C based equation accurately estimates glomerular filtration rate in children with solid and central nervous system tumours: enough evidence to change practice? Pediatric Blood and Cancer 2016;63:1535–1538.

scholarly journals Dabigatran overload in acute kidney injury: haemodialysis or idarucizumab? A case report and proposal for a decisional algorithm

2020 ◽  
Author(s):  
Andrea Galassi ◽  
Gianmarco Podda ◽  
Paola Monciino ◽  
Andrea Stucchi ◽  
Alberto Del Nero ◽  
...  
Keyword(s):  
Decision Making ◽  
Acute Kidney Injury ◽  
Case Report ◽  
Tranexamic Acid ◽  
Major Bleeding ◽  
Kidney Injury ◽  
Minor Bleeding ◽  
Surgical Emergencies ◽  
Decisional Algorithm

Abstract Dabigatran overload has been reported in acute kidney injury (AKI), leading to occasional major bleeding. Haemodialysis (HD) was the method used for reversing dabigatran anticoagulant effects before the approval of idarucizumab, which is now indicated for dabigatran reversal in major bleeding or surgical emergencies. There have been reports of rebound of dabigatran levels following idarucizumab administration in AKI, requiring HD to achieve effective dabigatran clearance. However, a decisional algorithm to individualize treatments for dabigatran overload seems lacking. We present a case of dabigatran accumulation in obstructive AKI with minor bleeding that was successfully treated with HD and tranexamic acid without using idarucizumab, and propose a decision-making algorithm including different pathways in the management of suspected dabigatran overload in AKI.

scholarly journals The role of Contrast-Enhanced Ultrasound for evaluating renal perfusion dynamics in partially reversible acute cortical kidney ischemia in a patient with sepsis

2020 ◽  
Author(s):  
Alina Bianca Giurgiu ◽  
Ina Maria Kacso ◽  
Daniela Ionescu ◽  
Radu Badea
Keyword(s):  
Acute Kidney Injury ◽  
Disseminated Intravascular Coagulation ◽  
Thrombotic Microangiopathy ◽  
Kidney Injury ◽  
Renal Perfusion ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Over Time ◽  
Kidney Ischemia

We report the case of a sepsis-induced acute kidney injury accompanied by disseminated intravascular coagulation and thrombotic microangiopathy, responsible for subsequent renal microvascular thrombosis. Contrast-enhanced ultrasound was used to assess the thrombotic cortical kidney ischemia and its evolution over time.

scholarly journals No Difference in Risk of Acute Kidney Injury Between Adult Patients Receiving Different Types of Extracorporeal Membrane Oxygenation

2020 ◽  
Author(s):  
Zhixiang Mou ◽  
Xu Zhang
Keyword(s):  
Acute Kidney Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Web Of Science ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Adult Patients ◽  
Membrane Oxygenation ◽  
Significant Difference ◽  
Different Types ◽  
Va Ecmo

AbstractAcute kidney injury (AKI) has been reported as one of the most common complications in patients receiving extracorporeal membrane oxygenation (ECMO), yet the risk of AKI on different types of ECMO remains unclear. This meta-analysis aimed to compare risk of AKI among adult patients requiring different types of ECMO. Two authors independently performed a literature search using PubMed, Web of Science, and Embase, encompassing publications up until Arpril 20, 2020 (inclusive). The number of AKI patients, non-AKI patients, patients required RRT and patients not required RRT receiving different types of ECMO were derived and analyzed by STATA. The results indicated there was no significant difference in risk of AKI (OR, 1.54; 95% CI: 0.75-3.16; P= 0.235) and severe AKI required RRT (OR, 1.0; 95% CI: 0.66-1.5, P= 0.994) in patients receiving different types of ECMO. In Conclusion, no difference in risk of AKI and severe AKI required RRT between patients receiving VA ECMO and VV ECMO. More studies are required to support the findings.

scholarly journals In-hospital outcomes of self-expanding and balloon-expandable transcatheter heart valves in Germany

2021 ◽  
Author(s):  
Peter Stachon ◽  
Philip Hehn ◽  
Dennis Wolf ◽  
Timo Heidt ◽  
Vera Oettinger ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Major Bleeding ◽  
Postoperative Delirium ◽  
Kidney Injury ◽  
Length Of Hospital Stay ◽  
Hospital Outcomes

Abstract Introduction The effect of valve type on outcomes in transfemoral transcatheter aortic valve replacement (TF-TAVR) has recently been subject of debate. We investigate outcomes of patients treated with balloon-expanding (BE) vs. self-expanding (SE) valves in in a cohort of all these procedures performed in Germany in 2018. Methods All patients receiving TF-TAVR with either BE (N = 9,882) or SE (N = 7,413) valves in Germany in 2018 were identified. In-hospital outcomes were analyzed for the endpoints in-hospital mortality, major bleeding, stroke, acute kidney injury, postoperative delirium, permanent pacemaker implantation, mechanical ventilation > 48 h, length of hospital stay, and reimbursement. Since patients were not randomized to the two treatment options, logistic or linear regression models were used with 22 baseline patient characteristics and center-specific variables as potential confounders. As a sensitivity analysis, the same confounding factors were taken into account using the propensity score methods (inverse probability of treatment weighting). Results Baseline characteristics differed substantially, with higher EuroSCORE (p < 0.001), age (p < 0.001) and rate of female sex (p < 0.001) in SE treated patients. After risk adjustment, no marked differences in outcomes were found for in-hospital mortality [risk adjusted odds ratio (aOR) for SE instead of BE 0.94 (96% CI 0.76;1.17), p = 0.617] major bleeding [aOR 0.91 (0.73;1.14), p = 0.400], stroke [aOR 1.13 (0.88;1.46), p = 0.347], acute kidney injury [OR 0.97 (0.85;1.10), p = 0.621], postoperative delirium [aOR 1.09 (0.96;1.24), p = 0.184], mechanical ventilation > 48 h [aOR 0.98 (0.77;1.25), p = 0.893], length of hospital stay (risk adjusted difference in days of hospitalization (SE instead of BE): − 0.05 [− 0.34;0.25], p = 0.762) and reimbursement [risk adjusted difference in reimbursement (SE instead of BE): − €72 (− €291;€147), p = 0.519)] There is, however, an increased risk of PPI for SE valves (aOR 1.27 [1.15;1.41], p < 0.001). Similar results were found after application of propensity score adjustment. Conclusions We find broadly equivalent outcomes in contemporary TF-TAVR procedures, regardless of the valve type used. Incidence of major complications is very low for both types of valve.

scholarly journals 599 Gender-based differences in TAVI outcomes: report from a large contemporary real-world population of self-expandable valves

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alessandro Sticchi ◽  
Francesco Gallo ◽  
Vincenzo De Marzo ◽  
Kim Won-keun ◽  
Tobias Zeus ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Primary Endpoint ◽  
Major Bleeding ◽  
Real World ◽  
Vascular Complications ◽  
Kidney Injury ◽  
World Population ◽  
Gender Based ◽  
The Impact

Abstract Aims Small sub-study data derived from randomized clinical trials suggest a gender-based disparity in TAVI outcomes. However, large real-world contemporary data is missing. The aim of this study is to compare the risk factors, procedural characteristics and clinical outcomes of male and female patients who underwent transcatheter aortic valve implantation (TAVI) using two next-generation self-expandable bioprostheses (ACURATE neo and Evolut R/Pro valves). Methods We performed a first unmatched comparison and a propensity score-matched analysis (PSM) to assess the outcomes derived by the sex difference beyond the impact of pre-procedural risk factors in a large, contemporary, real-world, multicentre, international, retrospective registry of 3862 consecutive patients. The primary endpoint was a composite of all-cause death or any stroke (disabling and non-disabling) at 1 year. Results Sixty-four per cent (2162/3353 patients) of the study cohort was female and was older (mean age 82.3 years vs. 81.1 years for men (P&lt;0.001)) had a higher BMI (27.7±5.7 for women vs. 27.2±4.5 for men), and lower prevalence of dyslipidaemia (50.2% vs. 54.7, P=0.037), diabetes (26.8% vs. 33.7, P&lt;0.001), smoking (10.0% vs. 24.3%, P&lt;0.001), COPD (17.4% vs. 21.9%, P=0.002), pacemaker/ICD (9.6% vs. 14.0%, P&lt;0.001), previous cardiac surgery (8.6% vs. 18.8%, P&lt;0.001), previous PCI (23.0% vs. 36.8%, P&lt;0.001). Mean STS score for women was higher 5.2±3.9% vs. 4.5±3.4% (P&lt;0.001). Women had higher mean valve gradients (45.4±17.1 vs. 42.7±14.7 mmHg; P&lt;0.001), smaller valve areas (mean 0.7 cm2 vs. 0.9 cm2, P=0.037) and smaller annular perimeters (56.8±23.0 vs. 62.0±23.8, P&lt;0.001). The primary endpoint was resulted in a rate of 7.9% vs. 6.9% (P=0.337) in the unmatched population and 9.4% vs. 6.0% (P=0.014) after the PSM, respectively for women and for men. Independently, there was no difference in mortality (5.9% vs. 5.6%; P=0.786) and stroke (2.5% vs. 1.8%; P=0.243) rates between women and men in the un-matched groups. Rates of cardiac tamponade (1.5% vs. 0.4%, P=0.008), major vascular complications (7.7% vs. 4.1%, P&lt;0.001), life-threatening bleeding (2.8% vs. 1.4%, P=0.016), major bleeding (5.1% vs. 2.9%, P=0.004), need of transfusion (8.9% vs. 4.6%, P&lt;0.001) and acute kidney injury (8.5% vs. 5.7%, P=0.009), were all significantly higher in women. After PSM, mortality was similar between the two groups (11.3% for women vs. 9.5% for men, P=0.264) but strokes were more prevalent in women (2.8% vs. 1.2%, P&lt;0.024). Furthermore, in the matched population, major vascular complications (6.8% vs. 4.1%, P=0.024), need of transfusion (9.1% vs. 4.6%, P&lt;0.001) and acute kidney injury (8.7% vs. 5.6%, P=0.009) remained significantly different between women and men, respectively. Conclusions In this large real-world contemporary TAVI registry, female gender was associated with higher rates of stroke, vascular complications, major bleeding, and acute kidney injury. Further studies are required to explore the underlying pathophysiological mechanisms for these observations.

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