62. Association Between Influenza Co-infection and Poor Outcomes in Patients Hospitalized with COVID-19

Abstract Background In December 2019, a novel coronavirus (COVID-19) infection emerged in Wuhan, China, establishing itself as a deadly pathogen leading to an ongoing pandemic. The incidence of co-infection of COVID-19 and Influenza has not been widely reported. Both infections have been known to share similar mechanisms of transmission, however currently, there is no evidence regarding the relationship between co-infection between this viruses and worsening outcomes. Once social distancing measures are eased, and daily activities resumed, there is a possibility for a second wave of cases. Given the incidence of influenza is higher during winter, a higher co-infection rate is expected in these months. Methods In this study, the aim was to assess the association of influenza co-infection with outcomes in patients diagnosed with COVID-19 in a hospital-based case-control study in Bronx, New York. 19 patients with Influenza co-infection were found in total. 1 patient did not meet inclusion/exclusion criteria. Charts were reviewed from 18 confirmed cases of influenza and COVID-19 patients. Controls were selected from the remaining pool of patients with COVID-19 in the same period. Cases were matched for age, sex and underlying comorbidities (Hypertension, Diabetes Mellitus, liver disease, cardiovascular disease, HIV status, immunocompromised state other than HIV). The measured outcomes were: in-hospital mortality, need for mechanical ventilation, need for vasopressors and need for renal replacement therapy. For each outcome, Chi Square test and Odds ratio were obtained. Results After statistical analysis, no significative difference was found in the following variables: in-hospital mortality [Odds ratio (OR) 0.769; 95% confidence interval (CI): 0.185–3.191; p value= 0.717], need for mechanical ventilation (OR 1.3; 95% CI: 0.313–5.393; p value= 0.717), need for vasopressors (OR 1.923; 95% CI: 0.383–9.646; p value= 0.423), need for renal replacement therapy (OR 1.0; 95% CI: 0.208–4.814; p value= 1.0). Conclusion There was no difference in the outcome in COVID-19 patients co-infected with influenza compared to non co-infected patients, however, a larger sample of cases will be needed for further assessment of these outcomes. Disclosures All Authors: No reported disclosures

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Risk factors for mortality in patients undergoing continuous renal replacement therapy after cardiac surgery

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02324-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chang Liu ◽

Hai-Tao Zhang ◽

Li-Jun Yue ◽

Ze-Shi Li ◽

Ke Pan ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Renal Replacement Therapy ◽

Confidence Interval ◽

Hospital Mortality ◽

Odds Ratio ◽

Intraoperative Bleeding ◽

Independent Risk Factors ◽

Mechanical Ventilation Time

Abstract Background To investigate the risk factors for mortality in patients with acute kidney injury requiring continuous renal replacement therapy (AKI-CRRT) after cardiac surgery. Methods In this retrospective study, patients who underwent AKI-CRRT after cardiac surgery in our centre from January 2015 to January 2020 were included. Univariable and multivariable analyses were performed to identify the risk factors for in-hospital mortality. Results A total of 412 patients were included in our study. Of these, 174 died after AKI-CRRT, and the remaining 238 were included in the survival control group. Multivariable logistic regression analysis revealed that EuroSCORE > 7 (odds ratio [OR], 3.72; 95% confidence interval [CI], 1.92–7.24; p < 0.01), intraoperative bleeding > 1 L (OR, 2.14; 95% CI, 1.19–3.86; p = 0.01) and mechanical ventilation time > 70 h (OR, 5.03; 95% CI, 2.40–10.54; p < 0.01) were independent risk factors for in-hospital mortality in patients who had undergone AKI-CRRT. Our study also found that the use of furosemide after surgery was a protective factor for such patients (odds ratio, 0.48; 95% confidence interval, 0.25–0.92; p = 0.03). Conclusions In summary, the mortality of patients with AKI-CRRT after cardiac surgery remains high. The EuroSCORE, intraoperative bleeding and mechanical ventilation time were independent risk factors for in-hospital mortality. Continuous application of furosemide may be associated with a better outcome.

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Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211027759 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110277

Author(s):

Tyler Pitre ◽

Angela (Hong Tian) Dong ◽

Aaron Jones ◽

Jessica Kapralik ◽

Sonya Cui ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Cohort Study ◽

Hospital Mortality ◽

Disease Severity ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Kidney Injury ◽

Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

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Intra-dialytic hypotension following the transition from continuous to intermittent renal replacement therapy

Annals of Intensive Care ◽

10.1186/s13613-021-00885-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

William Beaubien-Souligny ◽

Yifan Yang ◽

Karen E. A. Burns ◽

Jan O. Friedrich ◽

Alejandro Meraz-Muñoz ◽

...

Keyword(s):

Renal Replacement Therapy ◽

Hospital Mortality ◽

Replacement Therapy ◽

Kidney Injury ◽

Hemodynamic Instability ◽

Factors Associated ◽

Definition Of ◽

Vasopressor Use ◽

Cumulative Fluid Balance ◽

Intermittent Renal Replacement Therapy

Abstract Background Transition from continuous renal replacement therapy (CRRT) to intermittent renal replacement therapy (IRRT) can be associated with intra-dialytic hypotension (IDH) although data to inform the definition of IDH, its incidence and clinical implications, are lacking. We aimed to describe the incidence and factors associated with IDH during the first IRRT session following transition from CRRT and its association with hospital mortality. This was a retrospective single-center cohort study in patients with acute kidney injury for whom at least one CRRT-to-IRRT transition occurred while in intensive care. We assessed associations between multiple candidate definitions of IDH and hospital mortality. We then evaluated the factors associated with IDH. Results We evaluated 231 CRRT-to-IRRT transitions in 213 critically ill patients with AKI. Hospital mortality was 43.7% (n = 93). We defined IDH during the first IRRT session as 1) discontinuation of IRRT for hemodynamic instability; 2) any initiation or increase in vasopressor/inotropic agents or 3) a nadir systolic blood pressure of < 90 mmHg. IDH during the first IRRT session occurred in 50.2% of CRRT-to-IRRT transitions and was independently associated with hospital mortality (adjusted odds ratio [OR]: 2.71; CI 1.51–4.84, p < 0.001). Clinical variables at the time of CRRT discontinuation associated with IDH included vasopressor use, higher cumulative fluid balance, and lower urine output. Conclusions IDH events during CRRT-to-IRRT transition occurred in nearly half of patients and were independently associated with hospital mortality. We identified several characteristics that anticipate the development of IDH following the initiation of IRRT.

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Development and validation of prediction models for mechanical ventilation, renal replacement therapy, and readmission in COVID-19 patients

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocab029 ◽

2021 ◽

Author(s):

Victor Alfonso Rodriguez ◽

Shreyas Bhave ◽

Ruijun Chen ◽

Chao Pang ◽

George Hripcsak ◽

...

Keyword(s):

At Risk ◽

Mechanical Ventilation ◽

Renal Replacement Therapy ◽

Receiver Operating Characteristic ◽

Replacement Therapy ◽

Operating Characteristic ◽

Prediction Models ◽

External Validation ◽

Electronic Health Record Data ◽

Receiver Operating

Abstract Objective Coronavirus disease 2019 (COVID-19) patients are at risk for resource-intensive outcomes including mechanical ventilation (MV), renal replacement therapy (RRT), and readmission. Accurate outcome prognostication could facilitate hospital resource allocation. We develop and validate predictive models for each outcome using retrospective electronic health record data for COVID-19 patients treated between March 2 and May 6, 2020. Materials and Methods For each outcome, we trained 3 classes of prediction models using clinical data for a cohort of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2)–positive patients (n = 2256). Cross-validation was used to select the best-performing models per the areas under the receiver-operating characteristic and precision-recall curves. Models were validated using a held-out cohort (n = 855). We measured each model’s calibration and evaluated feature importances to interpret model output. Results The predictive performance for our selected models on the held-out cohort was as follows: area under the receiver-operating characteristic curve—MV 0.743 (95% CI, 0.682-0.812), RRT 0.847 (95% CI, 0.772-0.936), readmission 0.871 (95% CI, 0.830-0.917); area under the precision-recall curve—MV 0.137 (95% CI, 0.047-0.175), RRT 0.325 (95% CI, 0.117-0.497), readmission 0.504 (95% CI, 0.388-0.604). Predictions were well calibrated, and the most important features within each model were consistent with clinical intuition. Discussion Our models produce performant, well-calibrated, and interpretable predictions for COVID-19 patients at risk for the target outcomes. They demonstrate the potential to accurately estimate outcome prognosis in resource-constrained care sites managing COVID-19 patients. Conclusions We develop and validate prognostic models targeting MV, RRT, and readmission for hospitalized COVID-19 patients which produce accurate, interpretable predictions. Additional external validation studies are needed to further verify the generalizability of our results.

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Furosemide stress test as a predictive marker of acute kidney injury progression or renal replacement therapy: a systemic review and meta-analysis

10.21203/rs.2.23355/v2 ◽

2020 ◽

Author(s):

Jia-Jin Chen ◽

Chih-Hsiang Chang ◽

Yen Ta Huang ◽

George Kuo

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Diagnostic Accuracy ◽

Replacement Therapy ◽

Sensitivity And Specificity ◽

Odds Ratio ◽

Diagnostic Performance ◽

Stress Test ◽

Kidney Injury ◽

Diagnostic Odds Ratio

Abstract Background: The use of the furosemide stress test (FST) as an acute kidney injury (AKI) severity marker has been described in several trials. However, the diagnostic performance of the FST in predicting AKI progression has not yet been fully discussed. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed, Embase, Cochrane databases up to March, 2020. The diagnostic performance of the FST (in terms of sensitivity, specificity, number of events, true positive, false positive) was extracted and evaluated. Results: We identified eleven trials that enrolled a total of 1366 patients, including 517 patients and 1017 patients for whom the outcomes in terms of AKI stage progression and renal replacement therapy (RRT), respectively, were reported. The pooled sensitivity and specificity results of the FST for AKI progression prediction were 0.81 (95% CI: 0.74 - 0.87) and 0.88 (95% CI: 0.82- 0.92), respectively. The pooled positive likelihood ratio (LR) was 5.45 (95% CI: 3.96-7.50), the pooled negative LR was 0.26 (95% CI: 0.19-0.36), and the pooled diagnostic odds ratio (DOR) was 29.69 (95% CI: 17.00-51.85). The summary receiver operating characteristics (SROC) with pooled diagnostic accuracy was 0.88. The diagnostic performance of the FST in predicting AKI progression was not affected by different AKI criteria or underlying chronic kidney disease. The pooled sensitivity and specificity results of the FST for RRT prediction were 0.84 (95% CI: 0.72-0.91) and 0.77 (95% CI: 0.64-0.87), respectively. The pooled positive LR and pooled negative LR were 3.16 (95% CI: 2.06-4.86) and 0.25 (95% CI: 0.14-0.44), respectively. The pooled diagnostic odds ratio (DOR) was 13.59 (95% CI: 5.74-32.17) and SROC with pooled diagnostic accuracy was 0.86. The diagnostic performance of FST for RRT prediction is better in stage 1-2 AKI comparing to stage 3 AKI (relative DOR: 5.75, 95% CI: 2.51-13.33) Conclusion: The FST is a simple tool for the identification of AKI populations at high risk of AKI progression and the need for RRT and the diagnostic performance of FST in RRT prediction is better in early AKI population.

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Hubungan Pengetahuan dengan Keterampilan Kader dalam Menimbang Bayi dan Balita di Wilayah Kerja Puskesmas Natar Lampung Selatan

Jurnal Kebidanan Malahayati ◽

10.33024/jkm.v5i4.2059 ◽

2019 ◽

Vol 5 (4) ◽

pp. 333-337

Author(s):

Astriana Astriana ◽

Nita Evrianasari

Keyword(s):

Odds Ratio ◽

P Value ◽

Chi Square ◽

Double Burden ◽

Cross Sectional

Latar Belakang : Gizi pada bayi dan balita merupakan indikator pembangunan kualitas sumber daya manusia. Sumber daya manusia yang sehat dan berkualitas merupakan modal utama pembangunan kesehatan yang menentukan suatu bangsa. Saat ini indonesia dihadapkan tidak hanya pada masalah gizi kurang akan tetapi dihadapkan pada permasalahan gizi ganda (double burden) yaitu gizi lebih dan kurang. Berbagai usaha telah dilakukan untuk menangani masalah gizi diindonesia, salah satunya adalah dengan membuat suatu wadah pelayanan kesehatan bersumberdaya masyarakat yang dilaksanakan oleh, dari dan bersama masyarakat yaitu pos pelayanan terpadu (posyandu). Dalam observasi langsung pada kegiatan penimbangan bayi dan balita di posyandu kader tidak melakukan sesuai langkah penimbangan yang telah ditetapkan sehingga hasil penimbangan tidak valid. hal ini akan mengakibatkan gambaran status gizi yang dihasilkan menjadi kurang tepat, selain itu kader juga tidak menggambarkan grafik pada buku KMS dan tidak melakukan penyuluhan.Tujuan : Mengetahui hubungan pengetahuan dengan keterampilan kader dalam menimbang bayi dan balita di wilayah kerja Puskesmas Natar Lampung Selatan.Metode : Jenis penelitian yang digunakan adalah kuantitatif, dengan rancangan survey analitik dengan pendekatan cross sectional. Penelitian dilaksanakan di posyandu wilayah kerja Pukesmas Natar Lampung Selatan. Jumlah sampel penelitian sebanyak 132 responden menggunakan teksnik sampling simple random sampling.Analisa data menggunakan chi-SquareHasil: Uji statistic menggunakan chi-square diperoleh p-value 0,000 < α 0,05, yang berarti bahwa H0 ditolak dan Ha diterima atau berarti ada hubungan pengetahuan dengan keterampilan kader dalam menimbang bayi dan balita di wilayah kerja puskesmas natar lampung selatan. Dengan nilai Odds Ratio sebesar 416,667. Kesimpulan : Ada hubungan pengetahuan dengan keterampilan kader dalam menimbang bayi dan balita di posyandu wilayah kerja puskesmas Natar Lampung Selatan.Kata kunci: Pengetahuan kader, keterampilan, menimbang

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Contrast induced acute kidney injury prevention during angiographic procedure with early renal replacement therapy

European Heart Journal ◽

10.1093/ehjci/ehaa946.2572 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V Gritti ◽

S Pierini ◽

M Ornaghi ◽

A Paggi ◽

I Baragetti ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Contrast Media ◽

Replacement Therapy ◽

Kidney Injury ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

P Value ◽

Shock Onset ◽

Ventricular Ejection Fraction

Abstract Background and purpose Post-angiography renal replacement therapy (RRT) has shown protective effects from Ci-AKI (contrast induced acute kidney injury) in patients with pre-existing advanced renal disfunction. We analysed a series of 1095 continuative patients who undergone coronary or peripheral angiography in our center. In non-haemodialyzed patients with eGFR <20ml/min/1.73m2 or with poor renal reserve we performed an “early” RRT, starting during angiography procedure and applied for at least 6 h after procedure, thus diverging from previous literature data based only on post-procedure hours delayed RRT application. The RRT modality chosen was CVVHDF (continous veno-venous hemodiafiltration). Methods We considered following subjects variability: age, sex, weight, presence of hypertension, dyslipidaemia, diabetes, smoking habitude, left ventricular ejection fraction, amount of contrast media given and shock or infection occurrence during hospital stay. We evaluate statistic significative of serum creatine (SCr) variation in patients receiving RRT from pre-procedure time (T0), at 24h (T1), 48h (T2), 72h (T3) after procedure and at 3–8 weeks follow-up (T4). Quantitative data were compared with Student T test, qualitative data with Chi Square test, considering statistically significant p value <0.05 with two tails. Ci-AKI was defined as serum creatinine rise ≥0.3 mg/dL at 48h from contrast media administration, following KDIGO (kidney disease improving global outcomes) guidelines definition. Results 26 patients received RRT. Medium SCr at T0 was 3.37 mg/dl and showed a significative reduction (see figure) at T1 (−0.88mg/dl = −20.6%, p=0.003) and T2 (−0.96mg/dl = −18.33%, p=0.029) and a trend towards reduction at T3 (−0.78mg/dl, p=0.174) and at T4 (−0.28mg/dl, p=0.568). Between 26 pts, 6 pts (23%) developed Ci-AKI. Only contrast media amount significatively diverge between two groups (183 ml in the group with Ci-AKI vs 162 ml in pts with no Ci-AKI, p=0.03), showing also a trend towards significance for infection occurrence (83.3% pts Ci-AKI vs 40% pts no Ci-AKI, p=0.06) and shock onset (33.3%pts Ci-AKI vs 5% pts no Ci-AKI, p=0.06). Average SCr diverge at T2 (3.18mg/dl Ci-AKI vs 2.04mg/dl no Ci-AKI, p=0.01) and at T3 (3.33mg/dl CI-AKI vs 2.31mg/dl no CI-AKI, p=0.06); we also found a trend towards progressive increase of SCr for Ci-AKI pts (T0-T1: +0.17mg/dl, p=ns; T0-T2: +0.41mg/dl, p=ns; T0-T3: +0.57mg/dl, p=ns; T0-T4: +1.35mg/dl, p=ns) and a significative reduction in SCr for no Ci-AKI pts (T0-T1: −1.23mg/dl = −29.32% p=0.001; T0-T2: −1.46mg/dl = −30.78%, p=0.01; T0-T4: −0.41mg/dl = −15.5%, p=0.05). Conclusions Early RRT with CVVHDF modality results effective in 77% of patients in avoiding Ci-AKI, with a significative SCr reduction at 24 and 48h. An increased amount of contrast media is significatively related to Ci-AKI incidence. Ci-AKI development could also possibly be related to shock and infection occurrence. Figure 1 Funding Acknowledgement Type of funding source: None

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P2268Incidence and prognostic impact of sepsis in patients with acute myocardial infarction complicated by cardiogenic shock - Results of the CULPRIT-SHOCK study and registry

European Heart Journal ◽

10.1093/eurheartj/ehz748.0745 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

U Zeymer ◽

S Desch ◽

I Akin ◽

T Ouarrak ◽

S De Waha ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Renal Replacement Therapy ◽

Cardiogenic Shock ◽

Replacement Therapy ◽

P Value ◽

Prognostic Impact ◽

Risk Patients ◽

Baseline Characteristics ◽

Very High

Abstract Background Patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) have a high mortality. It has been proposed that one component is a systemic inflammatory response to shock. Some of these patients even develop sepsis. Therefore,we analyzed a large cohort of patients with AMI and CS and sought to determine the incidence of sepsis and its impact on outcome. Methods The CULPRIT-SHOCKtrial and registry included 1009 patients with AMI complicated by CStreated with early PCI. In the trial 686 patients were randomized to immediate multivessel PCI or culprit lesion only PCI. In the current subanalysis patients were compared in those developing sepsis during the ICU phase to thosewithout sepsis. Results From the total of 1009 patients 103 (10%) developed sepsis. The baseline characteristics and 30-day outcomes are shown in the table. Sepsis (n=103) No sepsis (n=906) p-value Age (yrs) 68 68 0.8 Women 22.3% 25.3% 0.5 Diabetes 34.3% 29.7% 0.3 GFR <60 ml/min 5.8% 6.4% 0.8 CPR 54.4% 54.2% 0.8 Lactat >5 mmol/l 54.2% 50.8% 0.6 Mechanical support device 35.0% 29.1% 0.2 Bleeding 28.2% 18.8% 0.02 Need for renal replacement therapy 37.9% 9.6% <0.0001 Mortality 54.4% 45.7% 0.08 Conclusion About 10% of patients with AMI complicated by CSdevelop sepsis. Sepsis is associated with a higher incidence of the need for renal replacement therapy, bleeding and and a trend towards higher mortality. Therefore,further research is needed to improve outcome of these very high risk patients.

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Evaluating the Risk of Developing Thrombocytopenia Within Five Days of Continuous Renal Replacement Therapy Initiation in Septic Patients

Journal of Pharmacy Practice ◽

10.1177/0897190020959175 ◽

2020 ◽

pp. 089719002095917

Author(s):

Lauren Fay ◽

Georgeanna Rechner-Neven ◽

Drayton A. Hammond ◽

Joshua M. DeMott ◽

Mary Jane Sullivan

Keyword(s):

Differential Diagnosis ◽

Platelet Count ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Primary Outcome ◽

Control Group ◽

Chi Square ◽

Time Zero ◽

Renal Replacement Therapy Initiation

Background: The differential diagnosis for thrombocytopenia in critical illness is often extensive. This study was performed to determine the incidence of thrombocytopenia in septic patients undergoing continuous renal replacement therapy (CRRT) versus those not undergoing CRRT. Objective: The primary outcome of this study was to compare the development of thrombocytopenia, defined as a platelet count ≤ 100 × 103/mm3, in septic patients within 5 days of time zero. Time zero was defined as the baseline platelet count upon hospital admission or CRRT initiation. Methods: An IRB approved, retrospective cohort study was conducted evaluating thrombocytopenia development in critically ill, septic patients who were initiated on CRRT versus those whom were not. Baseline and clinical characteristics were displayed using descriptive statistics. The primary outcome was evaluated overall and in subgroups of CRRT using Chi-square tests. Results: One hundred sixty patients, 80 per arm, were included in the study. Thrombocytopenia development within 5 days occurred more frequently in the renal replacement therapy (RRT) group compared to the control group (67.5% vs. 6.3%, p < 0.001). In the subgroup analysis of the RRT cohort, thrombocytopenia development within 5 days occurred more frequently in the continuous veno-venous hemofiltration (CVVH) group compared to the accelerated veno-venous hemofiltration (AVVH) group (76% vs. 53.3%, p = 0.049). Conclusion: There is a high likelihood that septic patients initiated on CRRT will develop thrombocytopenia during their hospital stay. Patients receiving CVVH may develop thrombocytopenia more frequently than those receiving AVVH. Overall, CRRT should remain a differential diagnosis for thrombocytopenia development in this patient population.

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The Impact of Hemodynamic Transesophageal Echocardiography on the Use of Continuous Renal Replacement Therapy in Trauma

The American Surgeon ◽

10.1177/000313481708300836 ◽

2017 ◽

Vol 83 (8) ◽

pp. 855-859 ◽

Cited By ~ 1

Author(s):

Madison Griffin ◽

Brett Howard ◽

Sam Devictor ◽

Josh Ferenczy ◽

Frances Cobb ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Transesophageal Echocardiography ◽

Replacement Therapy ◽

Kidney Injury ◽

Volume Overload ◽

P Value ◽

Trauma Patients ◽

The Impact

Post-traumatic fluid management is a widely debated topic. No best-practice consensus exists. Adverse outcomes such as acute kidney injury or volume overload are common. Continuous renal replacement therapy (CRRT) is an adjunct therapy for severe acute renal failure and volume overload, but is costly and not without risk. Hemodynamic transesophageal echocardiography (hTEE) is widely accepted as a reliable way to monitor volume status of intensive care unit (ICU) patients. Although data exist evaluating hTEE and CRRT independently, there is a lack of research mutually inclusive of the two. We hypothesized that the use of hTEE is associated with less need for CRRT. Retrospective review of a level I trauma center from 2009 to 2015 identified patients that required CRRT. In 2013, we implemented a protocol using hTEE in trauma patients with significant resuscitation needs. We compared CRRTuse before and after implementation of the protocol (pre- and post-hTEE). Multivariate analysis using two sample t tests and χ2 test of the odds ratio (O.R.) was completed on variables such as injury severity score (ISS), acute kidney injury network (AKIN), days of CRRT, ICU length of stay (LOS), and hospital LOS. A total of 5037 and 6699 trauma patients were evaluated in the pre- and post-hTEE groups, respectively. Mean ISS was 22 and 28 for pre- and post-hTEE, respectively (P value 0.19). Mean AKIN was 2.7 for both groups. Mean days on CRRT was eight before hTEE and seven after hTEE (P value 0.7); 23 patients required CRRT pre-hTEE, and 15 required CRRT post-hTEE (P value 0.01 O.R. 2.4). Given, the odds of CRRT pre-hTEE are more than twice that of CRRT post-hTEE; we conclude that the use of hTEE is associated with a reduction of CRRT.

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