scholarly journals Molecular and clinical signatures in Acute Kidney Injury define distinct subphenotypes that associate with death, kidney, and cardiovascular events

2021 ◽  
Author(s):  
George Vasquez-Rios ◽  
Wonsuk Oh ◽  
Samuel Lee ◽  
Pavan Bhatraju ◽  
Sherry G. Mansour ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Troponin T ◽  
Kidney Injury ◽  
Machine Learning Algorithms ◽  
Inflammatory Biomarker ◽  
Admission Rates ◽  
Risk Of Death ◽  
Clinical Events ◽  
Organ Specific ◽  
Injury And Repair

Introduction: AKI is a heterogeneous syndrome defined via serum creatinine and urine output criteria. However, these markers are insufficient to capture the biological complexity of AKI and not necessarily inform on future risk of kidney and clinical events. Methods: Data from ASSESS-AKI was obtained and analyzed to uncover different clinical and biological signatures within AKI. We utilized a set of unsupervised machine learning algorithms incorporating a comprehensive panel of systemic and organ-specific biomarkers of inflammation, injury, and repair/health integrated into electronic data. Furthermore, the association of these novel biomarker-enriched subphenotypes with kidney and cardiovascular events and death was determined. Clinical and biomarker concentration differences among subphenotypes were evaluated via classic statistics. Kaplan-Meier and cumulative incidence curves were obtained to evaluate longitudinal outcomes. Results: Among 1538 patients from ASSESS-AKI, we included 748 AKI patients in the analysis. The median follow-up time was 4.8 years. We discovered 4 subphenotypes via unsupervised learning. Patients with AKI subphenotype 1 (injury cluster) were older (mean age +/- SD): 71.2 +/- 9.4 (p<0.001), with high ICU admission rates (93.9%, p<0.001) and highly prevalent cardiovascular disease (71.8%, p<0.001). They were characterized by the highest levels of KIM-1, troponin T, and ST2 compared to other clusters (P<0.001). AKI subphenotype 2 (benign cluster) is comprised of relatively young individuals with the lowest prevalence of comorbidities and highest levels of systemic anti-inflammatory makers (IL-13). AKI Subphenotype 3 (chronic inflammation and low injury) comprised patients with markedly high pro-BNP, TNFR1, and TNFR2 concentrations while presenting low concentrations of KIM-1 and NGAL. Patients with AKI subphenotype 4 (inflammation-injury) were predominantly critically ill individuals with the highest prevalence of sepsis and stage 3 AKI. They had the highest systemic (IL-1B, CRP, IL-8) and kidney inflammatory biomarker activity (YKL-40, MCP-1) as well as high kidney injury levels (NGAL, KIM-1). AKI subphenotype 3 and 4 were independently associated with a higher risk of death compared to subphenotype 2. Moreover, subphenotype 3 was independently associated with CKD outcomes and CVD events. Conclusion: We discovered four clinically meaningful AKI subphenotypes with statistical differences in biomarker composites that associate with longitudinal risks of adverse clinical events. Our approach is a novel look at the potential mechanisms underlying AKI and the putative role of biomarkers investigation.

scholarly journals Seasonal Influenza and Low Flu Vaccination Coverage as Important Factors Modifying the Costs and Availability of Hospital Services in Poland: A Retrospective Comparative Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5173
Author(s):  
Robert Susło ◽  
Piotr Pobrotyn ◽  
Lidia Brydak ◽  
Łukasz Rypicz ◽  
Urszula Grata-Borkowska ◽  
...  
Keyword(s):  
Influenza Season ◽  
Influenza Infection ◽  
Hospital Staff ◽  
University Hospital ◽  
Control Group ◽  
Admission Rates ◽  
Risk Of Death ◽  
The Mean ◽  
Retrospective Comparative Study ◽  
The Cost

Introduction: Influenza infection is associated with potential serious complications, increased hospitalization rates, and a higher risk of death. Materials and Methods: A retrospective comparative analysis of selected indicators of hospitalization from the University Hospital in Wroclaw, Poland, was carried out on patients with confirmed influenza infection in comparison to a control group randomly selected from among all other patients hospitalized on the respective wards during the 2018–2019 influenza season. Results: The mean laboratory testing costs for the entire hospital were 3.74-fold higher and the mean imaging test costs were 4.02-fold higher for patients with confirmed influenza than for the control group; the hospital expenses were additionally raised by the cost of antiviral therapy, which is striking when compared against the cost of a single flu vaccine. During the 2018–2019 influenza season, influenza infections among the hospital patients temporarily limited the healthcare service availability in the institution, which resulted in reduced admission rates to the departments related to internal medicine; the mean absence among the hospital staff totaled approximately 7 h per employee, despite 7.3% of the staff having been vaccinated against influenza at the hospital’s expense. Conclusions: There were significant differences in the hospitalization indicators between the patients with confirmed influenza and the control group, which markedly increased the hospital care costs in this multi-specialty university hospital.

Fragmented QRS, a predictor of clinical events in patients on cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Martinez Milla ◽  
C Garcia-Talavera ◽  
B Arroyo ◽  
A Camblor ◽  
A Garcia-Ropero ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Cardiovascular Events ◽  
Hospital Admissions ◽  
Multivariate Logistic Regression Analysis ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Coronary Syndrome ◽  
Clinical Events ◽  
Increased Risk

Abstract Introduction Cardiac resynchronization therapy with defrilator (CRT-D) has been shown to reduce mortality in HFrEF. The width and morphology of the QRS are essential when deciding on the implantation of these devices. QRS fragmentation (fQRS) has been shown to be a good predictor of cardiovascular events in certain patients, but its role in patients with CRT-D has not been studied. The aim of this study is to determine whether the presence of a fQRS at the time of CRT-D implantation can predict clinical events. Methods All patients who underwent CRT-D implantation from 2010 to 2017 were included. Patients' ECG were evaluated at the time of implantation, and the incidence of clinical events during follow-up was also assessed. fQRS was defined as the presence of an RSR' pattern with a notch in the R wave or in the ascending or descending branch of the S wave in two continuous leads on the ECG. Results We studied 131 patients (mean age 73 years, 76.5% male). The mean follow-up period was 37±26 months. No difference in baseline characteristics was found (Table 1); the proportion of fQRS was 48.9%. 25 patients (19.1%) had hospital admissions secondary to cardiovascular causes (heart failure, arrhythmic events, acute coronary syndrome, and death from other causes). We performed a multivariate logistic regression analysis aiming at an association between the presence of fQRS and the increased risk of hospital admissions due to cardiovascular causes OR 2.92 (95% CI: 1.04–8.21, P=0.04). Conclusion The presence of a fQRS at the time of implantation of a CRT-D is an independent predictor of hospital admissions due to cardiovascular causes. Therefore this could be a useful marker to identify the population at high risk of cardiovascular events, for this we consider necessary to conduct future studies and thus assess the value of the fQRS for the selection of patients requiring closer monitoring thus avoiding further hospital admissions. Funding Acknowledgement Type of funding source: None

scholarly journals Differential organ-specific inflammatory response to progranulin in high-fat diet-fed mice

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maki Murakoshi ◽  
Tomohito Gohda ◽  
Eri Adachi ◽  
Saki Ichikawa ◽  
Shinji Hagiwara ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
High Fat Diet ◽  
Kidney Injury ◽  
Proximal Tubules ◽  
Tubular Damage ◽  
Standard Diet ◽  
Mrna Levels ◽  
High Fat ◽  
Organ Specific

AbstractProgranulin (PGRN) has been reported to bind tumor necrosis factor (TNF) receptor and to inhibit TNFα signaling. We evaluated the effect of augmentation of TNFα signaling by PGRN deficiency on the progression of kidney injury. Eight-week-old PGRN knockout (KO) and wild-type (WT) mice were fed a standard diet or high-fat diet (HFD) for 12 weeks. Albuminuria, markers of tubular damage, and renal mRNA levels of inflammatory cytokines were higher in HFD-fed KO (KO-HFD) mice than in HFD-fed WT (WT-HFD) mice. Body weight, vacuolization in proximal tubules, and systemic and adipose tissue inflammatory markers were lower in the KO-HFD mice than in the WT-HFD mice. The renal megalin expression was lower in the KO mice than in the WT mice regardless of the diet type. The megalin expression was also reduced in mouse proximal tubule epithelial cells stimulated with TNFα and in those with PGRN knockdown by small interfering RNA in vitro. PGRN deficiency was associated with both exacerbated renal inflammation and decreased systemic inflammation, including that in the adipose tissue of mice with HFD-induced obesity. Improved tubular vacuolization in the KO-HFD mice might partially be explained by the decreased expression of megalin in proximal tubules.

scholarly journals Autophagy in Acute Kidney Injury and Repair

2014 ◽  
Vol 127 (1-4) ◽  
pp. 56-60 ◽  
Author(s):  
Liyu He ◽  
Man J. Livingston ◽  
Zheng Dong
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Injury And Repair

Cellular plasticity in kidney injury and repair

2016 ◽  
Vol 13 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Monica Chang-Panesso ◽  
Benjamin D. Humphreys
Keyword(s):  
Kidney Injury ◽  
Cellular Plasticity ◽  
Injury And Repair
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