scholarly journals Nephrotoxicity in Patients with or without Cystic Fibrosis Treated with Polymyxin B Compared to Colistin

2017 ◽  
Vol 61 (4) ◽  
Author(s):  
Ryan L. Crass ◽  
W. Cliff Rutter ◽  
Donna R. Burgess ◽  
Craig A. Martin ◽  
David S. Burgess
Keyword(s):  
Risk Factors ◽  
Cystic Fibrosis ◽  
Retrospective Cohort ◽  
Loop Diuretic ◽  
Cox Regression ◽  
Kidney Injury ◽  
Polymyxin B ◽  
Baseline Serum ◽  
High Incidence ◽  
Stage Renal Disease

ABSTRACT Nephrotoxicity is the primary adverse effect of the polymyxins. The relative rates of toxicity of polymyxin B and colistin have not been fully elucidated, especially in patients with cystic fibrosis (CF). A retrospective cohort study of adults treated with polymyxin B or colistin for at least 48 h was conducted. The primary endpoint was the incidence of kidney injury assessed by RIFLE (i.e., risk, injury, failure, loss, end-stage renal disease) criteria. Risk factors for kidney injury were evaluated using multivariate Cox regression. A total of 414 patients were evaluated, 220 of whom had CF. In patients without CF, there was no difference in kidney injury with polymyxin B and colistin (42.9% versus 50.3%, P = 0.46). Loop diuretic exposure was a risk factor for kidney injury (adjusted hazard ratio [aHR], 1.82; 95% confidence interval [CI], 1.16 to 2.83) in this population. In patients with CF, polymyxin B and colistin were associated with similar rates of kidney injury (34.5% versus 29.8%, P = 0.77). Diabetes (aHR, 2.68; 95% CI, 1.01 to 7.11), loop diuretics (aHR, 3.02; 95% CI, 1.36 to 6.73), and progressive care unit admission (aHR, 8.21; 95% CI, 2.55 to 26.46) were risk factors for kidney injury, while higher baseline serum creatinine levels (per 1 mg/dl) were protective (aHR, 0.08; 95% CI, 0.01 to 0.48). Total unadjusted kidney injury in polymyxin-treated patients was less frequent in those who had CF (30.5% versus 48.5%, P < 0.001). Polymyxin B and colistin are associated with a high incidence of kidney injury; cystic fibrosis may be protective against polymyxin nephrotoxicity, but further investigation is needed to confirm this conjecture.

Pharmacokinetics of Polymyxin B in Hospitalized Adults with Cystic Fibrosis

2021 ◽  
Author(s):  
Ryan L. Crass ◽  
Tamara Al Naimi ◽  
Bo Wen ◽  
Ernane Souza ◽  
Susan Murray ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Bacterial Infections ◽  
Clinical Care ◽  
Kidney Injury ◽  
Polymyxin B ◽  
Volume Of Distribution ◽  
Fixed Dose ◽  
Liquid Chromatography Mass Spectrometry ◽  
Software Analysis ◽  
Linear Elimination

Background: The optimal polymyxin B dosage needed to achieve an efficacy target of 50-100 mg·h/L when treating multi-drug-resistant bacterial infections in adult cystic fibrosis (CF) patients is unclear. The pharmacokinetics of intravenous polymyxin B were evaluated to better inform dosing. Methods: This was a prospective, observational pharmacokinetic (PK) study of nine CF adults receiving intravenous polymyxin B as part of usual clinical care. Doses preceding PK sampling ranged from 50-100 mg every 12 hours. Five PK samples were collected following the fourth or fifth dose and concentrations of polymyxin subcomponents, B1 and B2, were quantified using Liquid Chromatography Mass Spectrometry (LC-MS). Population PK (NONMEM® software) analysis was performed using pooled polymyxin B1+B2 concentrations. Results: Participants were Caucasian, predominantly male, with mean age and weight of 31 years (range 21-57 years) and 58.0kg (range 38.3-70.4kg), respectively. A 1-compartment zero-order infusion and linear elimination model adequately described the data with estimated clearance and volume of distribution, 2.09 L/hr and 12.7 L, respectively, corresponding to a 4.1 hour mean half-life (t 1/2 ). Although body weight was observed to influence the volume of distribution, a fixed dose of 75 mg every 12 hours was predicted to achieve the target steady-state exposure. Neurotoxicities were reported in all patients; acute kidney injury events in two patients. These events resolved within 2-4 days after discontinuing polymyxin B. Conclusions: Fixed maintenance dosing of polymyxin B without loading is predicted to achieve the targeted therapeutic exposure in CF adults. Treatment-limiting neurotoxicities are very common in this population.

scholarly journals Risk factors for acute kidney injury in a pediatric intensive care unit: a retrospective cohort study

Medwave ◽  
2017 ◽  
Vol 17 (03) ◽  
pp. e6940-e6940 ◽  
Author(s):  
Lina María Serna-Higuita ◽  
John Fredy Nieto-Ríos ◽  
Jorge Eduardo Contreras-Saldarriaga ◽  
Juan Felipe Escobar-Cataño ◽  
Luz Adriana Gómez-Ramírez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Pediatric Intensive Care

scholarly journals Risk factors for mortality in hospitalized patients with COVID-19 from three hospitals in Peru: a retrospective cohort study

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 224
Author(s):  
Cristian Díaz-Vélez ◽  
Diego Urrunaga-Pastor ◽  
Anthony Romero-Cerdán ◽  
Eric Ricardo Peña-Sánchez ◽  
Jorge Luis Fernández Mogollon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Oxygen Saturation ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Vulnerable Groups ◽  
Vital Functions ◽  
The Mean

Background: Peru was one of the countries with the highest COVID-19 mortality worldwide during the first stage of the pandemic. It is then relevant to evaluate the risk factors for mortality in patients hospitalized for COVID-19 in three hospitals in Peru in 2020, from March to May, 2020.  Methods: We carried out a retrospective cohort study. The population consisted of patients from three Peruvian hospitals hospitalized for a diagnosis of COVID-19 during the March-May 2020 period. Independent sociodemographic variables, medical history, symptoms, vital functions, laboratory parameters and medical treatment were evaluated. In-hospital mortality was assessed as the outcome. We performed Cox regression models (crude and adjusted) to evaluate risk factors for in-hospital mortality. Hazard ratios (HR) with their respective 95% confidence intervals (95% CI) were calculated.  Results: We analyzed 493 hospitalized adults; 72.8% (n=359) were male and the mean age was 63.3 ± 14.4 years. COVID-19 symptoms appeared on average 7.9 ± 4.0 days before admission to the hospital, and the mean oxygen saturation on admission was 82.6 ± 13.8. While 67.6% (n=333) required intensive care unit admission, only 3.3% (n=16) were admitted to this unit, and 60.2% (n=297) of the sample died. In the adjusted regression analysis, it was found that being 60 years old or older (HR=1.57; 95% CI: 1.14-2.15), having two or more comorbidities (HR=1.53; 95% CI: 1.10-2.14), oxygen saturation between 85-80% (HR=2.52; 95% CI: 1.58-4.02), less than 80% (HR=4.59; 95% CI: 3.01-7.00), and being in the middle (HR=1.65; 95% CI: 1.15-2.39) and higher tertile (HR=2.18; 95% CI: 1.51-3.15) of the neutrophil-to-lymphocyte ratio, increased the risk of mortality.  Conclusions: The risk factors found agree with what has been described in the literature and allow the identification of vulnerable groups in whom monitoring and early identification of symptoms should be prioritized in order to reduce mortality.

scholarly journals The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ling Sang ◽  
Sibei Chen ◽  
Xia Zheng ◽  
Weijie Guan ◽  
Zhihui Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Partial Pressure ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Right Heart Failure ◽  
Partial Pressure Of Oxygen ◽  
Baseline Serum ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen

Abstract Background The clinical correlates, prognosis and determinants of acute kidney injury (AKI) in patients with coronavirus disease 2019 (Covid-19) remain largely unclear. Methods We retrospectively reviewed medical records of all adult patients with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University. Results Among 210 patients, 131 were males (62.4%). The median Age was 64 years (IQR: 56–71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) were classified as being at stage 1, 2 and 3, respectively. 54 patients (58.7%) received continuous renal replacement therapy. Age, sepsis, nephrotoxic drug, invasive mechanical ventilation and elevated baseline serum creatinine levels were associated with the occurrence of AKI. Renal recovery during hospitalization was identified among 16 patients with AKI (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure and higher ratio of partial pressure of oxygen to the fraction of inspired oxygen. Of 210 patients, 93 deceased within 28 days of ICU admission. AKI stage 3, critical disease, greater Age and the lowest ratio of partial pressure of oxygen to the fraction of inspired oxygen being < 150 mmHg were independently associated with death. Conclusions Among patients with Covid-19, the incidence of AKI was high. Our findings of the risk factors of the development of AKI and factors associated with renal function recovery may inform clinical management of patients with critical illness of Covid-19.

scholarly journals Risk factors and outcomes of early acute kidney injury in infective endocarditis: A retrospective cohort study

2020 ◽  
Vol 99 ◽  
pp. 421-427
Author(s):  
Florent Von Tokarski ◽  
Adrien Lemaignen ◽  
Antoine Portais ◽  
Laurent Fauchier ◽  
Fanny Hennekinne ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Infective Endocarditis ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Kidney Injury

scholarly journals Risk Factors for Acute Kidney Injury in Patients Treated with Polymyxin B: Experience from 139 Cases at a Tertiary University Hospital in Colombia

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Carlos Gomez ◽  
Jackeline Barreto ◽  
Johanna Osorio ◽  
Luis C Alvarez ◽  
Claudia F Samboni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Polymyxin B ◽  
University Hospital

scholarly journals Defining heart disease risk for death in COVID-19 infection

QJM ◽  
2020 ◽  
Vol 113 (12) ◽  
pp. 876-882 ◽  
Author(s):  
J Li ◽  
T Guo ◽  
D Dong ◽  
X Zhang ◽  
X Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Disease Risk ◽  
Demographic Data ◽  
Kidney Injury ◽  
Laboratory Findings ◽  
Course Of Disease ◽  
Clinical Observations ◽  
Independent Risk Factors ◽  
Heart Disease Risk

Summary Background Cardiovascular disease (CVD) was in common in coronavirus disease 2019 (COVID-19) patients and associated with unfavorable outcomes. We aimed to compare the clinical observations and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients with or without CVD. Methods Patients with laboratory-confirmed SARS-CoV-2 infection were clinically evaluated at Wuhan Seventh People’s Hospital, Wuhan, China, from 23 January to 14 March 2020. Demographic data, laboratory findings, comorbidities, treatments and outcomes were collected and analyzed in COVID-19 patients with and without CVD. Results Among 596 patients with COVID-19, 215 (36.1%) of them with CVD. Compared with patients without CVD, these patients were significantly older (66 vs. 52 years) and had higher proportion of men (52.5% vs. 43.8%). Complications in the course of disease were more common in patients with CVD, included acute respiratory distress syndrome (22.8% vs. 8.1%), malignant arrhythmias (3.7% vs. 1.0%) including ventricular tachycardia/ventricular fibrillation, acute coagulopathy(7.9% vs. 1.8%) and acute kidney injury (11.6% vs. 3.4%). The rate of glucocorticoid therapy (36.7% vs. 25.5%), Vitamin C (23.3% vs. 11.8%), mechanical ventilation (21.9% vs. 7.6%), intensive care unit admission (12.6% vs. 3.7%) and mortality (16.7% vs. 4.7%) were higher in patients with CVD (both P &lt; 0.05). The multivariable Cox regression models showed that older age (≥65 years old) (HR 3.165, 95% CI 1.722–5.817) and patients with CVD (HR 2.166, 95% CI 1.189–3.948) were independent risk factors for death. Conclusions CVD are independent risk factors for COVID-19 patients. COVID-19 patients with CVD were more severe and had higher mortality rate, early intervention and vigilance should be taken.

scholarly journals Risk of pneumothorax in pneumoconiosis patients in Taiwan: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e054098
Author(s):  
Jo-Hui Pan ◽  
Chih-Hung Cheng ◽  
Chao-Ling Wang ◽  
Chia-Yen Dai ◽  
Chau-Chyun Sheu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Cumulative Incidence ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Secondary Outcome ◽  
Matched Cohort ◽  
Cox Regression Analysis ◽  
Control Subjects

ObjectivesThis study was conducted to explore the association between pneumoconiosis and pneumothorax.DesignRetrospective cohort study.SettingNationwide population-based study using the Taiwan National Health Insurance Database.ParticipantsA total of 2333 pneumoconiosis patients were identified (1935 patients for propensity score (PS)-matched cohort) and matched to 23 330 control subjects by age and sex (7740 subjects for PS-matched cohort).Primary and secondary outcome measuresThe incidence and the cumulative incidence of pneumothorax.ResultsBoth incidence and the cumulative incidence of pneumothorax were significantly higher in the pneumoconiosis patients as compared with the control subjects (p<0.0001). For multivariable Cox regression analysis adjusted for age, sex, residency, income level and other comorbidities, patients with pneumoconiosis exhibited a significantly higher risk of pneumothorax than those without pneumoconiosis (HR 3.05, 95% CI 2.18 to 4.28, p<0.0001). The male sex, heart disease, peripheral vascular disease, chronic pulmonary disease and connective tissue disease were risk factors for developing pneumothorax in pneumoconiosis patients.ConclusionsOur study revealed a higher risk of pneumothorax in pneumoconiosis patients and suggested potential risk factors in these patients. Clinicians should be aware about the risk of pneumothorax in pneumoconiosis patients.

scholarly journals Molecular markers of acute kidney injury (review)

2021 ◽  
pp. 24-33
Author(s):  
Л.Д. Мальцева ◽  
Д.Ю. Лакомова ◽  
Д.А. Морозов ◽  
Н.Б. Захарова ◽  
З.Ш. Манасова ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Molecular Markers ◽  
Early Diagnosis ◽  
Kidney Injury ◽  
Cochrane Library ◽  
Early Stages ◽  
High Incidence ◽  
Low Sensitivity ◽  
The Cochrane Library

Несмотря на высокую частоту встречаемости острого повреждения почек (ОПП), диагностика его ранних этапов затруднена в связи с низкой чувствительностью и специфичностью стандартных методов исследования. Общеклинические и биохимические показатели крови и мочи не позволяют прогнозировать течение и исход патологии. Целью данного обзора явилась систематизация литературных данных относительно молекулярных маркёров ОПП. Проведён анализ белее ста источников по таким базам индексирования, как Scopus, MEDLINE, The Cochrane Library. Учитывались как факторы риска возникновения и прогрессирования заболевания, так и механизмы развития ОПП, а также маркеры его диагностики и прогноза исходов. Подробно представлены генетические аспекты возникновения и развития ОПП и перспективные методы ранней диагностики. Установлена возможность использования молекулярных маркёров для определения степени тяжести процесса. Предполагается, что идентификация конкретных генов и биомаркёров начальных стадий ОПП улучшит диагностику и поможет прогнозировать течение заболевания и его исходы. Despite the high incidence of acute kidney injury (AKI), diagnosis of its early stages is difficult due to low sensitivity and specificity of standard study methods. General clinical and biochemical blood and urine tests cannot predict the course and outcome of the disease. The aim of this review was to systematize reports of molecular markers for AKI. More than a hundred sources indexed in Scopus, MEDLINE, and Cochrane Library were analyzed. Both risk factors of AKI onset and progression and its mechanisms, and its diagnostic and predictive markers were included in the analysis. The review focused on genetic aspects of AKI onset and development and on promising methods for early diagnosis. A possibility of using molecular markers to determine the AKI severity has been demonstrated. The authors suggested that identifying specific genes and biomarkers for early stages of AKI would improve the diagnosis and the prediction of AKI course and outcome.

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