scholarly journals Proteinuria as an independent risk factor for contrast-induced acute kidney injury and mortality in patients with stroke undergoing cerebral angiography

2016 ◽  
Vol 9 (5) ◽  
pp. 445-448 ◽  
Author(s):  
Yiming Tao ◽  
Wei Dong ◽  
Zhilian Li ◽  
Yuanhan Chen ◽  
Huaban Liang ◽  
...  

BackgroundThe correlation between proteinuria and contrast-induced acute kidney injury (CI-AKI) in patients with cerebrovascular disease is still unknown.ObjectiveTo determine whether proteinuria is a risk factor for CI-AKI and death in patients with stroke undergoing cerebral angiography.MethodsData from 2015 patients with stroke undergoing cerebral angiography between January 2009 and December 2013 were retrospectively collected. Clinical parameters were obtained from the hospital's computerized database. All variables were analyzed by univariate analysis and multivariate logistic regression analysis.ResultsCI-AKI was seen in 85 patients (4.2%). After adjustment for potential confounding risk factors, patients with proteinuria had a fivefold higher risk of CI-AKI than patients without proteinuria (OR=5.74; 95% CI 2.23 to 14.83; p<0.001). Other independent risk factors for CI-AKI were estimated glomerular filtration rate <60 mL/min/1.73 m2, anemia, and a high National Institute of Health Stroke Scale score. Proteinuria did not increase in-hospital mortality (OR=1.25; 95% CI 0.49 to 3.17; p=0.639) but did increase 1-year mortality (HR=2.30, 95% CI 1.55 to 3.41, p<0.001).ConclusionsProteinuria is an independent risk factor for CI-AKI and 1-year mortality in patients with stroke undergoing cerebral angiography. More attention should be paid to the development of CI-AKI in patients with stroke with proteinuria.

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tian Xu ◽  
Maoning Lin ◽  
Xiaohua Shen ◽  
Min Wang ◽  
Wenjuan Zhang ◽  
...  

AbstractCongestive heart failure (HF) is a known risk factor of contrast-induced acute kidney injury (CI-AKI). However, the relationship of the classification and severity of HF with CI-AKI remains under-explored. From January 2009 to April 2019, we recruited patients undergoing elective PCI who had complete pre- and post-operative creatinine data. According to the levels of ejection fraction (EF), HF was classified as HF with reduced EF (HFrEF) [EF < 40%], HF with mid-range EF (HFmrEF) [EF 40–49%] and HF with preserved EF (HFpEF) [EF ≥ 50%]. CI-AKI was defined as an increase of either 25% or 0.5 mg/dL (44.2 μmoI/L) in serum baseline creatinine level within 72 h following the administration of the contrast agent. A total of 3848 patients were included in the study; mean age 67 years old, 33.9% females, 48.1% with HF, and 16.9% with CI-AKI. In multivariate logistic regression analysis, HF was an independent risk factor for CI-AKI (OR 1.316, p value < 0.05). Among patients with HF, decreased levels of EF (OR 0.985, p value < 0.05) and elevated levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) (OR 1.168, p value < 0.05) were risk factors for CI-AKI. These results were consistent in subgroup analysis. Patients with HFrEF were more likely to develop CI-AKI than those with HFmrEF or HFpEF (OR 0.852, p value = 0.031). Additionally, lower levels of EF were risk factors for CI-AKI in the HFrEF and HFmrEF groups, but not in the HFpEF group. NT-proBNP was an independent risk factor for CI-AKI in the HFrEF, HFmrEF and HFpEF groups. Elevated levels of NT-proBNP are independent risk factors for CI-AKI irrespective of the classification of HF. Lower levels of EF were risk factors for CI-AKI in the HFrEF and HFmrEF groups, but not in the HFpEF group.


2021 ◽  
Vol 8 ◽  
Author(s):  
Lijuan Chen ◽  
Xiaoli Wu ◽  
Haiyan Qin ◽  
Hongchao Zhu

Purpose: Considerable evidence suggests that inflammation and malnutrition are common in patients with acute kidney injury (AKI) and correlated with mortality of various diseases. Despite this, few studies have reported the underlying predictive effects of inflammatory and nutritional markers in combination on the mortality of AKI patients. Herein, we aimed to explore the values of PCT and CRP as well as the ratios of PCT/Alb and CRP/Alb in the poor prognosis of patients with sepsis-induced AKI.Patients and Methods: A total of 171 patients with AKI, caused by abdominal infection-evoked sepsis, were retrospectively studied and divided into a survival group (107 cases) and a non-survival group (64 cases). Univariate analysis was used to compare the clinical data of the two groups. Multivariate logistic regression analysis was used to analyze the independent risk factors of poor prognosis in patients with sepsis-induced AKI. The ROC curve was used to evaluate the diagnostic value of PCT, CRP, PCT/Alb, and CRP/Alb in the poor prognosis of patients with sepsis-induced AKI.Results: Univariate analysis revealed that the values of PCT, CRP, CRP/Alb, and PCT/Alb were significantly different between AKI survival and non-survival groups, and further analysis found that PCT and PCT/Alb were independent risk factors for poor prognosis in patients with sepsis-induced AKI after adjusting with age and gender. Of note, the predictive accuracy (0.864 vs. 0.807), specificity (83.2 vs. 69.2), and sensitivity (79.7 vs. 76.6) of PCT/Alb were all higher than that of the simple PCT.Conclusions: The ratio of PCT to Alb is an independent risk factor possessing a robust and accurate risk assessment for the poor prognosis of patients with sepsis-induced AKI, and it offers the potential to improve the management of this type of disease and a lower resultant mortality.


2021 ◽  
Vol 9 ◽  
Author(s):  
Fan Cao ◽  
Xinxin Chen ◽  
Guodong Huang ◽  
Wenhua Liu ◽  
Na Zhou ◽  
...  

Background: Acute kidney injury (AKI) is a common and serious complication faced by children following ventricular septal defect (VSD) surgery with cardiopulmonary bypass (CPB). The objective of this study was to explore potential predictors inherent to AKI.Methods: VSD infants who were scheduled for elective cardiac surgery with CPB from 2017 to 2020 were enrolled in this study. Based on the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria, patients were divided into AKI and non-AKI groups. Univariate and multivariate logistic regression analyses were carried out in order to evaluate potential risk factors for AKI. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive probabilities of risk factors for AKI.Results: Of all the 338 enrolled VSD infants, 49 manifested AKI with an incidence of 14.5% (49/338). The ROC curve indicated that albumin-to-fibrinogen ratio (AFR) during CPB was a significant predictor of AKI [area under the curve (AUC), 0.711; p &lt; 0.001]. Based on the univariate and multivariate logistic analyses, AFR during CPB [odds ratio (OR), 1.89; 95% confidence interval (CI), 1.22–2.76, p = 0.011] was the only independent risk factor for AKI.Conclusions: This study demonstrated that a low AFR (&lt;9.35) during CPB was an independent risk factor for AKI in VSD infants following cardiac surgery with CPB.


2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17559-e17559
Author(s):  
Esther Van Meerten ◽  
Catherine Owusuaa ◽  
Ewout Hoorn ◽  
Esther Oomen De Hoop

e17559 Background: Patients with advanced head and neck cancer (HNC) are commonly treated with chemoradiation with concomitant cisplatin. Acute kidney injury (AKI) is considered a dose-limiting toxicity of cisplatin. We aim to describe the incidence and risk factors of AKI. Methods: In our tertiary center, we retrospectively identified 261 patients with advanced HNC and adequate renal function who were treated curatively from 2008 to 2015 using radiotherapy and concurrent three-weekly cisplatin. Outcome was the first AKI episode, defined according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines as a ≥50% rise in serum creatinine compared to baseline. Several potential predictors were investigated by means of logistic regression analyses. Results: In our cohort (mean age 58 ± 8 years, 74.3% male), a total of 102 (39.1%) patients developed AKI. Factors significantly associated with AKI in the univariate analysis were: age, alcohol consumption, excessive smoking, diabetes, hypertension, diuretic use, renin-angiotensin-aldosterone-system blockers, and administration of furosemide when indicated during first cisplatin cycle. In the multivariable model smoking 6-25 and > 25 cigarettes per day (OR 1.85; 95% CI 1.01-3.39 and OR 3.22; 95% CI 1.34-7.70, respectively), diabetes (OR 2.58; 95% CI, 1.01-6.61), furosemide (OR 2.39; 95% CI, 1.36-4.18) , and hypertension (OR 2.79; 95% CI, 1.52-5.12) remained independent risk factors for AKI. Conclusions: The identified risk factors smoking, diabetes, and hypertension may have caused pre-existing kidney damage and therefore have predisposed to AKI. Co-administration of furosemide with cisplatin is a potentially reversible risk factor for AKI.


2020 ◽  
Author(s):  
Zhi Zhu ◽  
Ningning Song ◽  
Yoko Kato ◽  
Xi Chen ◽  
Weichao Jiang ◽  
...  

Abstract Objective To investigate risk factors for aneurysm rupture in intracranial aneurysm clipping (IAC). Methods Patients admitted for IAC from April 2010 to December 2017 in the Fujita Health University Hospital or the First Affiliated Hospital of Xiamen University were retrospectively reviewed. Clinical parameters were recorded and analyzed using univariate and multivariate analysis. The Hunt-Hess grade was used to assess the preoperative clinical status of patients. Modified Rankin Scale was applied to evaluate the prognosis of patients 6 months after surgery. Results Univariate analysis showed that the preoperative clinical status ( p = 0.015) and the preoperative aneurysm rupture ( p = 0.005) were significantly associated with intraoperative aneurysm rupture (IAR) during clipping. Multivariate logistic regression analysis showed that the preoperative aneurysm rupture was an independent risk factor of IAR ( p < 0.001, OR = 10.518). There was no significant difference in the prognosis between patients with and without IAR ( p > 0.05). No significant differences existed on aspects of incidences and time points of rupture in the operations conducted by experienced surgeons compared with that conducted by less-experienced surgeons ( p > 0.05). Conclusion Preoperative aneurysm rupture is the independent risk factor for aneurysm rupture during IAC. Intraoperative rupture, if treated properly in time, has no influence on the prognosis of patients receiving IAC. Less-experienced surgeons can also reduce the incidence rate of IAR by strictly controlling surgical indications.


2011 ◽  
Vol 115 (3) ◽  
pp. 602-611 ◽  
Author(s):  
Kiarash Shahlaie ◽  
Krista Keachie ◽  
Irene M. Hutchins ◽  
Nancy Rudisill ◽  
Lori K. Madden ◽  
...  

Object Posttraumatic vasospasm (PTV) is an underrecognized cause of ischemic damage after severe traumatic brain injury (TBI) that independently predicts poor outcome. There are, however, no guidelines for PTV screening and management, partly due to limited understanding of its pathogenesis and risk factors. Methods A database review of 46 consecutive cases of severe TBI in pediatric and adult patients was conducted to identify risk factors for the development of PTV. Univariate analysis was performed to identify potential risk factors for PTV, which were subsequently analyzed using a multivariate logistic regression model to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results Fever on admission was an independent risk factor for development of PTV (OR 22.2, 95% CI 1.9–256.8), and patients with hypothermia on admission did not develop clinically significant vasospasm during their hospital stay. The presence of small parenchymal contusions was also an independent risk factor for PTV (OR 7.8, 95% CI 0.9–69.5), whereas the presence of subarachnoid hemorrhage or other patterns of intracranial injury were not. Other variables, such as age, sex, ethnicity, degree of TBI severity, or admission laboratory values, were not independent predictors for the development of clinically significant PTV. Conclusions Independent risk factors for PTV include parenchymal contusions and fever. These results suggest that diffuse mechanical injury and activation of inflammatory pathways may be underlying mechanisms for the development of PTV, and that a subset of patients with these risk factors may be an appropriate population for aggressive screening. Further studies are needed to determine if treatments targeting fever and inflammation may be effective in reducing the incidence of vasospasm following severe TBI.


BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e047090
Author(s):  
Yiqi Su ◽  
Haoxuan Li ◽  
Yang Li ◽  
Xialian Xu ◽  
Bo Shen ◽  
...  

ObjectivesAcute kidney injury (AKI) is a common complication of cardiac surgery. This study aimed to explore the effects of hyperuricaemia, being overweight and hyperlipidaemia as risk factors for AKI in patients following cardiac surgery (cardiac surgery-associated acute kidney injury (CSA-AKI)).DesignRetrospective observational study.SettingUniversity teaching, grade-A tertiary hospital in Shanghai, China.ParticipantsPatients who underwent cardiac surgery from July 2015 to December 2015 in Zhongshan Hospital, Fudan University.Main outcome measuresWe investigated the effect of hyperuricaemia, in combination with being overweight and hyperlipidaemia, on the risk of CSA-AKI.ResultsA total of 1420 patients were enrolled. The AKI incidence in the highest uric acid group was 44.4%, while that in the lowest uric acid group was 28.5% (p<0.001). Patients in the higher uric acid quartiles were more likely to be overweight and hyperlipidaemic at the same time (p<0.001). Multivariate logistic regression analysis showed that hyperuricaemia was an independent risk factor for AKI (OR=1.237, 95% CI 1.095 to 1.885; p=0.009); being overweight or hyperlipidaemia alone was not an independent risk factor, but the combination of being overweight and hyperlipidaemia was (OR=1.544, 95% CI 1.059 to 2.252; p=0.024). In the final model, the OR value increased to 3.126 when hyperuricaemia was combined with being overweight and hyperlipidaemia, and the Hosmer-Lemeshow test showed that all three models fit well (p=0.433, 0.638 and 0.597, respectively).ConclusionsThe combination of being overweight and having hyperlipidaemia was an independent risk factor, but being overweight or having hyperlipidaemia alone was not. The combination of hyperuricaemia, being overweight and hyperlipidaemia further increased the risk of CSA-AKI.


Author(s):  
Anh Binh Ho

Đặt vấn đề: Tổn thương thận cấp do thuốc cản quang là một trong những biến chứng quan trọng mà nếu dự đoán sớm các YTNC chúng ta có biện pháp phòng ngừa. Gần đây các nhà nghiên cứu còn đề xuất ra nhiều bảng điểm để xác định nguy cơ xuất hiện tổn thương thận cấp do thuốc cản quang như: điểm nguy cơ Mehran tỉ số giữa lượng thuốc cản quang và mức lọc cầu thận ước đoán. Chúng tôi nghiên cứu đề tài với mục tiêu: Đánh giá mối liên quan giữa các yếu tố nguy cơ tim mạch, điểm Mehran với tổn thương thận cấp do thuốc cản quang Đối tượng: 221 BN bệnh động mạch vành có chỉ định chụp, can thiệp động mạch vành. Phương pháp nghiên cứu: Mô tả cắt ngang, tiến cứu. Kết quả: Hạ huyết áp quanh thủ thuật là YTNC độc lập của tổn thương thận cấp do thuốc cản quang với OR = 5,299, khoảng tin cậy 95% 1,177-23,854 và P = 0,030. Nồng độ NT-proBNP là YTNC độc lập của tổn thương thận cấp do thuốc cản quang với OR = 1,000, khoảng tin cậy 95% 1,000-1,000 và P = 0,018. Điểm nguy cơ Mehran ở nhóm nguy cơ cao (11-15 điểm) là YTNC độc lập của tổn thương thận cấp do thuốc cản quang với OR = 7,983, khoảng tin cậy 95% 1,080-58,990 và P = 0,042. Điểm nguy cơ Mehran ở nhóm nguy cơ rất cao (≥ 16 điểm) là YTNC độc lập của tổn thương thận cấp do thuốc cản quang với OR = 53,821, khoảng tin cậy 95% 3,046-951,033 và P = 0,007. Kết luận: Hạ huyết áp quanh thủ thuật, nồng độ NT-proBNP, điểm Mehran ở nhóm nguy cơ cao và rất cao là YTNC độc lập của tổn thương thận cấp do thuốc cản quang. Từ khóa: Điểm nguy cơ Mehran, tổn thương thận cấp, thuốc cản quang, động mạch vành. ABSTRACT STUDY OF RELATIONSHIP BETWEEN CARDIOVASCULAR RISK FACTORS, MEHRAN SCORE AND CONTRAST - ASSOCIATED ACUTE KIDNEY INJURY Background: Contrast - associated acute kidney injury which is one of the major complications of percutaneous coronary intervention (PCI) can be prevented if it is predicted through risk factors. In recent years, researchers suggest many risk scores to determine the risk of contrast - induced acute kidney injury such as: Mehran risk score, the ratio between the amount of contrast, and estimated GFR. So we implement the study to find out the relationship between cardiovascular risk factors and contrast - associated acute kidney injury Objects: 221 patients who were diagnosed with coronary disease and treated by PCI. Methods: Prospective observational study. Results: Hypotension during the procedure is a independent risk factor of contrast-associated acute kidney injury with OR = 5,299, 95%CI 1,177-23,854 (p = 0,030). NT-proBNP is is a independent risk factor of contrast-associated acute kidney injury with OR = 1,000, 95%CI 1,000-1,000 (p = 0,018). Mehran score for the high risk patients (11-15 points) is an independent risk factor of contrast-associated acute kidney injury with OR = 7,983, 95%CI 1,080-58,990 (P = 0,042). Mehran score for the very high risk patients (≥ 16 points) is an independent risk factor of contrast-associated acute kidney injury with OR = 53,821, 95%CI 3,046-951,033 (P = 0,007). Conclusion: Intraoperative hypotension, NT-proBNP, Mehran score in high and very high risk groups are independent risk factors of contrast-associated acute kidney injury.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
X.F Tang ◽  
Y Yao ◽  
S.D Jia ◽  
Y Liu ◽  
B Xu ◽  
...  

Abstract Objective To investigate the clinical characteristics and long-term prognosis of coronary intervention in patients with premature coronary artery disease (PCAD) between different genders. Methods From January 2013 to December 2013, 4 744 patients diagnosed as PCAD with percutaneous coronary intervention (PCI) in our hospital were enrolled. The general clinical data, laboratory results and interventional treatment data of all patients were collected, and the occurrence of major adverse cardio-cerebrovascular events (MACCE) within 2 years after PCI was followed up. Results Of the 4 744 patients undergoing PCI, 3 390 (71.5%) were males and 1 354 (28.5%) were females. The 2-year follow-up results showed that the incidence of BARC grade 1 hemorrhage in female patients was significantly higher than that in male patients (6.9% vs. 3.7%; P&lt;0.001); however, there was no significant difference in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), all-cause death, cardiac death, recurrent myocardial infarction, revascularization (target vessel revascularization and target lesion revascularization), stent thrombosis, stroke and BARC grade 2–5 hemorrhage between the two groups (P&gt;0.05). Multivariate COX regression analysis showed that gender was an independent risk factor for BARC grade 1 bleeding events in PCAD patients (HR=2.180, 95% CI: 1.392–3.416, P&lt;0.001), but it was not an independent risk factor for MACCE and BARC grade 2–5 bleeding. Hyperlipidemia, preoperative SYNTAX score, multivessel lesions and NSTE-ACS were the independent risk factors for MACCE in PCAD patients with PCI (HR=1.289, 95% CI: 1.052–1.580, P=0.014; HR=1.030, 95% CI: 1.019–1.042, P&lt;0.001; HR=1.758, 95% CI: 1.365–2.264, P&lt;0.001; HR=1.264, 95% CI: 1.040–1.537, P=0.019); gender, hyperlipidemia, anticoagulant drugs like low molecular weight heparin or sulfonate were the independent risk factors for bleeding events (HR=1.579,95% CI 1.085–2. 297, P=0.017; HR=1.305, 95% CI 1.005–1.695, P=0.046; HR=1.321, 95% CI 1.002–1.741, P=0.048; HR=1.659, 95% CI 1.198–2.298, P=0.002). Conclusion The incidence of minor bleeding in women with PCAD is significantly higher than that in men; After adjusting for various risk factors, gender is an independent risk factor for minor bleeding events, but not an independent risk factor for MACCE in patients with PCAD. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science and Technology Support Program of China


2009 ◽  
Vol 32 (3) ◽  
pp. 173-179 ◽  
Author(s):  
Dejan Petrović ◽  
Radmila Obrenović ◽  
Biljana Stojimirović

Introduction Aortic valve calcification (AVC) accelerates development of aortic valve stenosis and cardiovascular complications. Hyperphosphatemia is one of the key risk factors for aortic valve calcification. Aim The aim of this study was to evaluate the prevalence of AVC in patients on regular hemodialysis and to assess the impact of different factors on its appearance. Method: The study investigated a total of 115 patients treated in the Hemodialysis Department of the Urology and Nephrology Clinic at the Kragujevac Clinical Center in Serbia. The variables investigated were: serum albumin, C-reactive protein (CRP), homocysteine, total cholesterol, LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), triglycerides (TG), Apolipoprotein A-I (Apo A-I), Apolipoprotein B (Apo B) and lipoprotein (a), calcium, phosphate and parathormone, and calcium-phosphorus product (Ca × P). Patients were evaluated by echocardiography for AVC. Statistical analysis included univariate and multivariate logistic regression analysis. Results Univariate regression analysis showed that serum phosphate levels and Ca × P are the most important risk factors for AVC (p<0.001). Multivariate logistic regression analysis revealed that hyperphosphatemia is an independent risk factor for AVC (p<0.001). Conclusion Hyperphosphatemia is an independent risk factor for aortic valve calcification.


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