Hyperuricemia: An Early Marker for Severity of Illness in Sepsis

Background.Uric acid can acutely activate various inflammatory transcription factors. Since high levels of oxyradicals and lower antioxidant levels in septic patients are believed to result in multiorgan failure, uric acid levels could be used as a marker of oxidative stress and poor prognosis in patients with sepsis.Design.We conducted a prospective cohort study on Medical Intensive Care Unit (MICU) patients and hypothesized that elevated uric acid in patients with sepsis is predictive of greater morbidity. The primary end point was the correlation between hyperuricemia and the morbidity rate. Secondary end points were Acute Kidney Injury (AKI), mortality, Acute Respiratory Distress Syndrome (ARDS), and duration of stay.Results.We enrolled 144 patients. 54 (37.5%) had the primary end point of hyperuricemia. The overall morbidity rate was 85.2%. The probability of having hyperuricemia along with AKI was 68.5% and without AKI was 31.5%. Meanwhile the probability of having a uric acid value <7 mg/dL along with AKI was 18.9% and without AKI was 81.1% (pvalue < 0.0001).Conclusion.We report that elevated uric acid levels on arrival to the MICU in patients with sepsis are associated with poor prognosis. These patients are at an increased risk for AKI and ARDS.

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Contrast-induced acute renal injury: multi-factor analysis to establish risks and associations

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20204522 ◽

2020 ◽

Vol 7 (11) ◽

pp. 1695

Author(s):

Jacob Joseph ◽

Ashish Indani ◽

Poonam Bhutada ◽

Saji Jose

Keyword(s):

Heart Failure ◽

Contrast Media ◽

Kidney Injury ◽

Coronary Intervention ◽

Morbidity Rate ◽

Ethical Guidelines ◽

Mortality And Morbidity ◽

Post Hoc Analysis ◽

Increased Risk ◽

Post Hoc

Background: Contrast-induced acute kidney Injury (CIAKI) also called nephropathy is one of the recurrent complications with very high mortality and morbidity rate amongst the patients undergoing percutaneous coronary intervention (PCI). The purpose of this research was to validate the incidence, risk factors, and correlation of various comorbidities with CIAKI.Methods: The study was conducted on 308 patients who had undergone PCI procedures. All patients were recruited following all ethical guidelines. All patients were treated as per the hospital protocol. All patients were followed up for 7 days post PCI. Out of 308 patients, 35 developed CIKAI while remaining was classified as control for post-hoc analysis comparison. Evaluation of the patients was done using Mehran’s risk score, ODD analysis and RADHIKa method.Results: The incidence of CIAKI was found in 35 (11.37%) out of 308 patients. No patients required dialysis within 1 week of the procedure. The use of the ionization optimized contrast medium (IOCM) is linked with the reduction of +CIAKI. The obvious relationship between the volume of contrast media, MRS, and CIAKI was reestablished. Post-hoc analysis of CIAKI and non-CIAKI revealed that the CIAKI is closely linked with heart failure as a risk factor. Congestive heart failure (CHF) increases the risk of CIAKI and that results in an increased risk of heart failure.Conclusion: In conclusion, the pre-existing multiple co-morbidities, volume, and ionization value of the contrast media were found to be directly associated with CIAKI.

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Acute Kidney Injury at Hospital Admission for SARS-CoV-2 Infection as a Marker of Poor Prognosis: Clinical Implications for Triage Risk Stratification

Kidney & Blood Pressure Research ◽

10.1159/000518271 ◽

2022 ◽

pp. 1-4

Author(s):

Carlo Andrea Bravi ◽

Walter Cazzaniga ◽

Marco Simonini ◽

Alessandro Larcher ◽

Elisabetta Messaggio ◽

...

Keyword(s):

Acute Kidney Injury ◽

Risk Stratification ◽

Hospital Admission ◽

Poor Prognosis ◽

Cox Regression ◽

Wide Spectrum ◽

Kidney Injury ◽

Prognostic Indicator ◽

Increased Risk ◽

Overall Mortality

Background/Aims: The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a wide spectrum of effects, including acute kidney injury (AKI) in up to 40% of hospitalized patients. Given the established relationship between AKI and poor prognosis, whether AKI might be a prognostic indicator for patients admitted to the hospital for SARS-CoV-2 infection would allow for a straightforward risk stratification of these patients. Methods: We analyzed data of 623 patients admitted to San Raffaele Hospital (Milan, IT) between February 25 and April 19, 2020, for laboratory-confirmed SARS-CoV-2 infection. Incidence of AKI at hospital admission was calculated, with AKI defined according to the KDIGO criteria. Multivariable Cox regression models assessed the association between AKI and overall mortality and admission to the intensive care unit (ICU). Results: Overall, 108 (17%) patients had AKI at hospital admission for SARS-CoV-2 infection. After a median follow-up for survivors of 14 days (interquartile range: 8, 23), 123 patients died, while 84 patients were admitted to the ICU. After adjusting for confounders, patients who had AKI at hospital admission were at increased risk of overall mortality compared to those who did not have AKI (hazards ratio [HR]: 2.00; p = 0.0004), whereas we did not find evidence of an association between AKI and ICU admission (HR: 0.95; p = 0.9). Conclusions: These data suggest that AKI might be an indicator of poor prognosis for patients with SARS-CoV-2 infection, and as such, given its readily availability, it might be used to improve risk stratification at hospital admission.

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Evaluation of the risk of acute kidney injury with the use of piperacillin/tazobactam among adult critically ill patients

Infection ◽

10.1007/s15010-020-01480-x ◽

2020 ◽

Vol 48 (5) ◽

pp. 741-747 ◽

Cited By ~ 1

Author(s):

Mohamed O. Saad ◽

Adham M. Mohamed ◽

Hassan A. Mitwally ◽

Ahmed A. Shible ◽

Ali Ait Hssain ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Primary Outcome ◽

Kidney Injury ◽

Outcome Analysis ◽

Control Group ◽

Multiple Logistic Regression ◽

Increased Risk ◽

Medical Intensive Care

Abstract Purpose Piperacillin/tazobactam (PT), when combined with vancomycin, is associated with an increased risk of acute kidney injury (AKI). It is not known whether PT alone is associated with a higher incidence of AKI compared to other β-lactams among critically ill patients. The objective of this study was to compare the incidence of AKI associated with the use of PT to other β-lactams among adult critically ill patients Methods This retrospective study was conducted in the surgical and the medical intensive care units at two hospitals within Hamad Medical Corporation (HMC) in Qatar and included adult critically ill patients who received at least one dose of anti-pseudomonal β-lactams. The primary outcome was acute kidney injury, defined using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Multiple logistic regression with adjustment for pre-specified potential confounders was used for the primary outcome analysis. Results A total of 669 patients were included in the analysis: 507 patients in the PT group and 162 patients in the control (meropenem/cefepime) group. AKI occurred in 136 (26.8%) members of the PT group and 38 (23.5%) members of the control group [odds ratio (OR) 1.2; 95% confidence interval (CI) 0.79–1.8]. The results were not significantly altered after adjusting for the pre-specified potential confounders (adjusted OR 1.38; 95% CI 0.88–2.15). Conclusion In this study, PT was not associated with a higher risk of AKI compared to cefepime or meropenem among adult critically ill patients.

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Serum Uric Acid and Risk for Acute Kidney Injury Following Contrast

Angiology ◽

10.1177/0003319716644395 ◽

2016 ◽

Vol 68 (2) ◽

pp. 132-144 ◽

Cited By ~ 17

Author(s):

Mehmet Kanbay ◽

Yalcin Solak ◽

Baris Afsar ◽

Ionut Nistor ◽

Gamze Aslan ◽

...

Keyword(s):

Acute Kidney Injury ◽

Clinical Trials ◽

Uric Acid ◽

Cohort Studies ◽

Meta Analysis ◽

Kidney Injury ◽

Significant Heterogeneity ◽

Increased Risk ◽

Hospital Acquired ◽

Significant Protective Effect

Contrast-induced acute kidney injury (CI-AKI) is a common cause of hospital-acquired acute kidney injury (AKI). We evaluated the evidence that uric acid (UA) plays a pathogenic role in CI-AKI. Ten studies were eligible for inclusion for meta-analysis. Hyperuricemia predicted risk for cases with AKI in prospective cohort studies. Higher levels of serum UA (SUA), as defined by the authors, were associated with a 2-fold increased risk to develop AKI (pooled odds ratio 2.03; 95% confidence interval [CI] 1.48-2.78). Significant heterogeneity was found in cohort studies ( P = .001, I2 = 85.7%). In 2 clinical trials, lowering of SUA with saline hydration was significantly associated with reduced risk for AKI compared with saline hydration alone or saline hydration with N-acetyl cysteine. An analysis of 2 randomized controlled trials found that allopurinol with saline hydration had a significant protective effect on renal function (assessed by serum creatinine values) compared with hydration alone (mean difference: −0.52 mg/dL; 95% CI: −0.81 to −0.22). Hyperuricemia independently predicts CI-AKI. Two clinical trials suggest lowering SUA may prevent CI-AKI. The mechanism by which UA induces CI-AKI is likely related to acute uricosuria.

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Higher clinical acuity and 7-day hospital mortality in non-COVID-19 acute medical admissions: prospective observational study

Emergency Medicine Journal ◽

10.1136/emermed-2020-210030 ◽

2021 ◽

Vol 38 (5) ◽

pp. 366-370

Author(s):

Marcus J Lyall ◽

Nazir I Lone

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Kidney Injury ◽

Severity Of Illness ◽

Hospital Death ◽

Hospital Inpatient ◽

Day Hospital ◽

Inpatient Mortality ◽

Increased Risk ◽

The Uk

ObjectivesTo understand the effect of COVID-19 lockdown measures on severity of illness and mortality in non-COVID-19 acute medical admissions.DesignA prospective observational study.Setting3 large acute medical receiving units in NHS Lothian, Scotland.ParticipantsNon-COVID-19 acute admissions (n=1682) were examined over the first 31 days after the implementation of the COVID-19 lockdown policy in the UK on 23 March 2019. Patients admitted over a matched interval in the previous 5 years were used as a comparator cohort (n=14 954).Main outcome measuresPatient demography, biochemical markers of clinical acuity and 7-day hospital inpatient mortality.ResultsNon-COVID-19 acute medical admissions reduced by 44.9% across all three sites in comparison with the mean of the preceding 5 years (p<0.001). Patients arriving during this period were more likely to be male, of younger age and to arrive by emergency ambulance transport. Non-COVID-19 admissions during lockdown had a greater incidence of acute kidney injury, lactic acidaemia and an increased risk of hospital death within 7 days (4.2% vs 2.5%), which persisted after adjustment for confounders (OR 1.87, 95% CI 1.43 to 2.41, p<0.001).ConclusionsThese data demonstrate a significant reduction in non-COVID-19 acute medical admissions during the early weeks of lockdown. Patients admitted during this period were of higher clinical acuity with a higher incidence of early inpatient mortality.

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Increased Risk of Complications After Pancreatoduodenectomy in Uninephrectomized Patients

International Surgery ◽

10.9738/intsurg-d-18-00022.1 ◽

2018 ◽

Vol 103 (7-8) ◽

pp. 386-395

Author(s):

Tadataka Takagi ◽

Masayuki Sho ◽

Satoshi Nishiwada ◽

Takahiro Akahori ◽

Minako Nagai ◽

...

Keyword(s):

Acute Kidney Injury ◽

Postoperative Complications ◽

Kidney Injury ◽

Surgical Site Infections ◽

Morbidity Rate ◽

Control Group ◽

Study Objective ◽

Soft Pancreas ◽

Increased Risk ◽

The Impact

Objective: The study objective is to investigate the impact of unilateral nephrectomy on the complications after pancreatoduodenectomy (PD). Summary of background data: Preoperative renal insufficiency is a risk factor for postoperative complications and mortality after various types of surgery. However, the specific postoperative risks in uninephrectomized (UN) patients are largely unknown. Methods: Between January 2010 and June 2014, a total of 177 patients underwent PD at the Department of Surgery, Nara Medical University. Among them, 7 patients (4.0%) were UN. We retrospectively evaluated the influence of the UN status on the postoperative complications. Results: The rate of acute kidney injury in the UN group was significantly higher than that in the control group (28.6% versus 1.2%; P = 0.017). In addition, the rates of surgical site infection of the organ/space (57.1% versus 9.0%; P = 0.006) and sepsis (42.9% versus 3.5%; P = 0.003) in UN group were significantly higher. Even on a reanalysis of only patients with soft pancreas, the significance remained. Conclusions: The UN status has a significant impact on the rate of morbidities, such as acute kidney injury and various infectious complications, including surgical site infections of organ/space, sepsis, and cholangitis after PD. Appropriate intervention should be implemented to decrease the morbidity rate for UN patients.

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Increased mortality associated with hypermagnesemia in severe COVID-19 illness

Kidney360 ◽

10.34067/kid.0002592021 ◽

2021 ◽

pp. 10.34067/KID.0002592021

Author(s):

Jacob S. Stevens ◽

Andrew A. Moses ◽

Thomas L. Nickolas ◽

S. Ali Husain ◽

Sumit Mohan

Keyword(s):

New York ◽

Acute Kidney Injury ◽

Care Center ◽

Kidney Injury ◽

Severity Of Illness ◽

Study Cohort ◽

Event Analysis ◽

Protein Levels ◽

Final Study ◽

Increased Risk

BACKGROUND: While electrolyte abnormalities are common among patients with COVID-19, very little has been reported on magnesium homeostasis in these patients. Here we report the incidence of hypermagnesemia and its association with outcomes among patients admitted with COVID-19. METHODS: We retrospectively identified all patients with a positive test result for SARS-CoV-2 who were admitted to a large quaternary care center in New York City in spring 2020. Details of the patients' demographics and hospital course were obtained retrospectively from the medical record. Patients were defined as having hypermagnesemia if their median magnesium over the course of their hospitalization was >2.4 mg/dL. RESULTS: A total of 1685 patients hospitalized with COVID-19 had magnesium levels checked during their hospitalization and were included in the final study cohort, among whom 355 (21%) had hypermagnesemia. Hypermagnesemic patients had a higher incidence of shock requiring pressors (35 vs 27%, p<0.01), respiratory failure requiring mechanical ventilation (28 vs 21%, p=0.01), acute kidney injury (65 vs 50%, p<0.001), and acute kidney injury severe enough to require renal replacement therapy (18 vs. 5%, p<0.001). In an adjusted multivariable model, hypermagnesemia was observed more commonly with increasing age, male sex, AKI requiring RRT, hyperkalemia, and higher CPK. Survival probability at 30 days was 34% for the patients with hypermagnesemia compared to 65% for patients without hypermagnesemia. An adjusted multivariable time to event analysis identified an increased risk of mortality with older age, need for vasopressors, higher C-reactive protein levels, and hypermagnesemia (HR 2.03, 95% CI 1.63-2.54, p<0.001). CONCLUSIONS: In conclusion, we identified an association between hypermagnesemia among patients hospitalized with COVID-19 and increased mortality. While the exact mechanism of this relationship remains unclear, hypermagnesemia potentially represents increased cell turnover and higher severity of illness which is frequently associated with more severe forms of AKI.

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Working conditions and occupational pathology of coal miners in the Arctic

Russian Journal of Occupational Health and Industrial Ecology ◽

10.31089/1026-9428-2019-59-8-452-457 ◽

2019 ◽

pp. 452-457 ◽

Cited By ~ 2

Author(s):

S. A. Gorbanev ◽

S. A. Syurin ◽

N. M. Frolova

Keyword(s):

Coal Mining ◽

Working Conditions ◽

Occupational Diseases ◽

Climatic Factors ◽

Coal Mines ◽

The Arctic ◽

Morbidity Rate ◽

Coal Miners ◽

Increased Risk ◽

The Impact

Introduction. Due to the impact of adverse working conditions and climate, workers in coal-mining enterprises in the Arctic are at increased risk of occupational diseases (OD).The aim of the study was to study the working conditions, causes, structure and prevalence of occupational diseases in miners of coal mines in the Arctic.Materials and methods. Th e data of social and hygienic monitoring “Working conditions and occupational morbidity” of the population of Vorkuta and Chukotka Autonomous District in 2007–2017 are studied.Results. It was established that in 2007–2017 years, 2,296 ODs were diagnosed for the first time in 1851 coal mines, mainly in the drifters, clearing face miners, repairmen and machinists of mining excavating machines. Most often, the ODs occurred when exposed to the severity of labor, fibrogenic aerosols and hand-arm vibration. The development of professional pathology in 98% of cases was due to design flaws of machines and mechanisms, as well as imperfections of workplaces and technological processes. Diseases of the musculoskeletal system (36.2%), respiratory organs (28.9%) and nervous system (22.5%) prevailed in the structure of professional pathology of miners of coal mines. Among the three most common nosological forms of OD were radiculopathy (32.1%), chronic bronchitis (27.7%) and mono-polyneuropathy (15.4%). In 2017, coal miners in the Arctic had a professional morbidity rate of 2.82 times higher than the national rates for coal mining.Conclusions. To preserve the health of miners of coal mining enterprises, technical measures to improve working conditions and medical interventions aimed at increasing the body’s resistance to the effects of harmful production and climatic factors are necessary.

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