Association Between Unbalanced Solutions and Acute Kidney Injury During Fluid Resuscitation in Children With Sepsis

2021 ◽  
pp. 088506662110044
Author(s):  
Jaime Fernández-Sarmiento ◽  
Catalina Alcalá-Lozano ◽  
Pedro Alexander Barrera ◽  
Sofía Camila Erazo Vargas ◽  
Laura Bibiana Gómez Cortes ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Metabolic Acidosis ◽  
Propensity Score ◽  
Organ Dysfunction ◽  
Fluid Resuscitation ◽  
Kidney Injury ◽  
Middle Income Country ◽  
Middle Income ◽  
Balanced Solutions

Objective: To evaluate the outcomes of patients with sepsis-associated organ dysfunction and septic shock who receive fluid resuscitation with balanced and unbalanced solutions in a middle-income country. Design: An observational, analytical cohort study with propensity score matching (PSM) in children admitted to a pediatric intensive care unit (PICU). Patients from one month to 17 years old who required fluid boluses due to hemodynamic instability were included. The primary outcome was the presence of acute kidney injury and the secondary outcomes were the need to begin continuous renal replacement therapy (CRRT), metabolic acidosis, PICU length of stay and mortality. Measurements and Main Results: Out of the 1,074 admissions to the PICU during the study period, 99 patients had sepsis-associated organ dysfunction and septic shock. Propensity score matching was performed including each patient´s baseline characteristics. The median age was 9.9 months (IQR 4.9-22.2) with 55.5% of the patients being male. Acute kidney injury was seen less frequently in children who received a balanced solution than in those who received an unbalanced solution (20.3% vs 25.7% P = 0.006 ORa, 0.75; 95% CI, 0.65-0.87), adjusted for disease severity. In addition, the group that received balanced solutions had less need for CRRT (3.3 % vs 6.5%; P = 0.02 ORa 0.48; 95% CI, 0.36-0.64) and a shorter PICU stay (6 days IQR 4.4-20.2 vs 10.2 days IQR 4.7-26; P < 0.001) than the group with unbalanced solutions. We found no difference in the frequency of metabolic acidosis ( P = 0.37), hyperchloremia ( P = 0.11) and mortality ( P = 0.25) between the 2 groups. Conclusion: In children with sepsis-associated organ dysfunction and septic shock, the use of unbalanced solutions for fluid resuscitation is associated with a higher frequency of acute kidney injury, a greater need for continuous renal support and a longer PICU stay compared to the use of balanced solutions, in a middle-income country.

Community-acquired pneumonia and acute kidney injury

2018 ◽  
Author(s):  
Norbert Lameire
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Severe Sepsis ◽  
Organ Dysfunction ◽  
Kidney Injury ◽  
Community Acquired Pneumonia

It is known that in one-half of the patients hospitalized for community-acquired pneumonia, severe sepsis develops, with non-pulmonary organ dysfunction developing in more than one-third and septic shock in 4.5%. Some years ago, it was found that acute kidney injury was common in community-acquired pneumonia even in patients who appeared to have an uncomplicated course of community-acquired pneumonia and where acute kidney injury was observed in one-quarter of them.

The Attributable Mortality of Sepsis for Acute Kidney Injury: A Propensity Score Matched Study

2021 ◽  
Author(s):  
Huimiao Jia ◽  
Yijia Jiang ◽  
Xi Zheng ◽  
Wen Li ◽  
Meiping Wang ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Mortality Rate ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Excess Mortality ◽  
Kidney Injury ◽  
Attributable Mortality ◽  
Hospital Death ◽  
Significant Difference

Abstract Background: Both sepsis and AKI are diseases of major concern in intensive care unit (ICU). This study aimed to evaluate the excess mortality attributable to sepsis for acute kidney injury (AKI).Methods: A propensity score-matched analysis of a prospective cohort study about sepsis epidemiology in 18 Chinese ICUs (January 2014-August 2015) was performed (registration number: ChiCTR-ECH-13003934). Propensity score model was sequentially conducted to match AKI patients with and without sepsis on day 1, day 2, and day 3-5. The primary outcome was hospital death of AKI patients. Propensity score-matched analyses were conducted to estimate the excess mortality attributable to sepsis for AKI. Results: A total of 2008 AKI patients (40.9%) were eligible for the study. Of the 1010 AKI patients with sepsis, 619 (61.3%) were matched to 619 AKI patients in whom sepsis did not develop during the screening period of the study. The hospital mortality rate of matched AKI patients with sepsis was 205 of 619 (33.1%) compared with 150 of 619 (24.0%) for their matched AKI controls without sepsis (p = 0.001). The attributable mortality of total sepsis for AKI patients was 9.1% (95% CI 4.8-13.3%). Matched AKI patients with and without sepsis were subgrouped according to the severity of sepsis (sepsis, septic shock). Of the matched patients with sepsis, 328 (53.0%) diagnosed septic shock. The mortality rate showed remarkably higher in matched AKI patients with septic shock (43.9%) than their controls of patients without sepsis (27.7%). The attributable mortality of septic shock for AKI was 16.2% (95% CI 11.3-20.8%, p < 0.001). Further, the attributable mortality of sepsis for AKI was 1.4% (95% CI 4.1-5.9%, p = 0.825), although there was no significant difference of mortality rate observed between matched AKI patients with and without sepsis (21.0% vs. 19.6%).Conclusions: The attributable hospital mortality of total sepsis for AKI were 9.1%. Septic shock contributes to major excess mortality rate for AKI than sepsis.

scholarly journals Paediatric porphyria and human hemin: a treatment challenge in a lower middle income country

2020 ◽  
Vol 13 (1) ◽  
pp. e232236 ◽  
Author(s):  
Syeda Anum Fatima ◽  
Humaira Jurair ◽  
Qalab Abbas ◽  
Arshalooz Jamila Rehman
Keyword(s):  
Emergency Department ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Acute Intermittent Porphyria ◽  
Paediatric Population ◽  
Middle Income Country ◽  
Middle Income ◽  
Glucose Intake ◽  
Days Of Therapy

Here, we report a case of a 15-year-old girl who presented to the emergency department with symptoms of abdominal pain, nausea, vomiting and seizures. She was diagnosed with acute intermittent porphyria. Treatment was started by removing all porphogenic drugs, providing high glucose intake (oral and intravenous), which initially resulted in good clinical outcomes. However, she deteriorated again and also developed neurological manifestation (paraplegia) for which she required mechanical ventilation because of acute respiratory failure. This time she was initiated on human hemin for four consecutive days. After 2 days of therapy, her porphobilinogen levels decreased to 50% of the initial raised value. Increased lactic acid and blood urea nitrogen were the two side effects observed after the treatment, with no apparent signs of acute kidney injury. To the best of our knowledge, in paediatric population, this is the first reported case of treatment of acute intermittent porphyria with human hemin in Pakistan.

Association between Procalcitonin and Acute Kidney Injury in Patients with Bacterial Septic Shock

2021 ◽  
pp. 1-10
Author(s):  
Guang Fu ◽  
Hai-chao Zhan ◽  
Hao-li Li ◽  
Jun-fu Lu ◽  
Yan-hong Chen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Piecewise Linear ◽  
Kidney Injury ◽  
Multiple Logistic Regression ◽  
Primary Analysis ◽  
Female Patients ◽  
Potential Biomarker ◽  
The Relationship

Objective: The objective of this study was to assess the relationship between serum procalcitonin (PCT) and acute kidney injury (AKI) induced by bacterial septic shock. Methods: A retrospective study was designed which included patients who were admitted to the ICU from January 2015 to October 2018. Multiple logistic regression and receiver operating characteristic (ROC) as well as smooth curve fitting analysis were used to assess the relationship between the PCT level and AKI. Results: Of the 1,631 patients screened, 157 patients were included in the primary analysis in which 84 (53.5%) patients were with AKI. Multiple logistic regression results showed that PCT (odds ratio [OR] = 1.017, 95% confidence interval [CI] 1.009–1.025, p < 0.001) was associated with AKI induced by septic shock. The ROC analysis showed that the cutoff point for PCT to predict AKI development was 14 ng/mL, with a sensitivity of 63% and specificity 67%. Specifically, in multivariate piecewise linear regression, the occurrence of AKI decreased with the elevation of PCT when PCT was between 25 ng/mL and 120 ng/mL (OR 0.963, 95% CI 0.929–0.999; p = 0.042). The AKI increased with the elevation of PCT when PCT was either <25 ng/mL (OR 1.077, 95% CI 1.022–1.136; p = 0.006) or >120 ng/mL (OR 1.042, 95% CI 1.009–1.076; p = 0.013). Moreover, the PCT level was significantly higher in the AKI group only in female patients aged ≤75 years (p = 0.001). Conclusions: Our data revealed a nonlinear relationship between PCT and AKI in septic shock patients, and PCT could be used as a potential biomarker of AKI in female patients younger than 75 years with bacterial septic shock.

Sign in / Sign up

Export Citation Format

Share Document