Time to peak bilirubin concentration and advanced AKI were associated with increased mortality in rheumatic heart valve replacement surgery patients with severe postoperative hyperbilirubinemia: a retrospective cohort study

Abstract Background Hyperbilirubinemia after heart valve surgery (HVS) with cardiopulmonary bypass is frequently observed and associated with worse outcomes. We investigated the characteristics and prognosis of patients with severe hyperbilirubinemia after HVS for rheumatic heart disease (RHD) to identify the clinical outcomes and potential risk factors. Methods Between 2015 and 2018, patients who underwent HVS in the cardiac surgery intensive care unit of our hospital were retrospectively screened. Risk factors for acute kidney injury (AKI), the requirement for continuous renal replacement therapy (CRRT), and in-hospital and long-term mortality were identified by univariate and multivariate analyses. The patient survival proportion was graphically presented with the Kaplan–Meier method. Results A total of 149 patients who underwent HVS for RHD and had severe postoperative hyperbilirubinemia were included. Of the included patients, 80.5% developed postoperative AKI, and 18.1% required CRRT. The in-hospital mortality was 30.2%. Backward logistic regression analysis showed that the time to peak TB concentration (odds ratio [OR] 1.557, 95% confidence interval [CI] 1.259–1.926; P < 0.001) and advanced AKI (stage 2 and 3 AKI) (OR 19.408, 95% CI 6.553–57.482; P < 0.001) were independent predictors for in-hospital mortality. The cutoff value of the time to peak TB levels for predicting in-hospital mortality was 5 postoperative days. Conclusions Severe postoperative hyperbilirubinemia is a life-threatening complication in patients who undergo HVS for RHD. Patients whose bilirubin levels continued to increase past the 5th postoperative day and who had advanced AKI (stages 2 and 3) were associated with a higher risk of mortality.

Download Full-text

Incidence, Severity, and Outcomes of Acute Kidney Injury in Octogenarians following Heart Valve Replacement Surgery

International Journal of Nephrology ◽

10.1155/2015/237951 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Michael A. Mao ◽

Charat Thongprayoon ◽

YiFan Wu ◽

Vickram Tejwani ◽

Myriam Vela-Ortiz ◽

...

Keyword(s):

Acute Kidney Injury ◽

Valve Replacement ◽

Heart Valve ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

Heart Valve Replacement ◽

Replacement Surgery ◽

Kaplan Meier ◽

Stage 1 ◽

Valve Replacement Surgery

Background. The study investigates the occurrence, severity, and outcomes of acute kidney injury (AKI) in octogenarians following heart valve surgery.Methods. All patients, age>80 years, not on dialysis and without kidney transplant, undergoing heart valve replacement at Mayo Clinic, Rochester, in the years 2002-2003 were enrolled. AKI was diagnosed based on AKIN criteria.Results. 209 octogenarians (88.0% aortic valve, 6.2% mitral valve, 1.0% tricuspid valve, and 4.8% multivalve) with (58.4%) and without CABG were studied. 34 (16.3%) had preexisting CKD. After surgery, 98 (46.8%) developed AKI. 76.5% of the AKI were in Stage 1, 9.2% in Stage 2, and 14.3% in Stage 3. 76.5% CKD patients developed AKI. Length of hospital stay was longer for AKI patients. More AKI patients were discharged to care facilities. Patient survival at 30 days and 1 year for AKI versus non-AKI was 88.8 versus 98.7%,p=0.003, and 76.5 versus 88.3%,p=0.025, respectively. With follow-up of3.94±0.28years, Kaplan-Meier analysis showed a reduced survival for AKI octogenarians. Preexisting CKD and large volume intraoperative fluid administration were independent AKI predictors.Conclusions. Nearly half of the octogenarians developed AKI after valve replacement surgery. AKI was associated with significant functional impairment and reduced survival.

Download Full-text

Comparison of clinical and cost effectiveness of accelerated study of sterility of intravascular catheters and drains

Medical alphabet ◽

10.33667/2078-5631-2021-32-44-47 ◽

2021 ◽

pp. 44-47

Author(s):

V. G. Kormilitsyna ◽

V. G. Zaletaeva ◽

S. O. Sharapchenko ◽

R. Sh. Saidgareev ◽

M. Yu. Sinyak ◽

...

Keyword(s):

Risk Factors ◽

Cost Effectiveness ◽

Hospital Mortality ◽

Human Body ◽

External Environment ◽

Invasive Procedure ◽

Central Venous ◽

Life Threatening ◽

Associated Conditions ◽

Intravascular Catheters

The results of a new method for detecting the contamination of intravascular catheters and drains are presented to assess its clinical and cost-effectiveness. Catheters are one of the most widely used devices in critically ill patients. The insertion of a catheter into the central venous system is an invasive procedure that can potentially lead to life-threatening complications for the patient. Catheters are a gateway for infection as they connect the external environment to the internal parts of the human body, causing catheter-associated infections. More than 15 % of patients with an established IVC develop complications, of which the most frequent and requiring removal of the vascular catheter are infectious (5–26 %) and mechanical (up to 25 %). Risk factors for catheter-associated conditions are crucial for hospital mortality.

Download Full-text

In-hospital mortality after hip arthroplasty in China

The Bone & Joint Journal ◽

10.1302/0301-620x.101b10.bjj-2018-1608.r1 ◽

2019 ◽

Vol 101-B (10) ◽

pp. 1209-1217 ◽

Cited By ~ 5

Author(s):

Chao Zeng ◽

Nancy E. Lane ◽

Martin Englund ◽

Dongxing Xie ◽

Hu Chen ◽

...

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Hip Arthroplasty ◽

Potential Risk ◽

Sociodemographic Factors ◽

North West ◽

North East ◽

The North ◽

South Central ◽

Potential Risk Factors

Aims There is an increasing demand for hip arthroplasty in China. We aimed to describe trends in in-hospital mortality after this procedure in China and to examine the potential risk factors. Patients and Methods We included 210 450 patients undergoing primary hip arthroplasty registered in the Hospital Quality Monitoring System in China between 2013 and 2016. In-hospital mortality after hip arthroplasty and its relation to potential risk factors were assessed using multivariable Poisson regression. Results During the study period, 626 inpatient deaths occurred within 30 days after hip arthroplasty. Mortality decreased from 2.9% in 2013 to 2.6% in 2016 (p for trend = 0.02). Compared with their counterparts, old age, male sex, and divorced or widowed patients had a higher rate of mortality (all p < 0.05). Risk ratio (RR) for mortality after arthroplasty for fracture was two-fold higher (RR 2.0, 95% confidence interval (CI) 1.5 to 2.6) than that for chronic disease. RRs for mortality were 3.3 (95% CI 2.7 to 3.9) and 8.2 (95% CI 6.5 to 10.4) for patients with Charlson Comorbidity Index (CCI) of 1 to 2 and CCI ≥ 3, respectively, compared with patients with CCI of 0. The rate of mortality varied according to geographical region, the lowest being in the East region (1.8%), followed by Beijing (2.1%), the North (2.9%), South-West (3.6%), South-Central (3.8%), North-East (4.1%), and North-West (5.2%) regions. Conclusion While in-hospital mortality after hip arthroplasty in China appears low and declined during the study period, discrepancies in mortality after this procedure exist according to sociodemographic factors. Healthcare resources should be allocated more to underdeveloped regions to further reduce mortality. Cite this article: Bone Joint J 2019;101-B:1209–1217

Download Full-text

Risk factors for acute kidney injury among patients with rhabdomyolysis

10.21203/rs.3.rs-19317/v1 ◽

2020 ◽

Author(s):

Jia Yang ◽

Jiaojiao Zhou ◽

Xin Wang ◽

Siwen Wang ◽

Yi Tang ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

High Risk ◽

Hospital Mortality ◽

Laboratory Data ◽

Elevated Serum ◽

Kidney Injury ◽

Chronic Alcoholism ◽

Multiple Organ ◽

Bee Sting

Abstract Background Acute kidney injury (AKI) is a life-threatening complication of rhabdomyolysis (RM). The aim of the present study was to assess patients at high risk for the occurrence of AKI defined by the Kidney Disease Improving Global Outcomes criteria and in-hospital mortality. Methods We performed a retrospective study of patients with creatine kinase levels >1000 U/L, who were admitted to the West China Hospital of Sichuan University between January 2011 and March 2019. The sociodemographic, clinical and laboratory data of these patients were obtained from an electronic medical records database, and univariate and multivariate regression analyses were subsequently conducted. Results For the 329 patients included in our study, the incidence of AKI was 61.4%, and the overall mortality rate was 19.8%; furthermore, patients with AKI tended to have higher mortality rates than those without AKI (24.8% vs. 11.8%; P<0.01). The clinical conditions most frequently associated with RM were trauma (28.3%), sepsis (14.6%), bee sting (12.8%), thoracic and abdominal surgery (11.2%) and exercise (7.0%). Furthermore, patients with RM resulting from sepsis, bee sting and acute alcoholism were more susceptible to AKI. The risk factors for the occurrence of AKI among RM patients included age ≥60 years (OR=3.070), chronic alcoholism (OR=3.256), hypertension (OR=4.252), multiple organ dysfunction syndrome (MODS; OR=7.244), high levels of white blood cell count (OR=1.047) and elevated serum phosphorus (OR=5.526). Age ≥60 years (OR=3.188), MODS (OR=2.262), diabetes (OR=2.746) and elevated prothrombin time (OR=1.079) were independent risk factors for in-hospital mortality in RM patients with AKI. Conclusions AKI is independently associated with mortality in patients with RM, and several risk factors were found to be associated with the occurrence of AKI and in-hospital mortality. These findings suggest that, to improve the quality of medical care, the early prevention of AKI should focus on high-risk patients and more effective management.

Download Full-text

Incidence and risk factors of acute kidney injury after femoral neck fracture in elderly patients: a retrospective case-control study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04966-3 ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Sizheng Zhan ◽

Wenyong Xie ◽

Ming Yang ◽

Dianying Zhang ◽

Baoguo Jiang

Keyword(s):

Risk Factors ◽

Femoral Neck ◽

Elderly Patients ◽

Femoral Neck Fracture ◽

Kidney Injury ◽

Intraoperative Hypotension ◽

Neck Fracture ◽

Potential Risk Factors ◽

Independent Risk Factors ◽

Postoperative Aki

Abstract Background Hip fracture is highly associated with disability and consequently, mortality in the elderly population. Postoperative acute kidney injury (AKI) is not unusual and is associated with considerable morbidity and mortality. We aimed to determine the incidences and potential risk factors for postoperative AKI in elderly patients with femoral neck fracture. Methods We retrospectively evaluated patients over 65 years of age who had been subjected to surgery for femoral neck fracture at Peking University People's Hospital from January 2015 to December 2019. Demographic characteristics and potential risk factors were collected. AKI was defined according to the Kidney Disease Improving Global Outcomes Guidelines (KDIGO). Results A total of 308 elderly patients with femoral neck fracture were included in the study. The overall incidence of postoperative AKI was 12% (37 cases). Through binary logistic regression analysis, adjusted for age, intraoperative blood loss and BMI, we identified that early postoperative albumin levels, hemoglobin changes and intraoperative hypotension are independent risk factors for postoperative AKI. The model considering the three factors can improve accuracy of predicting the possibility of developing AKI. The patients with AKI had a significantly higher mortality of 40.5% than those without AKI (24.0%, p < 0.001) Conclusion The incidence of postoperative AKI in elderly patients with femoral neck fracture was 12%. Independent risk factors for postoperative AKI included hemoglobin changes, early postoperative hypoalbuminemia and intraoperative hypotension. At the same time, postoperative AKI significantly increased mortality in elderly patients with femoral neck fracture. Taking multiple possible factors into consideration can better predict the possibility of elderly patients developing AKI after surgery.

Download Full-text

Acute Kidney Disease and Mortality in Acute Kidney Injury Patients with COVID-19

Journal of Clinical Medicine ◽

10.3390/jcm10194599 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4599

Author(s):

Filipe Marques ◽

Joana Gameiro ◽

João Oliveira ◽

José Agapito Fonseca ◽

Inês Duarte ◽

...

Keyword(s):

Risk Factors ◽

Kidney Disease ◽

Hospital Mortality ◽

Significant Risk ◽

Kidney Injury ◽

Risk Of Mortality ◽

Number Of Patients ◽

Acute Kidney Disease ◽

Risk Patients ◽

Stage 1

Background: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients is variable and has been associated with worse prognosis. A significant number of patients develop persistent kidney damage defined as Acute Kidney Disease (AKD). There is a lack of evidence on the real impact of AKD on COVID-19 patients. We aim to identify risk factors for the development of AKD and its impact on mortality in COVID-19 patients. Methods: Retrospective analysis of COVID-19 patients with AKI admitted at the Centro Hospitalar Universitário Lisboa Norte between March and August of 2020. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. AKD was defined by presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. Results: In 339 COVID-19 patients with AKI, 25.7% patients developed AKD (n = 87). The mean age was 71.7 ± 17.0 years, baseline SCr was 1.03 ± 0.44 mg/dL, and the majority of patients were classified as KDIGO stage 3 AKI (54.3%). The in-hospital mortality was 18.0% (n = 61). Presence of hypertension (p = 0.006), CKD (p < 0.001), lower hemoglobin (p = 0.034) and lower CRP (p = 0.004) at the hospital admission and nephrotoxin exposure (p < 0.001) were independent risk factors for the development of AKD. Older age (p = 0.003), higher serum ferritin at admission (p = 0.008) and development of AKD (p = 0.029) were independent predictors of in-hospital mortality in COVID-19-AKI patients. Conclusions: AKD was significantly associated with in-hospital mortality in this population of COVID-19-AKI patients. Considering the significant risk of mortality in AKI patients, it is of paramount importance to identify the subset of higher risk patients.

Download Full-text

Preprocedural Lp(a) level and ApoB/ApoA-Ι ratio and the risk for contrast-induced acute kidney injury in patients undergoing emergency PCI

Lipids in Health and Disease ◽

10.1186/s12944-021-01535-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Jun Tao ◽

Wen Dai ◽

Chenglin Ye ◽

Qian Yao ◽

Man Zhou ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Kidney Diseases ◽

Kidney Injury ◽

Cubic Spline ◽

High Serum ◽

Serum Lipoprotein ◽

Creatinine Concentration ◽

Potential Risk Factors

Abstract Background High serum Lipoprotein(a) (Lp(a)) level and Apolipoprotein B/Apolipoprotein AΙ (ApoB/ApoA-Ι) ratio are risk factors for cardiovascular disease and kidney disease and have been found to be correlated with the prevalence and prognosis of various kidney diseases. However, it is not clear whether the serum Lp(a) level and ApoB/ApoA-Ι ratio pre-PCI are correlated with the prevalence of contrast-induced acute kidney injury (CI-AKI). Methods A total of 931 participants undergoing emergency PCI from July 2018 to July 2020 were included. According to whether the serum creatinine concentration was higher than the baseline concentration (by ≥25% or ≥ 0.5 mg/dL) 48–72 h after contrast exposure, these participants were divided into a CI-AKI group (n = 174) and a non-CI-AKI group (n = 757). Serum Lp(a), ApoA-Ι and ApoB concentration were detected in the patients when they were admitted to hospital, and the ApoB/ApoA-Ι ratio was calculated. Logistic regression and restricted cubic spline analyses were used to explore the correlation between the Lp(a) concentration or the ApoB/ApoA-Ι ratio and the risk of CI-AKI. Results Among the 931 participants undergoing emergency PCI, 174 (18.69%) participants developed CI-AKI. Compared with the non-CI-AKI group, the Lp(a) level and ApoB/ApoA-Ι ratio pre-PCI in the CI-AKI group were significantly higher (P < 0.05). The incidence of CI-AKI was positively associated with the serum Lp(a) level and ApoB/ApoA-Ι ratio pre-PCI in each logistic regression model (P < 0.05). After adjusting for all the risk factors included in this study, restricted cubic spline analyses found that the Lp(a) level and the ApoB/ApoA-Ι ratio before PCI, within certain ranges, were positively associated with the prevalence of CI-AKI. Conclusion High Lp(a) levels and high ApoB/ApoA-Ι ratios before PCI are potential risk factors for CI-AKI.

Download Full-text

Acute kidney injury in hospitalized patients with COVID-19

10.21203/rs.3.rs-39131/v1 ◽

2020 ◽

Cited By ~ 2

Author(s):

Joana Gameiro ◽

José Agapito Fonseca ◽

João Oliveira ◽

Filipe Marques ◽

João Bernardo ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Multivariate Analysis ◽

Kidney Disease ◽

Hospital Mortality ◽

Kidney Injury ◽

Hospitalized Patients ◽

Single Center ◽

Transient Aki ◽

Worse Prognosis

Abstract Introduction: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients ranges from 0.5 to 35% and has been associated with worse prognosis. The purpose of this study was to evaluate the incidence, severity, duration, risk factors and prognosis of AKI in hospitalized patients with COVID-19.Methods: We conducted a retrospective single-center analysis of 192 hospitalized COVID-19 patients from March to May of 2020. AKI was diagnosed using the Kidney Disease Improving Global Outcome (KDIGO) classification based on serum creatinine (SCr) criteria. Persistent and Transient AKI were defined according to the Acute Disease Quality Initiative (ADQI) workgroup definitions.Results: In this cohort of COVID-19 patients, 55.2% developed AKI (n=106). The majority of AKI patients had persistent AKI (n=64, 60.4%). Overall, in-hospital mortality was 18.2% (n=35) and was higher in AKI patients (28.3% vs 5.9%, p<0.001, unadjusted OR 6.03 (2.22-16.37), p<0.001). On a multivariate analysis, older age (adjusted OR 1.08 (95% CI 1.02-1.13), p=0.004), lower Hb level (adjusted OR 0.69 (95% CI 0.53-0.91), p=0.007) and acidemia at presentation (adjusted OR 5.53 (95% CI 1.70-18.63), p=0.005), duration of AKI (adjusted OR 7.91 for persistent AKI (95% CI 2.39-26.21), p=0.001) and severity of AKI (adjusted OR 2.30 per increase in KDIGO stage (95% CI 1.10-4.82), p=0.027) were independent predictors of mortality.Conclusion: AKI was frequent in hospitalized patients with COVID-19. Persistent AKI and higher severity of AKI were independent predictors of in-hospital mortality.

Download Full-text

Characteristics and outcomes of Stanford type A aortic dissection patients with post-operation severe hyperbilirubinemia: a retrospective cohort study

10.21203/rs.3.rs-30855/v1 ◽

2020 ◽

Author(s):

Xiaolan Chen ◽

Ming Bai ◽

Lijuan Zhao ◽

Yangping Li ◽

Yan Yu ◽

...

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Aortic Dissection ◽

Hospital Mortality ◽

Multivariate Logistic Regression Analysis ◽

Kidney Injury ◽

Type A ◽

Type A Aortic Dissection ◽

Post Operation ◽

Severe Hyperbilirubinemia

Abstract Background Hyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the report on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients is limited. Methods Patients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints. Results 271 (12.3%) patients were included. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. In-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9%, 33.9%, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age (P < 0.033), AKI stage 3 (P < 0.001), the amount of blood transfusion after surgery (P = 0.019), mean arterial pressure (MAP) in the first postoperative day (P = 0.012), the use of extracorporeal membrane oxygenation (ECMO) (P = 0.02), and the peak total bilirubin (TB) concentration (P = 0.023) were independent risk factors of in-hospital mortality. The optimal cut-off value of peak TB on predicting in-hospital mortality was 121.2 µmol/l. Survival analysis showed significantly decreased survival for patients who developed severe, rather than mild, hyperbilirubinemia. Conclusions Post-operation severe hyperbilirubinemia is a common clinical presentation in AAD surgery patients. Post-operation severe hyperbilirubinemia AAD patients with older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB had higher risk of in-hospital mortality.

Download Full-text

Unclogging the effects of the Angiojet® thrombectomy system on kidney function: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-03062-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Tayeba Roper ◽

Muhammad Amaran ◽

Prakash Saha ◽

Cormac Breen ◽

David Game

Keyword(s):

Risk Factors ◽

Early Recognition ◽

Femoral Vein ◽

Kidney Injury ◽

Major Surgery ◽

Percutaneous Mechanical Thrombectomy ◽

Intravascular Haemolysis ◽

Post Procedure ◽

Potential Risk Factors ◽

Laboratory Investigations

Abstract Background AngioJet® is an increasingly used method of percutaneous mechanical thrombectomy for the treatment of patients with arterial and venous thromboses. AngioJet® has been shown to cause intravascular haemoylsis universally. We report the case of a 29 year old patient who underwent AngioJet® thrombectomy and post-procedure developed a stage 3 Acute kidney injury (AKI.) requiring renal replacement therapy (RRT), secondary to intravascular haemolysis. We aim to explore the mechanism and potential risk factors associated with developing AKI in these patients and suggest steps to optimise patient management. Case presentation A 29 year old Caucasian male who developed a stage 3 AKI, requiring RRT, following AngioJet® thrombectomy for an occluded femoral vein stent. Urine and laboratory investigations showed evidence of intravascular haemolysis, which was the likely cause of AKI. Following a brief period of RRT he completely recovered renal function. Conclusions AKI is an increasingly recognised complication following AngioJet® thrombectomy, but remains underappreciated in clinical practice. AKI results from intravascular haemolysis caused by the device. Up to 13% of patients require RRT, but overall short-term prognosis is good. Pre-procedural risk factors for the development of AKI include recent major surgery. Sodium bicarbonate should be administered to those who develop renal impairment. Renal biopsy is high risk and does not add to management. Increased clinician awareness and vigilance for AKI post-procedure can allow for early recognition and referral to nephrology services for ongoing management.

Download Full-text