scholarly journals Dialysis circuit clotting in critically ill patients with COVID-19 infection

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Benjamin Zhi En Khoo ◽  
Regina Shaoying Lim ◽  
Yong Pey See ◽  
See Cheng Yeo
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Kidney Injury ◽  
Control Group ◽  
Intermittent Hemodialysis ◽  
Cox Regression Analysis ◽  
Kidney Replacement Therapy ◽  
Efficacy Of Treatment

Abstract Background Coronavirus Disease 2019 (COVID-19) infection has been associated with a hypercoagulable state with increased reports of thrombotic events. Acute kidney injury requiring dialysis is common in critically ill patients and circuit clotting compromises efficacy of treatment. This study aims to analyze the circuit life and circuit clotting during continuous kidney replacement therapy (CKRT) and intermittent hemodialysis in patients with and without COVID-19. Methods This is a single-center, retrospective cohort study in critically ill patients undergoing CKRT or intermittent hemodialysis between 1 February 2020 to 22 May 2020. Patients in the intensive care unit (ICU) with COVID-19 infection and contemporary controls who tested negative were included. Co-primary outcomes were functional circuit life for patients on CKRT and all circuit clotting events for patients on CKRT and/or intermittent hemodialysis. Results Seventy CKRT circuits and 32 intermittent hemodialysis sessions for 12 COVID-19 cases and 22 CKRT circuits and 18 intermittent hemodialysis sessions for 15 controls were analyzed. CKRT circuit clotting was more common in the COVID-19 group compared to the control group (64% vs 36%, p = 0.02), despite higher anticoagulation use in the COVID-19 group (41% vs 14%, p = 0.02). Functional CKRT circuit life was similar in COVID-19 patients and controls (median 11 vs 12 h, p = 0.69). On Cox regression analysis, circuit clotting was similar with hazard ratio (HR) 1.90 [95% confidence interval (CI): 0.89–4.04]; however, clotting was increased in COVID-19 patients after adjustment for anticoagulation use (HR: 3.31 [95% CI 1.49–7.33]). In patients with COVID-19, CKRT circuits with anticoagulation had a longer circuit life compared to CKRT circuits without anticoagulation (median 22 versus 7 h respectively, p <  0.001). Circuit clotting was similar in both groups undergoing intermittent hemodialysis. Conclusion Dialysis clotting amongst COVID-19 patients is increased despite more anticoagulation use and the hazard for clotting is greater especially after adjusting for anticoagulation use. Circuit life was suboptimal in COVID-19 patients on circuits without anticoagulation and therefore routine use of anticoagulation amongst COVID-19 patients should be considered whenever possible.

scholarly journals TIMP-2*IGFBP7 as an auxiliary identification of successful discontinuation CRRT and prediction of renal recovery in critically ill patients: a case control study

2020 ◽  
Author(s):  
yuanyuan xie ◽  
Alexander Zarbock ◽  
Alessandra Brendolan ◽  
Francesca Martino ◽  
Sara Samoni ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Kidney Injury ◽  
Renal Recovery ◽  
Cox Regression Analysis ◽  
Cycle Arrest ◽  
Kaplan Meier ◽  
Icu Discharge ◽  
The Moment

Abstract Background Cell cycle arrest biomarkers as TIMP-2*IGFBP7 are elevated in the Acute Kidney Stress and can predict the probability of developing Acute Kidney Injury (AKI). Approximately 25% of those patients with AKI deteriorate clinically and are unable to maintain adequate homeostasis, eventually requiring continuous renal replacement therapy. However, when clinical improvement occurs, the ideal mode of weaning patients from CRRT is an unmet medical need. Methods We performed a prospective single-center study of AKI patients treated with CRRT between October 2017 to April 2019 in a multidisciplinary ICU of an Italian hospital. All patients admitted to ICU requiring CRRT were enrolled. Urine samples for measuring urinary TIMP-2*IGFBP7 levels were collected immediately upon enrollment and at the moment when CRRT was discontinued. The primary endpoint was independence from RRT for at least 7 days after CRRT discontinuation. Renal recovery, which was defined as serum creatinine (SCr) level <1.5 times the baseline value at ICU discharge or day 28, was the secondary endpoint. Results 73 patients were enrolled of whom 45 patients effectively discontinued CRRT (61.6%). The patients with a TIMP-2*IGFBP7 concentration >2(ng/ml) 2 /1000 at enrollment were longer CRRT-dependent. The ROC-AUC values for the prediction of successful discontinuation with TIMP-2*IGFBP7 concentrations at enrollment, at discontinuation of CRRT and with the final model were 0.828, 0.814 and 0.882, respectively. The risk for CRRT discontinuation failure was nearly 5 times higher patients with a positive biomarker at CRRT discontinuation (OR 4.879, P=0.043), and 3.5 times higher in patients with a TIMP-2*IGFBP7 concentration >2(ng/ml) 2 /1000 at patient enrollment (OR 3.515, P=0.016). Multivariate Cox regression analysis showed a significant association between successful discontinuation of CRRT and TIMP-2*IGFBP7-negative patients at CRRT discontinuation (RR 0.436, 95% CI 0.202-0.939, P=0.034). Kaplan-Meier curves revealed that TIMP-2*IGFBP7 concentration <2 (ng/ml) 2 /1000 at enrollment and TIMP-2*IGFBP7 turning negative were positively related to high renal recovery rate. Conclusions Urinary TIMP-2*IGFBP7 can serve as a biomarker for identifying successful discontinuation CRRT and predicting renal recovery in critically ill patients.

scholarly journals Association Between Serum Osmolality and Acute Kidney Injury in Critically Ill Patients: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Jie Yang ◽  
Yisong Cheng ◽  
Ruoran Wang ◽  
Bo Wang
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
High Serum ◽  
Serum Osmolality ◽  
Multivariate Logistic Regression ◽  
Low Serum

Purposes: Acute kidney injury (AKI) is a common complication in critically ill patients and is usually associated with poor outcomes. Serum osmolality has been validated in predicting critically ill patient mortality. However, data about the association between serum osmolality and AKI is still lacking in ICU. Therefore, the purpose of the present study was to investigate the association between early serum osmolality and the development of AKI in critically ill patients.Methods: The present study was a retrospective cohort analysis based on the medical information mart for intensive care III (MIMIC-III) database. 20,160 patients were involved in this study and divided into six subgroups according to causes for ICU admission. The primary outcome was the incidence of AKI after ICU admission. The association between early serum osmolality and AKI was explored using univariate and multivariate logistic regression analyses.Results: The normal range of serum osmolality was 285–300 mmol/L. High serum osmolality was defined as serum osmolality &gt;300 mmol/L and low serum osmolality was defined as serum osmolality &lt;285 mmol/L. Multivariate logistic regression indicated that high serum osmolality was independently associated with increased development of AKI with OR = 1.198 (95% CL = 1.199–1.479, P &lt; 0.001) and low serum osmolality was also independently associated with increased development of AKI with OR = 1.332 (95% CL = 1.199–1.479, P &lt; 0.001), compared with normal serum osmolality, respectively.Conclusions: In critically ill patients, early high serum osmolality and low serum osmolality were both independently associated with an increased risk of development of AKI.

scholarly journals Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin-Tazobactam, Cefepime, or Meropenem

2019 ◽  
Vol 63 (5) ◽  
Author(s):  
Adam M. Blevins ◽  
Jennifer N. Lashinsky ◽  
Craig McCammon ◽  
Marin Kollef ◽  
Scott Micek ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Independent Predictor ◽  
Kidney Injury ◽  
University Hospital ◽  
Increased Risk ◽  
Kdigo Guidelines

ABSTRACT Critically ill patients are frequently treated with empirical antibiotic therapy, including vancomycin and β-lactams. Recent evidence suggests an increased risk of acute kidney injury (AKI) in patients who received a combination of vancomycin and piperacillin-tazobactam (VPT) compared with patients who received vancomycin alone or vancomycin in combination with cefepime (VC) or meropenem (VM), but most studies were conducted predominately in the non-critically ill population. A retrospective cohort study that included 2,492 patients was conducted in the intensive care units of a large university hospital with the primary outcome being the development of any AKI. The rates of any AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, were 39.3% for VPT patients, 24.2% for VC patients, and 23.5% for VM patients (P < 0.0001 for both comparisons). Similarly, the incidences of stage 2 and stage 3 AKI were also significantly higher for VPT patients than for the patients in the other groups. The rates of stage 2 and stage 3 AKI, respectively, were 15% and 6.6% for VPT patients, 5.8% and 1.8% for VC patients, and 6.6% and 1.3% for VM patients (P < 0.0001 for both comparisons). In multivariate analysis, the use of vancomycin in combination with piperacillin-tazobactam was found to be an independent predictor of AKI (odds ratio [OR], 2.161; 95% confidence interval [CI], 1.620 to 2.883). In conclusion, critically ill patients receiving the combination of VPT had the highest incidence of AKI compared to critically ill patients receiving either VC or VM.

scholarly journals Low Myostatin Serum Levels Are Associated with Poor Outcome in Critically Ill Patients

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 574
Author(s):  
Theresa H. Wirtz ◽  
Sven H. Loosen ◽  
Lukas Buendgens ◽  
Berkan Kurt ◽  
Samira Abu Jhaisha ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Muscle Growth ◽  
Serum Levels ◽  
Serum Concentrations ◽  
Icu Patients ◽  
Cox Regression Analysis ◽  
Independent Prognostic Marker ◽  
Unfavorable Clinical Outcome

Background: Growth differentiation factor 8, GDF-8 (Myostatin), is a protein released by myocytes inhibiting muscle growth and differentiation. Serum concentrations of Myostatin can predict poor survival in different chronic diseases, but its role in critical illness and sepsis is obscure. Our aim was to investigate Myostatin levels as a potential prognostic biomarker in critically ill patients with sepsis. Methods: We therefore measured Myostatin serum concentrations in 165 critically ill patients (106 with sepsis, 59 without sepsis) upon admission to the medical intensive care unit (ICU), in comparison to 14 healthy controls. Results: Myostatin levels were significantly decreased in ICU patients compared to controls but did not differ in patients with or without sepsis. However, Myostatin concentrations were significantly lower in patients requiring mechanical ventilation and indicated a trend towards dependency of intravenous vasopressors. Interestingly, we observed a negative correlation between Myostatin levels and markers of systemic inflammation. Strikingly, overall survival (OS) was significantly impaired in patients with low Myostatin levels in all critically ill patients. Low Myostatin levels at baseline turned out as an independent prognostic marker for OS in multivariate Cox-regression analysis (HR: 0.433, 95% CI: 0.211–0.889, p = 0.023). Conclusions: In summary, serum Myostatin concentrations are significantly decreased in critically ill patients and associated with disease severity. Low Myostatin levels also identify a subgroup of ICU patients that are more likely to face an unfavorable clinical outcome in terms of OS.

Which dialysis method should be used for patients with COVID-19?

2020 ◽  
Vol 54 ◽  
Author(s):  
Patricia Maria Gregoria Mina-Cuaño ◽  
Cary Amiel G. Villanueva ◽  
John Jefferson V. Besa ◽  
Andrew Rufino M. Villafuerte ◽  
Jayson M. Villavicencio ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Control Measures ◽  
Intermittent Hemodialysis ◽  
Strict Adherence ◽  
Infection Control Measures ◽  
Dialysis Method ◽  
American Society

KEY FINDINGS• Very low-quality evidence from a single retrospective study suggests that continuous renal replacementtherapy (CRRT) may reduce mortality among COVID-19 patients on invasive mechanical ventilation. Guidelinesrecommend CRRT for critically ill patients to minimize the risk of possible transmission, if this option is available.• Although uncommon, acute kidney injury (AKI) can occur in association with coronavirus disease 2019(COVID-19) and is associated with increased in-hospital mortality.• There are currently no published or ongoing clinical trials directly comparing dialysis modalities for acutekidney injury in COVID-19 patients.• In reducing the risk of transmission during dialysis: currently, there are no studies comparing one dialysismodality to another. The method of dialysis is still primarily determined by the clinical picture of the patient, theexpertise of the center, and the resources available. The American Society of Nephrology (ASN) recommendsCRRT over intermittent hemodialysis (IHD) for critically ill patients with COVID-19 to minimize patient contactwhen it is available, and resources allow. Otherwise, intermittent hemodialysis may be done provided that,infection control measures are strictly followed.• Several international and local guidelines recommend strict adherence to infection prevention and controlmeasures (e.g. hand hygiene, physical distancing, proper use of personal protective equipment (PPE), andcohorting of patients) who are undergoing dialysis.

scholarly journals The Impact of Early Achievement of Therapeutic Levels of Vancomycin in Critically Ill Patients With Confirmed Gram-Positive Infection: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Abdulrahman Alshaya ◽  
Amjad Alsaeed ◽  
Nadiyah Alshehri ◽  
Ramesh Vishwakarma ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Gram Positive ◽  
The Impact ◽  
Trough Levels

Abstract BackgroundVancomycin is a commonly used antibiotic in critically ill patients for various indications. Critical illness imposes pharmacokinetic-pharmacodynamics challenges which makes optimizing vancomycin in this population cumbersome. Data are scarce on the clinical impact of time to therapeutic trough levels of vancomycin in critically ill patients. Objective (s)The aim of this study to evaluate the timing to achieve therapeutic trough level vancomycin on 30-day mortality in critically ill patients.SettingAdult critically ill patients admitted to intensive care units (ICUs) between January 1st, 2017 and December 31st, 2018 at a tertiary teaching hospital.MethodA retrospective cohort study for all adult critically ill patients aged 18 years or older with confirmed gram-positive infection and received vancomycin. We compared early (<48 hours) versus late (≥ 48 hours) attainment of vancomycin therapeutic trough levels. Main outcomesPrimary outcome was the 30-day mortality in critically ill patients. Secondary outcomes were development of resistant organisms, eradicating microorganisms within 4-5 days of vancomycin initiation, vancomycin-induced acute kidney injury (AKI), and ICU LOS. ResultsTwo hundred and nine patients were included. No significant differences between comparative groups in baseline characteristics. Achieving therapeutic levels were associated with better survival at 30 days (OR: 0.48; 95% CI [0.26-0.87]; p<0.01). Additionally, patients who achieved therapeutic levels of vancomycin early were less likely to develop resistant organisms (OR=0.08; 95% CI [0.01-0.59]; p=0.01). Acute kidney injury (AKI) and ICU length of stay (LOS) were not significant between the two groups.ConclusionEarly attainment of vancomycin therapeutic levels was associated with possible survival benefit.

scholarly journals Association between tocilizumab and emerging multidrug-resistant organisms in critically ill patients with COVID-19: A multicenter, retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ohoud Aljuhani ◽  
Khalid Al Sulaiman ◽  
Adel Alshabasy ◽  
Khalid Eljaaly ◽  
Abdulrahman I. Al Shaya ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Randomized Clinical Trials ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Control Group ◽  
Microbial Isolation

Abstract Background Tocilizumab is an IgG1 class recombinant humanized monoclonal antibody that directly inhibits the IL-6 receptor. Several randomized clinical trials have evaluated its safety and efficacy in patients with coronavirus disease 2019 (COVID-19), and these studies demonstrate conflicting results. Our study aimed to determine the association between tocilizumab treatment and microbial isolation and emergence of multidrug-resistant bacteria in critically ill patients with COVID-19. Methods A multicenter retrospective cohort study was conducted at two tertiary government hospitals in Saudi Arabia. All critically ill patients admitted to intensive care units with a positive COVID-19 PCR test between March 1 and December 31, 2020, who met study criteria were included. Patients who received tocilizumab were compared to those who did not receive it. Results A total of 738 patients who met our inclusion criteria were included in the analysis. Of these, 262 (35.5%) received tocilizumab, and 476 (64.5%) were included in the control group. Patients who received tocilizumab had higher odds for microbial isolation (OR 1.34; 95% CI 0.91–1.94, p = 0.13); however, the difference was not statistically significant. Development of resistant organisms (OR 1.00; 95% CI 0.51–1.98, p = 0.99) or detection of carbapenem-resistant Enterobacteriaceae (CRE) (OR 0.67; 95% CI 0.29–1.54, p = 0.34) was not statistically significant between the two groups. Conclusions Tocilizumab use in critically ill patients with COVID-19 is not associated with higher microbial isolation, the emergence of resistant organisms, or the detection of CRE organisms.

scholarly journals Whether Early Pulse Steroid dose is associated with lower mortality in COVID-19 critically ill Patients- An exploratory retrospective Chart Review

2020 ◽  
Author(s):  
Abhishek Goyal ◽  
Saurabh Saigal ◽  
Ankur Joshi ◽  
Dodda Brahmam ◽  
Yogesh Niwariya ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Protective Effect ◽  
Critically Ill ◽  
Steroid Therapy ◽  
Critically Ill Patients ◽  
Chart Review ◽  
Cox Regression ◽  
Exploratory Analysis ◽  
Model Diagnostics ◽  
Cox Regression Analysis

Introduction: Steroids have shown its usefulness in critically ill COVID19 patients. However time of starting steroid and dose tailored to severity remains a matter of inquiry due to still emerging evidences and wide-ranging concerns of benefits and harms. We did a retrospective record analysis in an apex teaching hospital ICU setting to explore optimal doses and duration of steroid therapy which minimizes the hazard of death. Methodology: 114 adults with COVID19-ARDS admitted to ICU between 20thMarch-15thAugust2020 were included in chart review. We did preliminary exploratory analysis(rooted in steroid therapy matrix categorized by dose and duration) to understand the effect of several covariates on survival. This was followed by univariate and multivariate Cox proportion hazard regression analysis and model diagnostics. Results: Exploratory analysis and visualization indicated age, optimal steroid, severity (measured in P/F) of disease and infection status as potential covariates for survival. Univariate cox regression analysis showed significant positive association of age>60 years{2.6 (1.5-4.7)} and protective effect of optimum steroid{0.38(0.2-0.72)} on death (hazard) in critically ill patients. Multivariate cox regression analysis after adjusting effect of age showed protective effect of optimum steroid on hazard defined as death {0.46(0.23-0.87),LR=17.04,(p=2e-04)}.The concordance was 0.70 and model diagnostics fulfilled the assumption criteria for proportional hazard model. Conclusion: Optimal dose steroid as per defined optimum(<24 hours and doses tailored to P/F at presentation) criteria can offer protective effect from mortality which persists after adjusting for age. This protective effect was not found to be negatively influenced by the risk of infection.

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