scholarly journals High dose intravenous vitamin C treatment in Sepsis: associations with acute kidney injury and mortality

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thomas R. McCune ◽  
Angela J. Toepp ◽  
Brynn E. Sheehan ◽  
Muhammad Shaheer K. Sherani ◽  
Stephen T. Petr ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
High Dose ◽  
Clinical Covariates ◽  
Observational Cohort ◽  
Intravenous Vitamin

Abstract Background The effects of vitamin C on clinical outcomes in critically ill patients remain controversial due to inconclusive studies. This retrospective observational cohort study evaluated the effects of vitamin C therapy on acute kidney injury (AKI) and mortality among septic patients. Methods Electronic medical records of 1390 patients from an academic hospital who were categorized as Treatment (received at least one dose of 1.5 g IV vitamin C, n = 212) or Comparison (received no, or less than 1.5 g IV vitamin C, n = 1178) were reviewed. Propensity score matching was conducted to balance a number of covariates between groups. Multivariate logistic regressions were conducted predicting AKI and in-hospital mortality among the full sample and a sub-sample of patients seen in the ICU. Results Data revealed that vitamin C therapy was associated with increases in AKI (OR = 2.07 95% CI [1.46–2.93]) and in-hospital mortality (OR = 1.67 95% CI [1.003–2.78]) after adjusting for demographic and clinical covariates. When stratified to examine ICU patients, vitamin C therapy remained a significant risk factor of AKI (OR = 1.61 95% CI [1.09–2.39]) and provided no protective benefit against mortality (OR = 0.79 95% CI [0.48–1.31]). Conclusion Ongoing use of high dose vitamin C in sepsis should be appraised due to observed associations with AKI and death.

scholarly journals High Dose Intravenous Vitamin C Treatment in Sepsis: Associations with Acute Kidney Injury and Mortality Running Title Vitamin C associated AKI and mortality

2021 ◽  
Author(s):  
Thomas McCune ◽  
Brynn E Sheehan ◽  
Muhammad Shaheer K Sherani ◽  
Stephan T Petr ◽  
Angela J Toepp ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
High Dose ◽  
Clinical Covariates ◽  
Observational Cohort ◽  
Intravenous Vitamin

Abstract The effects of vitamin C on clinical outcomes in critically ill patients remain controversial due to inconclusive studies. This retrospective observational cohort study evaluated the effects of vitamin C therapy on acute kidney injury (AKI) and mortality among septic patients. Participants were 1390 patients from an academic hospital who were categorized as Treatment (received at least one dose of 1.5g IV vitamin C, n = 212) or Comparison (received no, or less than 1.5g IV vitamin C, n = 1178). Propensity score matching was conducted to balance a number of covariates between groups. Multivariate logistic regressions were conducted predicting AKI and in-hospital mortality among the full sample and a sub-sample of patients seen in the ICU. Results revealed that vitamin C therapy was associated with increases in AKI (OR = 2.07 95% CI [1.46–2.93]) and in-hospital mortality (OR = 1.67 95% CI [1.003–2.78]) after adjusting for demographic and clinical covariates. When stratified to examine ICU patients, vitamin C therapy remained a significant risk factor of AKI (OR = 1.61 95% CI [1.09–2.39]) and provided no protective benefit against mortality (OR = 0.79 95% CI [0.48–1.31]). Ongoing use of high dose vitamin C in sepsis should be appraised due to observed associations with AKI and death.

scholarly journals Efficacy of Using High-Dose Vitamin C, Thiamine, and Hydrocortisone in Sepsis and Septic Shock: A Retrospective Before-After Study

2021 ◽  
Author(s):  
Haytham Wali ◽  
William Malik ◽  
Juliane Mayette
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
P Value ◽  
Permeability Barrier ◽  
High Dose ◽  
High Dose Vitamin

Abstract Background/Objective Sepsis can be associated with increased production of reactive oxygen species that deplete antioxidant molecules and increase the consumption of vitamin C, which correlates with multiorgan failure and death. Intravenous vitamin C may protect several microvascular functions, including capillary blood flow, microvascular permeability barrier, and arteriolar responsiveness to vasoconstrictors and vasodilators. This study was conducted to assess the practice of administering high-dose vitamin C in critically ill patients with sepsis or septic shock at our institution retrospectively.Methods We conducted an electronic health record (EHR)-based, retrospective, before-after study. The primary objective was to assess the efficacy of using a high-dose vitamin C regimen in decreasing hospital mortality. A two-sided P-value of < 0.05 was considered statistically significant.Results A total of 84 patient records were included in this study. Administration of high-dose vitamin C, thiamine, and hydrocortisone was associated with higher hospital mortality (64.3% versus 42.9%; P = 0.049), higher ICU mortality (59.5% versus 42.9%; P = 0.07), shorter ICU length of stay (three versus seven days; P = 0.53), higher incidence of acute kidney injury (61.9% versus 26.2%; P = 0.001), and a higher requirement for renal replacement therapy (76.9% versus 45.5%; P = 0.06).Conclusion Administration of high-dose vitamin C, thiamine, and hydrocortisone in critical care patients with sepsis or septic shock was associated with higher hospital mortality and higher incidence of acute kidney injury.

scholarly journals Incidence and risk predictors of acute kidney injury among HIV-positive patients presenting with sepsis in a low resource setting

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Davis Kimweri ◽  
Julian Ategeka ◽  
Faustine Ceasor ◽  
Winnie Muyindike ◽  
Edwin Nuwagira ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
Hiv Positive ◽  
Volume Depletion ◽  
Adjusted Risk ◽  
Adjusted Analysis ◽  
Resource Setting ◽  
Risk Predictors

Abstract Background Acute kidney injury (AKI) is a frequently encountered clinical condition in critically ill patients and is associated with increased morbidity and mortality. In our resource-limited setting (RLS), the most common cause of AKI is sepsis and volume depletion. Sepsis alone, accounts for up to 62 % of the AKI cases in HIV-positive patients. Objective The major goal of this study was to determine the incidence and risk predictors of AKI among HIV-infected patients admitted with sepsis at a tertiary hospital in Uganda. Methods In a prospective cohort study, we enrolled adult patients presenting with sepsis at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda between March and July 2020. Sepsis was determined using the qSOFA criteria. Patients presenting with CKD or AKI were excluded. Sociodemographic characteristics, physical examination findings, and baseline laboratory values were recorded in a data collection tool. The serum creatinine and urea were done at admission (0-hour) and at the 48-hour mark to determine the presence of AKI. We performed crude and multivariable binomial regression to establish the factors that predicted developing AKI in the first 48 h of admission. Variables with a p < 0.01 in the adjusted analysis were considered as significant predictors of AKI. Results Out of 384 patients screened, 73 (19 %) met our inclusion criteria. Their median age was 38 (IQR 29–46) years and 44 (60.3 %) were male. The median CD4 T-cell count was 67 (IQR 35–200) cells, median MUAC was 23 (IQR 21–27) cm and 54 (74.0 %) participants were on a regimen containing Tenofovir Disoproxil Fumarate (TDF). The incidence of AKI in 48 h was 19.2 % and in the adjusted analysis, thrombocytopenia (Platelet count < 150) (adjusted risk ratio 8.21: 95 % CI: 2.0–33.8, p = 0.004) was an independent predictor of AKI. Conclusions There is a high incidence of AKI among HIV-positive patients admitted with sepsis in Uganda. Thrombocytopenia at admission may be a significant risk factor for developing AKI. The association of thrombocytopenia in sepsis and AKI needs to be investigated.

scholarly journals High-dose versus low-dose haemofiltration for the treatment of critically ill patients with acute kidney injury: an updated systematic review and meta-analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e014171 ◽  
Author(s):  
Peng Li ◽  
Li-ping Qu ◽  
Dong Qi ◽  
Bo Shen ◽  
Yi-mei Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Meta Analysis ◽  
Kidney Injury ◽  
High Dose

ObjectiveThe purpose of this study was to perform a systematic review and meta-analysis to evaluate the effect of high-dose versus low-dose haemofiltration on the survival of critically ill patients with acute kidney injury (AKI). We hypothesised that high-dose treatments are not associated with a higher risk of mortality.DesignMeta-analysis.SettingRandomised controlled trials and two-arm prospective and retrospective studies were included.ParticipantsCritically ill patients with AKI.InterventionsContinuous renal replacement therapy.Primary and secondary outcome measuresPrimary outcomes: 90-day mortality, intensive care unit (ICU) mortality, hospital mortality; secondary outcomes: length of ICU and hospital stay.ResultEight studies including 2970 patients were included in the analysis. Pooled results showed no significant difference in the 90-mortality rate between patients treated with high-dose or low-dose haemofiltration (pooled OR=0.90, 95% CI 0.73 to 1.11, p=0.32). Findings were similar for ICU (pooled OR=1.12, 95% CI 0.94 to 1.34, p=0.21) and hospital mortality (pooled OR=1.03, 95% CI 0.81 to 1.30, p=0.84). Length of ICU and hospital stay were similar between high-dose and low-dose groups. Pooled results are not overly influenced by any one study, different cut-off points of prescribed dose or different cut-off points of delivered dose. Meta-regression analysis indicated that the results were not affected by the percentage of patients with sepsis or septic shock.ConclusionHigh-dose and low-dose haemofiltration produce similar outcomes with respect to mortality and length of ICU and hospital stay in critically ill patients with AKI.This study was not registered at the time the data were collected and analysed. It has since been registered on 17 February 2017 athttp://www.researchregistry.com/, registration number: reviewregistry211.

scholarly journals Serum chloride and sodium concentration as a predictor of acute kidney injury in premature newborns

2017 ◽  
Vol 145 (7-8) ◽  
pp. 340-345
Author(s):  
Drazenka Todorovic ◽  
Vesna Stojanovic ◽  
Aleksandra Doronjski
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
Sodium Concentration ◽  
Premature Newborns ◽  
Serum Chloride

Introduction/Objective. Hyperchloremia is often registered in adults? studies after administration with 0.9% sodium chloride, which contributes to the development of acute kidney injury (AKI) as it leads to vasoconstriction of renal blood vessels. The aim of this study was to determine the correlation of sodium and chloride imbalance with the development of AKI, with consideration of other risk factors for this disorder. Methods. This retrospective study included 146 randomly selected preterm infants hospitalized at the Neonatal Intensive Care Unit from 2008 to 2015. Results. Among the patients registered for the study, 23.97% developed AKI, and they were of a significantly lower gestational age (26.3 ? 2.8 weeks vs. 31.7 ? 2.90 weeks, p < 0.05); birth weight (971.31 ? 412.1 g vs. 1,753.3 ? 750.3 g, p < 0.05); Apgar score in the first (3.2 ? 1.7 vs. 5.7 ? 2.4, p < 0.05) and fifth minute (5.3 ? 1.7 vs. 7.1 ? 1.8, p < 0.05) of life compared to those without AKI. The neonates with AKI had significantly higher maximum chloremia (Clmax: 114.1 ? 8.4 vs. 111.7 ? 4.6, p = 0.029) and maximum natremia (Namax: 147.9 ? 8.8 vs. 142.9 ? 4, p < 0.05). Each of these parameters is (independently) a statistically significant risk factor for the development of AKI, and gestational age is the strongest (OR = 1 / 0.643 = 1.55; 95% CI 1.24?1.94). Mortality in neonates with AKI was higher than in neonates without AKI (19.4% vs. 92.7%, p < 0.05). Conclusion. Hyperchloremia and hypernatremia are more common in the premature newborns with AKI compared to the premature newborns without AKI. Higher maximum sodium and chloride values are independent risk factors for AKI.

scholarly journals Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Charuhas V. Thakar ◽  
Annette Christianson ◽  
Peter Almenoff ◽  
Ron Freyberg ◽  
Marta L. Render
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Fold Increase ◽  
Mortality Rates ◽  
Dialysis Initiation ◽  
Icu Patients ◽  
Mortality Model ◽  
Electrolyte Disturbances ◽  
Observational Cohort

In a multicenter observational cohort of patients-admitted to intensive care units (ICU), we assessed whether creatinine elevation prior to dialysis initiation in acute kidney injury (AKI-D) further discriminates risk-adjusted mortality. AKI-D was categorized into four groups (Grp) based on creatinine elevation after ICU admission but before dialysis initiation: Grp I  > 0.3 mg/dL to <2-fold increase, Grp II ≥2 times but <3 times increase, Grp III ≥3-fold increase in creatinine, and Grp IV none or <0.3 mg/dl increase. Standardized mortality rates (SMR) were calculated by using a validated risk-adjusted mortality model and expressed with 95% confidence intervals (CI). 2,744 patients developed AKI-D during ICU stay; 36.7%, 20.9%, 31.2%, and 11.2% belonged to groups I, II, III, and IV, respectively. SMR showed a graded increase in Grp I, II, and III (1.40 (95% CI, 1.29–1.42), 1.84 (1.66–2.04), and 2.25 (2.07–2.45)) and was 0.98 (0.78–1.20) in Grp IV. In ICU patients with AKI-D, degree of creatinine elevation prior to dialysis initiation is independently associated with hospital mortality. It is the lowest in those experiencing minor or no elevations in creatinine and may represent reversible fluid-electrolyte disturbances.

535 Vitamin C in the Management of Burn Patients: A Review of Benefits and Risks

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S115-S116
Author(s):  
Mahwash Siddiqi ◽  
Francesca Bryan ◽  
Faran Bokhari
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Vitamin C ◽  
Total Body Surface Area ◽  
Kidney Injury ◽  
Healing Time ◽  
Current Evidence ◽  
High Dose ◽  
Burn Patients ◽  
Fluid Requirement

Abstract Introduction Burns are global public health problem. Micronutrients play an essential role in defense mechanisms and immunity. Vitamin C has fostered a growing interest. We reviewed current evidence regarding the effects of Vitamin C on management of burn patients and aims to understand its benefits and risks. Methods A narrative review was performed from January 2000 through September 2020 via PubMed by searching the terms “vitamin C”, “ascorbic acid” and “burns”. The search yielded a total of 170 journal articles. The following were excluded: commentaries, experimental research and studies on non-human subjects. Ultimately, 20 articles qualified for review. Results A total of 924 patients were studied. The literature collectively endorsed a difference in patient outcomes when vitamin C is administered on the first day of admission. The average age across the studies was 15–45 years old. Only 10% of studies included vulnerable age groups (2–15 years old). The Mean Total Body Surface Area (TBSA) of patients was 31%. Most of the studies excluded patients with co-morbidities. The benefits of vitamin C in various aspects of burn management were documented in 70% of studies. Patients who were given vitamin C exhibited a decrease in fluid requirement in 42% of the studies when compared to controls. Additionally, a decrease in wound healing time was reported in 35% of studies, a decreased rate of post-burn infections was reported in 28%, and 14% of studies state that patients given vitamin C had reduced edema. The effect of vitamin C dosing methods on outcomes was also examined. It was reported by 14% of Studies that low-dose Vitamin C infusion does not improve outcomes, while 50% of studies that used high-dose infusion revealed improved results. Additionally, when comparing oral route of administration 20 % of studies used high-dose with favorable results. In regards to risk, oxalate nephropathy, acute kidney injury, and renal failure was documented by six studies. Conclusions Our review concludes that there is decreased fluid requirement, improvement in edema, healing time and post burn infections when high-dose vitamin C (66mg/kg/hr) is given to adults on first day of admission and continuously infused for 24 hours in 1st and 2nd degree burn involving 10 to 40% TBSA. However, there is an associated risk of acute kidney injury and renal failure.

scholarly journals Impact of timing of initiation of dialysis on mortality of patients with acute kidney injury

2020 ◽  
Vol 7 (1) ◽  
pp. e07-e07
Author(s):  
Reginaldo Passoni dos Santos ◽  
Letícia Giroldo Vieira ◽  
Danielle Fernanda Miner de Oliveira ◽  
Raissa Fritz Schmitt ◽  
Vinicius Ferreira de Barros ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Mortality Rate ◽  
Serum Creatinine ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
Median Number ◽  
Bivariate Analysis ◽  
Initiation Of Dialysis ◽  
Timing Of Initiation

Introduction: In Brazil, primary studies on this issue are still limited and the ideal timing of initiation of dialysis in severe acute kidney injury (AKI) still generates disagreements among experts. Objectives: To assess if the timing of initiation of dialysis is associated with the mortality of patients with AKI in intensive care unit (ICU). Patients and Methods: We retrospectively analyzed medical records of patients that developed severe AKI in the ICU. Bivariate analysis was carried out to compare data between groups of patients who underwent early dialysis (ED - initiated up to two days after the AKI diagnosis) and late dialysis (LD – initiated more than two days after the AKI diagnosis), while multivariate logistic regression was applied to identify factors associated with mortality. Results: Of the 76 patients included in the study, 27 (35.5%) were allocated in the ED group and 49 (64.5%) in the LD group. LD group had a higher frequency of sepsis [26 (53%) vs. 12 (44%); P = 0.472], while the ED group had a higher median number of dialysis sessions (6 vs. 3; P = 0.477) and higher total median time on dialysis (17.5 h vs. 13 h; P = 0.629). The overall mortality rate was 61.8% (n = 47) and of 76% (n = 22) in the ED group. The patients’ serum creatinine level at admission in the ICU was the only statistically significant risk factor for death [OR= 0.453 (95% CI= 0.257–0.801); P = 0.006]. Conclusion: The overall and in the ED group mortality rate was elevated, however, the timing of initiation of dialysis did not show statistically significant association with death. The serum creatinine at ICU admission seems to be an important mortality predictor.

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