In-line filtration of intravenous infusion may reduce organ dysfunction of adult critical patients

Abstract Background The potential harmful effects of particle-contaminated infusions for critically ill adult patients are yet unclear. So far, only significant improved outcome in critically ill children and new-borns was demonstrated when using in-line filters, but for adult patients, evidence is still missing. Methods This single-centre, retrospective controlled cohort study assessed the effect of in-line filtration of intravenous fluids with finer 0.2 or 1.2 μm vs 5.0 μm filters in critically ill adult patients. From a total of n = 3215 adult patients, n = 3012 patients were selected by propensity score matching (adjusting for sex, age, and surgery group) and assigned to either a fine filter cohort (with 0.2/1.2 μm filters, n = 1506, time period from February 2013 to January 2014) or a control filter cohort (with 5.0 μm filters, n = 1506, time period from April 2014 to March 2015). The cohorts were compared regarding the occurrence of severe vasoplegia, organ dysfunctions (lung, kidney, and brain), inflammation, in-hospital complications (myocardial infarction, ischemic stroke, pneumonia, and sepsis), in-hospital mortality, and length of ICU and hospital stay. Results Comparing fine filter vs control filter cohort, respiratory dysfunction (Horowitz index 206 (119–290) vs 191 (104.75–280); P = 0.04), pneumonia (11.4% vs 14.4%; P = 0.02), sepsis (9.6% vs 12.2%; P = 0.03), interleukin-6 (471.5 (258.8–1062.8) ng/l vs 540.5 (284.5–1147.5) ng/l; P = 0.01), and length of ICU (1.2 (0.6–4.9) vs 1.7 (0.8–6.9) days; P < 0.01) and hospital stay (14.0 (9.2–22.2) vs 14.8 (10.0–26.8) days; P = 0.01) were reduced. Rate of severe vasoplegia (21.0% vs 19.6%; P > 0.20) and acute kidney injury (11.8% vs 13.7%; P = 0.11) was not significantly different between the cohorts. Conclusions In-line filtration with finer 0.2 and 1.2 μm filters may be associated with less organ dysfunction and less inflammation in critically ill adult patients. Trial registration The study was registered at ClinicalTrials.gov (number: NCT02281604).

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Acute kidney injury and mortality in critically ill children

Paediatrica Indonesiana ◽

10.14238/pi54.5.2014.251-5 ◽

2014 ◽

Vol 54 (5) ◽

pp. 251

Author(s):

Putri Amelia ◽

Munar Lubis ◽

Ema Mutiara ◽

Yunnie Trisnawati

Keyword(s):

Acute Kidney Injury ◽

Mortality Rate ◽

Critically Ill ◽

Organ Dysfunction ◽

Kidney Injury ◽

Cross Sectional Study ◽

Critically Ill Children ◽

Cross Sectional ◽

Logistic Organ Dysfunction ◽

Stage Renal Disease

Background Mortality from acute kidney injury (AKI) can be ashigh as 60% in critically ill children. This high mortality rate isinfluenced by the severity of primary diseases, organ dysfunction,and the stage of acute kidney injury.Objective To assess for an as sedation between AKI and mortalityin critically ill children hospitalized in the pediatric intensive careunit (PICU).Methods A cross-sectional study was conducted from Aprilto July 2012. All patients aged 1 month to 18 years who werehospitalized in the PICU for more than 24 hours were included.Urine output and serum creatinine levels were evaluated daily.Patients were categorized according to the pediatric risk, injury,failure, loss, and end stage renal disease (pRIFLE) criteria. Chisquare, Fisher's exact, Mann-\X'hitney U, and Kruskal-Wallis testswere used to assess for an association between AKI, mortality,pediatric logistic organ dysfunction (PELOD) score, and lengthof PICU stay. AP value of < 0.05 was considered as statisticallysignificant.Results During the study period, 57 children were admitted,consisting of 25 (43.9%) females and 32 (56.1 %) males, witha median age of 43 months. The prevalance of AKI was 31.5%(18/57) and classified into stages: risk 13/18, injury 3/18, andfailure 2/18. The mortality rate for AKI was 16. 7%. There was noassociation between AKI and mortality (P=0.592). The PELODscores were found to be similar among patients (SD 11.3 2 vs. SD12.23; P=0.830), and there was no association between AKI andlength of PICU stay (P=0.819).Conclusion There is no association between AKI and mortalityin critically ill children admitted in PICU.

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Long Term Renal Outcomes in Survivors of Acute Kidney Injury in Critically-Ill Children and Neonates

Journal of Clinical Pediatric Nephrology ◽

10.15401/jcpn/2014/v2i2/66350 ◽

2014 ◽

Vol 2 (2) ◽

pp. 51

Author(s):

Kathy Lee-Son ◽

Cherry Mammen

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Kidney Injury ◽

Critically Ill Children ◽

Renal Outcomes

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Pediatric Multi-Organ Dysfunction Syndrome: Analysis by an Untargeted “Shotgun” Lipidomic Approach Reveals Low-Abundance Plasma Phospholipids and Dynamic Recovery over 8-Day Period, a Single-Center Observational Study

Nutrients ◽

10.3390/nu13030774 ◽

2021 ◽

Vol 13 (3) ◽

pp. 774

Author(s):

Mara L. Leimanis-Laurens ◽

Karen Ferguson ◽

Emily Wolfrum ◽

Brian Boville ◽

Dominic Sanfilippo ◽

...

Keyword(s):

Mass Spectrometry ◽

Intensive Care ◽

Critically Ill ◽

Organ Dysfunction ◽

Lipid Profiles ◽

Critically Ill Children ◽

P Value ◽

Time Points ◽

Logistic Organ Dysfunction ◽

Multi Organ Dysfunction Syndrome

Lipids are molecules involved in metabolism and inflammation. This study investigates the plasma lipidome for markers of severity and nutritional status in critically ill children. Children with multi-organ dysfunction syndrome (MODS) (n = 24) are analyzed at three time-points and cross-referenced to sedation controls (n = 4) for a total of N = 28. Eight of the patients with MODS, needed veno-arterial extracorporeal membrane oxygenation (VA ECMO) support to survive. Blood plasma lipid profiles are quantified by nano-electrospray (nESI), direct infusion high resolution/accurate mass spectrometry (MS), and tandem mass spectrometry (MS/MS), and compared to nutritional profiles and pediatric logistic organ dysfunction (PELOD) scores. Our results show that PELOD scores were not significantly different between MODS and ECMO cases across time-points (p = 0.66). Lipid profiling provides stratification between sedation controls and all MODS patients for total lysophosphatidylserine (lysoPS) (p-value = 0.004), total phosphatidylserine (PS) (p-value = 0.015), and total ether-linked phosphatidylethanolamine (ether-PE) (p-value = 0.03) after adjusting for sex and age. Nutrition intake over time did not correlate with changes in lipid profiles, as measured by caloric and protein intake. Lipid measurement in the intensive care environment shows dynamic changes over an 8-day pediatric intensive care unit (PICU) course, suggesting novel metabolic indicators for defining critically ill children.

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Epidemiology of acute kidney injury in critically ill children and young adults

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/0004563217693559 ◽

2017 ◽

Vol 54 (3) ◽

pp. 416-416

Author(s):

Yachana Kataria

Keyword(s):

Acute Kidney Injury ◽

Young Adults ◽

Critically Ill ◽

Kidney Injury ◽

Critically Ill Children ◽

Children And Young Adults

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Acute Kidney Injury in Critically Ill Children — An Ominous Legacy

New England Journal of Medicine ◽

10.1056/nejme1613456 ◽

2017 ◽

Vol 376 (1) ◽

pp. 82-83

Author(s):

Julie R. Ingelfinger

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Kidney Injury ◽

Critically Ill Children

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OR007: Nutrition Support Guidelines in Critically Ill Children with Acute Kidney Injury

Clinical Nutrition ◽

10.1016/s0261-5614(15)30104-7 ◽

2015 ◽

Vol 34 ◽

pp. S2

Author(s):

J.C. Silva ◽

U.G. Kyle ◽

M. Treviño ◽

J.L. Lusk ◽

G. Dardon ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Kidney Injury ◽

Nutrition Support ◽

Critically Ill Children ◽

Support Guidelines

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Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

10.21203/rs.3.rs-111865/v1 ◽

2020 ◽

Author(s):

Hui Huang ◽

Huiting Zhou ◽

Wenwen Wang ◽

Xiaomei Dai ◽

Wenjing Li ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Inflammatory Mediator ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Surviving Sepsis Campaign ◽

Predictive Values ◽

Specific Setting ◽

Potential Indicator

Abstract Background: Acute kidney injury (AKI) biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, in the prediction of AKI, especially in heterogeneous population. The urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. Whether uCXCL10 is associated with AKI and predicts AKI in critically ill patients remains unclear. The aims of the study were to investigate clinical variables potentially associated with uCXCL10 levels and determine the associations of uCXCL10 with AKI, sepsis and PICU mortality in critically ill children, as well as its predictive values of aforementioned issues. Methods: Urinary CXCL10 levels were serially measured in a heterogeneous group of children during the first week after pediatric intensive care unit (PICU) admission. AKI diagnosis was based on the criteria of Kidney Disease: Improving Global Outcomes with serum creatinine and urine output. Sepsis was diagnosed according to surviving sepsis campaign international guidelines for children. Mortality was defined as all-cause death occurring during the PICU stay.Results: Among 342 critically ill children, 52 (15.2%) developed AKI during the first week after PICU admission, and 132 (38.6%) were diagnosed as sepsis and 30 (12.3%) died during PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI with adjusted odds ratios (AORs) of 1.791 (P = 0.010) and 2.002 (P = 0.002), sepsis with AORs of 1.679 (P = 0.003) and 1.752 (P = 0.002), septic AKI with AORs of 3.281 (P <0.001) and 3.172 (P <0.001), and PICU mortality with AORs of 2.779 (P = 0.001) and 3.965 (P <0.001), respectively. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI, and PICU mortality were 0.63 (0.53-0.72), 0.62 (0.56-0.68), 0.75 (0.64-0.87), and 0.77 (0.68-0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56-0.75), sepsis 0.63 (0.57-0.69), septic AKI 0.76 (0.65-0.87), and PICU mortality 0.84 (0.76-0.91).Conclusions: Urinary CXCL10 is independently associated with AKI and sepsis, and may be a potential indicator of septic AKI and PICU mortality in critically ill children.

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