Effects of perioperative tight glycemic control on postoperative outcomes: a meta-analysis

Background The optimal glycemic target during the perioperative period is still controversial. We aimed to explore the effects of tight glycemic control (TGC) on surgical mortality and morbidity. Methods PubMed, EMBASE and CENTRAL were searched from January 1, 1946 to February 28, 2018. Appropriate trails comparing the postoperative outcomes (mortality, hypoglycemic events, acute kidney injury, etc.) between different levels of TGC and liberal glycemic control were identified. Quality assessments were performed with the Jadad scale combined with the allocation concealment evaluation. Pooled relative risk (RR) and 95% CI were calculated using random effects models. Heterogeneity was detected by the I2 test. Results Twenty-six trials involving a total of 9315 patients were included in the final analysis. The overall mortality did not differ between tight and liberal glycemic control (RR, 0.92; 95% CI, 0.78–1.07; I 2 = 20.1%). Among subgroup analyses, obvious decreased risks of mortality were found in the short-term mortality, non-diabetic conditions, cardiac surgery conditions and compared to the very liberal glycemic target. Furthermore, TGC was associated with decreased risks for acute kidney injury, sepsis, surgical site infection, atrial fibrillation and increased risks of hypoglycemia and severe hypoglycemia. Conclusions Compared to liberal control, perioperative TGC (the upper level of glucose goal ≤150 mg/dL) was associated with significant reduction of short-term mortality, cardic surgery mortality, non-diabetic patients mortality and some postoperative complications. In spite of increased risks of hypoglycemic events, perioperative TGC will benefits patients when it is done carefully.

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Renal Failure

10.1093/med/9780199755691.003.0473 ◽

2012 ◽

Author(s):

Kianoush B. Kashani ◽

Amy W. Williams

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Renal Failure ◽

Kidney Disease ◽

Kidney Injury ◽

Diabetic Patients ◽

Clinical Approach ◽

Mortality And Morbidity ◽

Electrolyte Disturbances ◽

Metabolic Bone

Renal failure is caused by acute kidney injury or chronic kidney disease. Acute kidney injury (AKI) is a common, devastating complication that increases mortality and morbidity among patients with various medical and surgical illnesses. Also known as acute renal failure, AKI is a rapid deterioration of kidney function that results in the accumulation of nitrogenous metabolites and medications and in electrolyte and acid-base imbalances. This chapter discusses the definition, epidemiology, pathophysiology, and etiology of AKI; the clinical approach to patients with AKI; and the management of AKI. Chronic kidney disease (CKD) has been categorized into 5 stages. When renal function decreases to stage 3, the complications of CKD become evident. These complications include hypertension, cardiovascular disease, lipid abnormalities, anemia, metabolic bone disease, and electrolyte disturbances. To prevent the progression of CKD, therapy must be directed toward preventing these complications and achieving adequate glucose control in diabetic patients with CKD.

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FP648LOWER SHORT-TERM MORTALITY IN ICU PATIENTS ON CHRONIC DIALYSIS THAN IN THOSE REQUIRING DIALYSIS FOR ACUTE KIDNEY INJURY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy104.fp648 ◽

2018 ◽

Vol 33 (suppl_1) ◽

pp. i262-i263

Author(s):

Robin Lohse ◽

Michael Ibsen ◽

Jørgen Wiis ◽

Anders Perner ◽

Theis Lange ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Chronic Dialysis ◽

Short Term ◽

Icu Patients ◽

Short Term Mortality

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Uric acid albumin ratio as a predictive marker of short-term mortality in patients with acute kidney injury

Clinical and Experimental Emergency Medicine ◽

10.15441/ceem.20.024 ◽

2021 ◽

Vol 8 (2) ◽

pp. 82-88

Author(s):

Yasemin Özgür ◽

Seydahmet Akın ◽

Nuran Gamze Yılmaz ◽

Murat Gücün ◽

Özcan Keskin

Keyword(s):

Acute Kidney Injury ◽

Uric Acid ◽

Kidney Injury ◽

Predictive Marker ◽

Short Term ◽

Albumin Ratio ◽

Short Term Mortality

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P1517Risk of acute kidney injury in transcatheter aortic valve implantation procedures and impact on 30-day outcome

European Heart Journal ◽

10.1093/eurheartj/ehz748.0279 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

F A Sgura ◽

S Arrotti ◽

P Magnavacchi ◽

S Tondi ◽

D Gabbieri ◽

...

Keyword(s):

Acute Kidney Injury ◽

Aortic Valve ◽

Kidney Injury ◽

Short Term ◽

Transcatheter Aortic Valve ◽

Increased Risk ◽

Short Term Mortality ◽

Sts Score ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) is a safe and effective procedure for patients with symptomatic aortic stenosis who do not qualify for surgery. Nevertheless, post-procedure acute kidney injury (AKI) is a frequent complication and it is associated with worse outcomes. Aim To assess the impact of acute kidney injury (AKI) occurring immediately after the TAVI procedure on patients' outcome. Methods We conducted a multicenter retrospective study on patients treated with TAVI from 2010 to 2018. The assigned treatment, the selection of the device (self-expandable/balloon-expandable valve) and the type of approach used were determined by each individual Center on the basis of the patient's characteristics and the choice of the operator. All patients had an intermediate or high Society of Thoracic Surgeons (STS) score. Basal creatinine and glomerular filtrate (using the body mass index, sex and age) were evaluated for each patient. According to the KDIGO criteria, AKI is defined as an increase in serum creatinine (SCr) ≥0,3mg/dl within 48 hours or an increase in SCr ≥1.5 times baseline or urine volume <0,5ml/kg/h for 6 hours. The incidence of post procedural AKI and its correlation with the short-term mortality and outcomes was evaluated as primary end point (stroke/TIA/RIND, cardiac tamponade, bleeding, vascular complications, cardiocirculatory arrest with subsequent ROSC, definitive pacemaker implantation, postoperative atrial fibrillation, left bundle branch block de novo).Postoperative outcomes were defined according to the updated Valve Academic Research Consortium 2 definitions Results A total of 371 pts were analysed. Mean age was 82.3±5.9 and the majority of the pts had an STS score>10 (97.6%). Incidence of Acute kidney Injury (AKI) stage 3 post TAVI, according to VARC-2 criteria, was 16,2%. In patient with AKI, the hospitalization time was longer 18,7±6,1 days vs 8,4±6,1 days without AKI (p<0,01). Patients with AKI had an increased risk of in hospital mortality (OR 50,0; 95% CI 5,2–390,16; p<0,01) and 30 day mortality (OR: 5,88; 95% CI 2,08–16,60; p<0,01). Acute Kidney Injury instead was more common in patients treated with transapical access (OD 3,9-CI 95% 2,16–7,07; p<0,01) or with PAD (OR 1,87 - CI 95% 1,03–3,41; p=0,03) AKI and short term mortality Conclusion Acute kidney injury is a frequent complication after TAVI. AKI seems to be the strongest predictor for 30 day mortality and increases the hospitalization time. AKI was more common in patients treated with a transapical approach or if they presented a PAD. In contrast, pre-procedural chronic kidney disease did not seem to correlate directly with an increased risk of AKI.

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Acute kidney injury and adverse outcomes of critical illness: correlation or causation?

Clinical Kidney Journal ◽

10.1093/ckj/sfz158 ◽

2019 ◽

Vol 13 (2) ◽

pp. 133-141

Author(s):

Benedict J Girling ◽

Samuel W Channon ◽

Ryan W Haines ◽

John R Prowle

Keyword(s):

Acute Kidney Injury ◽

Critical Illness ◽

Kidney Injury ◽

Adverse Outcomes ◽

Short Term ◽

Term Survival ◽

Risk Of Death ◽

Increased Risk ◽

Short Term Mortality ◽

The Relationship

Abstract Critically ill patients who develop acute kidney injury (AKI) are more than twice as likely to die in hospital. However, it is not clear to what extent AKI is the cause of excess mortality, or merely a correlate of illness severity. The Bradford Hill criteria for causality (plausibility, temporality, magnitude, specificity, analogy, experiment & coherence, biological gradient and consistency) were applied to assess the extent to which AKI may be causative in adverse short-term outcomes of critical illness. Plausible mechanisms exist to explain increased risk of death after AKI, both from direct pathophysiological effects of renal dysfunction and mechanisms of organ cross-talk in multiple-organ failure. The temporal relationship between increased mortality following AKI is consistent with its pathophysiology. AKI is associated with substantially increased mortality, an association that persists after accounting for known confounders. A biological gradient exists between increasing severity of AKI and increasing short-term mortality. This graded association shares similar features to the increased mortality observed in ARDS; an analogous condition with a multifactorial aetiology. Evidence for the outcomes of AKI from retrospective cohort studies and experimental animal models is coherent however both of these forms of evidence have intrinsic biases and shortcomings. The relationship between AKI and risk of death is maintained across a range of patient ages, comorbidities and underlying diagnoses. In conclusion many features of the relationship between AKI and short-term mortality suggest causality. Prevention and mitigation of AKI and its complications are valid targets for studies seeking to improve short-term survival in critical care.

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846 DIAGNOSTIC VALUE OF CYSTATIN C FOR PREDICTING ACUTE KIDNEY INJURY AND SHORT TERM MORTALITY IN CIRRHOSIS

Journal of Hepatology ◽

10.1016/s0168-8278(10)60847-1 ◽

2010 ◽

Vol 52 ◽

pp. S330

Author(s):

D.W. Jun ◽

M.Y. Chung ◽

S.A. Sung ◽

T.Y. Kim ◽

J.H. Sohn

Keyword(s):

Acute Kidney Injury ◽

Cystatin C ◽

Kidney Injury ◽

Diagnostic Value ◽

Short Term ◽

Short Term Mortality

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Urinary neutrophil gelatinase‐associated lipocalin determines short‐term mortality and type of acute kidney injury in cirrhosis

JGH Open ◽

10.1002/jgh3.12377 ◽

2020 ◽

Vol 4 (5) ◽

pp. 970-977

Author(s):

Suhas Udgirkar ◽

Pravin Rathi ◽

Nikhil Sonthalia ◽

Sanjay Chandnani ◽

Qais Contractor ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Short Term ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Short Term Mortality ◽

Neutrophil Gelatinase

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Etiology and Short term Outcome of Acute Kidney Injury (AKI) in Hospitalized Patients : A Single Center Study

Bangladesh Critical Care Journal ◽

10.3329/bccj.v7i2.43455 ◽

2019 ◽

Vol 7 (2) ◽

pp. 77-80

Author(s):

Tania Mahbub ◽

Chowdhury Rifat Niger ◽

Rawshan Arra Khanam ◽

Mohammad Omar Faruq

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Developed Countries ◽

Limited Information ◽

Short Term ◽

Drug Induced ◽

Term Outcome ◽

Mortality And Morbidity ◽

Single Center Study ◽

The Developed Countries

Acute Kidney Injury (AKI) is a common cause of morbidity and mortality worldwide. However it is a treatablecondition. Any disease when associated with AKI, mortality and morbidity increase manifolds.1 Early diagnosis andtreatment is important to reduce morbidity, mortality and ICU admission. Causes of AKI may vary in country to countryeven within the country. International society of Nephrology has set a high ambitious goal “0 by 25” targeting zerodeath due to untreated AKI by 2025. Heading this challenge, it is important to know the causes of AKI worldwide.However, most of the AKI studies have been done in the developed countries and limited information is availableregarding Asia, Africa and south America. Inspired by this slogan, this study was directed to find out the causes of AKIin admitted patients in United Hospital Limited between July 2015 to February 2017. Total 98 patients were includedin the study. In our study, Infection and cardio-renal syndrome were the leading causes of AKI. Drug induced AKI alsocontributed a significant portion. Bangladesh Crit Care J September 2019; 7(2): 77-80

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