scholarly journals Predictors of In-hospital Mortality in Patients with Acute Limb Ischemia – Lesson Learnt from A Tertiary Hospital in Jakarta

2020 ◽  
Author(s):  
Suci Indriani ◽  
Suko Adiarto ◽  
Hananto Andriantoro ◽  
Ismoyo Sunu ◽  
Taofan Siddiq ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Vitamin E ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
Limb Ischemia ◽  
Clinical History ◽  
Tertiary Hospital ◽  
Acute Limb Ischemia ◽  
History Of

Abstract Background This study aims to identify risk factors associated with in-hospital and 30-days mortality in patients with acute limb ischemia (ALI). Methods This study was a single-centered cohort enrolling a total of 160 consecutive patients with a diagnosis of ALI. The ALI diagnosis was based on clinical history, physical examination, and Doppler studies of the extremities. The main outcome of this study is in-hospital and 30-days mortality. Results There were a total of 170 patients involving 192 limbs with the diagnosis of ALI. Intra-aortic balloon pump (IABP) insertion (HR 3.4; 95% CI 1.0-11.3, p = 0.042), no vitamin E treatment (HR 5.6; CI 1.7–18.3, 0.004), arrhythmia (HR 12.00; CI 3.8–37.7, p < 0.001), and acute renal failure (HR 6.70; CI 1.88–24.3, p = 0.003) were an independent predictor of intra-hospital mortality. For 30-days mortality, the independent predictors were menopause (HR 3.2; CI 1.16–8.85, p = 0.02); IABP insertion (HR 4.51; CI 1.14–17.92, p = 0.03); arrhythmia (HR 0.11; CI 0.04–0.32, p < 0.001); bleeding requiring transfusion (HR 3.77; CI 0.10-14.28, p = 0.05); and acute renal failure (HR 5.5; CI 1.79–16.95, p = 0.003). Conclusion In-hospital mortality in patients with ALI remains high in our center. Several factors contributing to mortality were arrhythmia, renal failure, no vitamin E supplementation, and a history of recent cardiac operation.

Complications of Reperfusion in Acute Aortic Artery Occlusion Following Saddle Embolization Originating from an Atrial Myxoma

Vascular ◽  
2004 ◽  
Vol 12 (3) ◽  
pp. 202-205 ◽  
Author(s):  
Tahir Ali ◽  
J. Castro ◽  
C.P. Young ◽  
K.G. Burnand
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Limb Ischemia ◽  
Artery Occlusion ◽  
Acute Onset ◽  
Atrial Myxoma ◽  
Cardiac Massage ◽  
Life Threatening ◽  
History Of ◽  
Bilateral Lower Limb

A 58-year-old man presented to the hospital with an 8-hour history of acute-onset bilateral lower limb ischemia. A large saddle embolus had occluded the aorta and could not be removed by balloon endarterectomy through the femoral arteries. Successful open aortic and femoral thromboembolectomy followed by extensive fasciotomies was accompanied by severe reperfusion injury. Life-threatening hyperkalemia was associated with three episodes of intraoperative ventricular fibrillation and ventricular tachycardia requiring cardiac massage and defibrillation. A dextrose-insulinbicarbonate infusion was required to correct the hyperkalemia. Rhabdomyolysis developed at 24 hours, causing marked myoglobinuria and acute renal failure, which required hemofiltration. Histology of the recovered embolus confirmed an atrial myxoma, and when the patient had fully recovered, open cardiac surgery was carried out to resect the tiny stump of residual myxoma. Rhabdomyolysis associated with a myxomatous saddle embolus has not been previously reported. This case highlights the need for pre- and perioperative measures to be taken to overcome hyperkalemia and acute renal failure when revascularizing acute, massive, prolonged ischemia of the lower body.

scholarly journals The Protective Effect of Vitamin E for Reducing Intra-Hospital Mortality in Acute Limb Ischemia Patients

2021 ◽  
Author(s):  
Suci Indriani ◽  
Suko Adiarto ◽  
Hananto Andriantoro ◽  
Ismoyo Sunu ◽  
Taofan Siddiq ◽  
...  
Keyword(s):  
Vitamin E ◽  
Hospital Mortality ◽  
Reperfusion Injury ◽  
Univariate Analysis ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Logistic Regression Models ◽  
Cardiovascular Center ◽  
Huge Challenge

Background Management of acute limb ischemia (ALI) is still a huge challenge. Current advances of endovascular therapeutic approach in management of ALI have decreased the overall amputation rate, nevertheless, mortality rate remains high which may be caused by metabolic consequences of reperfusion injury. Aim To understand the role of vitamin E to intra-hospital and 30-day mortality among acute limb ischemia patients. Methods This retrospective cohort study included all patients with ALI between 2015 to 2018. Vitamin E 2x400 mg orally for seven days was given based on physician preference after ALI diagnosis was confirmed. Data were collected from Vascular Registries of National Cardiovascular Center Harapan Kita (NCCHK), Jakarta, Indonesia. Univariate analysis and logistic regression models were used to explore factors that contribute to intra-hospital and 30-day mortality. Results                                        A total of 160 patients with ALI involving 192 limbs were admitted to our hospital. Mostly were male (63.1%) and mean age were 56±13 years old. Majority of the patients had unilateral lesion (80%), and were diagnosed with Rutherford stage IIA (36.3%), followed by stage IIB (33.8%), stage I (20%), and stage III (10%) respectively. Intra-hospital and 30-day mortality were 28.1% and 36.9%, respectively. Low treatment of vitamin E increased intra-hospital mortality (HR 5,6 95%CI 1.7-18.3), however, it did not affect 30-day mortality. Other factors including IABP insertion, arrhythmia, bleeding requiring transfusion and acute renal failure were associated with higher intra-hospital and 30-day mortality. In addition, menopause (HR 3.2; CI 1.16-8.85) was also a predictor of 30-day mortality. Conclusion Vitamin E administration reduced intra-hospital mortality but not on 30-day mortality in acute limb ischemia patients. Keywords: Acute Limb Ischemia, vitamin E, mortality, reperfusion injury

Abstract 2301: Frail Elderly Patients at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Dana H Lee ◽  
Billie Jean Martin ◽  
Alexandra M Yip ◽  
Karen J Buth ◽  
Gregory M Hirsch
Keyword(s):  
Renal Failure ◽  
Cardiac Surgery ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Frail Elderly ◽  
Independent Predictor ◽  
Institutional Care ◽  
Biological Age ◽  
Younger Patients ◽  
Frail Patients

Patients referred for cardiac surgery are increasingly older, but chronological age does not always capture biological age. This study assessed frailty, as a functional parameter of biological age, as a predictor of mortality or prolonged institutional care. Functional measures of frailty and clinical preoperative data were collected for all cardiac surgery patients at a single center (2004 –2007). Based on the Katz Index of Activities of Daily Living, frailty was defined as any impairment in feeding, bathing, dressing, transferring, toileting, continence, or ambulation, or dementia. The impact of frailty on in-hospital mortality or institutional discharge (other hospital or nursing facility) was assessed with multivariate logistic regression. The interaction of frailty and age was examined, with non-frail patients age<70 as the referent group. Results: Of 3096 patients, 133 (4.3%) were frail. Frail patients were older, more likely to be female, have COPD, CHF, EF<40%, recent MI, pre-operative renal failure, cerebrovascular disease, greater acuity, and more complex operations (p<0.05). Frail patients experienced higher rates of mortality, sepsis, delirium, post-operative renal failure, and transfusion (p<0.001). A greater proportion of frail patients than non-frail patients (49% vs. 9%) were discharged to a setting other than home. In the risk-adjusted models, frailty was an independent predictor of mortality (OR 1.8, 95% CI 1.0 –3.2) or institutional discharge (OR 6.4, 95% CI 4.1–9.9). Furthermore, frail elderly (age≥70) patients had greater risk of institutional discharge (OR 22.7, CI 12.4 – 41.7) than frail younger patients (OR 6.5, CI 3.4 –12.5) or non-frail elderly patients (OR 3.5, CI 2.6 – 4.6). Similarly, frail elderly patients had greater risk of mortality (OR 4.0, CI 1.9 – 8.1) than frail younger patients (OR 1.9, CI 0.8 – 4.7) or non-frail elderly patients (OR 2.4, CI 1.7–3.5). Frailty was an independent predictor of in-hospital mortality and prolonged institutional care. Frailty combined with older age further discriminated those at highest risk. Special consideration should be given to the management of frail elderly patients who have surgical cardiac disease.

scholarly journals Expanding the pool of kidney donors: use of kidneys with acute renal dysfunction

2015 ◽  
Vol 13 (2) ◽  
pp. 319-325 ◽  
Author(s):  
Ana Cristina Carvalho de Matos ◽  
Lúcio Roberto Requião-Moura ◽  
Gabriela Clarizia ◽  
Marcelino de Souza Durão Junior ◽  
Eduardo José Tonato ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Dysfunction ◽  
Patient Survival ◽  
Machine Perfusion ◽  
Acute Renal Dysfunction ◽  
Morphological Findings ◽  
History Of ◽  
Expanded Criteria ◽  
Support Decision Making

ABSTRACT Given the shortage of organs transplantation, some strategies have been adopted by the transplant community to increase the supply of organs. One strategy is the use of expanded criteria for donors, that is, donors aged >60 years or 50 and 59 years, and meeting two or more of the following criteria: history of hypertension, terminal serum creatinine >1.5mg/dL, and stroke as the donor´s cause of death. In this review, emphasis was placed on the use of donors with acute renal failure, a condition considered by many as a contraindication for organ acceptance and therefore one of the main causes for kidney discard. Since these are well-selected donors and with no chronic diseases, such as hypertension, renal disease, or diabetes, many studies showed that the use of donors with acute renal failure should be encouraged, because, in general, acute renal dysfunction is reversible. Although most studies demonstrated these grafts have more delayed function, the results of graft and patient survival after transplant are very similar to those with the use of standard donors. Clinical and morphological findings of donors, the use of machine perfusion, and analysis of its parameters, especially intrarenal resistance, are important tools to support decision-making when considering the supply of organs with renal dysfunction.

P1515Female sex is an independent predictor of mortality in patients with STEMI in Spain: a study in 325,017 episodes over 11 years (2005–2015)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Anguita ◽  
A Sambola Ayala ◽  
J Elola ◽  
J L Bernal ◽  
C Fernandez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
National Health System ◽  
Anterior Myocardial Infarction ◽  
Female Sex ◽  
Spanish National Health System ◽  
History Of ◽  
The Impact

Abstract Background Recent studies reported a decrease in the mortality of ST-elevation myocardial infarction (STEMI) patients. This favorable evolution could not extend to women. The interaction between gender and mortality in STEMI remains controversial. Purpose To assess the impact of female sex on mortality of patients with STEMI through of period of 11 years. Methods We conducted a retrospective longitudinal study using information provided by the minimal database system of the Spanish National Health System to identify all hospitalizations in patients aged 35–94 years with the principal diagnosis of STEMI from 2005–2015. Results A total of 325,017 STEMI were identified. Of them, 273,182 were included, and 106,277 (38.8%) were women. Women were older than men and had more comorbidities. Through the study period 53% men vs 37.2% underwent PTCA; women presented more frequently heart failure, shock and stroke than men (p<0.001, respectively). The mean crude in-hospital mortality rate for the whole study period was higher in women (OR: 2.18; 95% CI: 2.12.-2.23, p<0.0001). Female sex was independently associated with higher in-hospital mortality (adjusted OR: 1.18; 95% CI: 1.14–1.22, p<0.001) (Table 1). The risk was maintained through the whole study period (lower OR: 1.14 in 2014; higher OR: 1.28 in 2006). Table 1. Variables independently associated with in-hospital mortality adjusted by risk in a multilevel logistic regression model, 2005–2015 STEMI In-hospital mortality Odds Ratio P 95% CI Woman 1.18 <0.001 1.14 1.22 Age 1.06 <0.001 1.06 1.06 History of PTCA 1.58 <0.001 1.40 1.77 Congestive heart failure 1.26 <0.001 1.22 1.30 Acute Myocardial Infarction 1.84 <0.001 1.54 2.20 Anterior myocardial infarction 1.47 <0.001 1.23 1.76 Cardio-respiratory failure or shock 15.25 <0.001 14.78 15.75 Hypertension 0.81 <0.001 0.79 0.84 Stroke 5.76 <0.001 5.18 6.42 Cerebrovascular disease 0.86 <0.001 0.79 0.93 Renal failure 1.95 <0.001 1.88 2.02 Vascular disease and complications 7.03 <0.001 5.72 8.63 CI, Confidence Interval. Conclusions Female sex is an independent predictor of mortality in patients with STEMI in Spain, maintaining through a period of the 11 years.

scholarly journals Ascites, a New Cause for Bilateral Hydronephrosis: Case Report

2009 ◽  
Vol 9 ◽  
pp. 1035-1039 ◽  
Author(s):  
Deepika Jain ◽  
Smrita Dorairajan ◽  
Madhukar Misra
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Liver Cirrhosis ◽  
Case Report ◽  
Abdominal Ultrasound ◽  
Back Pressure ◽  
Alcoholic Liver Cirrhosis ◽  
Bilateral Hydronephrosis ◽  
History Of

Bilateral hydronephrosis secondary to urinary obstruction leads to a buildup of back pressure in the urinary tract and may lead to impairment of renal function. We present a case of a 57-year-old male with a history of alcoholic liver cirrhosis, who presented with tense ascites and acute renal failure. Bilateral hydronephrosis was seen on abdominal ultrasound. Multiple large-volume paracenteses resulted in resolution of hydronephrosis and prompt improvement in renal function.

Effect of Vitamin E and Pentoxifylline on Glycerol-Induced Acute Renal Failure

Nephron ◽  
2000 ◽  
Vol 84 (3) ◽  
pp. 243-247 ◽  
Author(s):  
Tekin Akpolat ◽  
Ilkser Akpolat ◽  
Hamit Öztürk ◽  
Şaban Sarıkaya ◽  
Arif Mansur Coşar ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Vitamin E

Risk of acute renal failure among breast cancer patients and chemotherapy treatment of breast cancer patients with a history of renal insufficiency in a commercially-insured population in the United States

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22104-e22104 ◽  
Author(s):  
W. J. Langeberg ◽  
C. D. O'Malley ◽  
C. W. Critchlow ◽  
J. P. Fryzek
Keyword(s):  
Breast Cancer ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Insufficiency ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
The United States ◽  
First Year ◽  
Breast Cancer Patients ◽  
History Of

e22104 Background: Risk of acute renal failure (ARF) among breast cancer (BC) patients may increase with nephrotoxic chemotherapy and other exposures, but this risk is not well characterized. Furthermore, among patients who present with renal insufficiencies (RI) at cancer diagnosis, subsequent treatment patterns are not well described. Methods: We performed a retrospective cohort study using a large national commercial claims database. The cohort included all women diagnosed with BC from 2000 to 2007 who were 18–64 years at diagnosis with no history of cancer (n=13,296). We defined a diagnosis of BC as at least one inpatient or two outpatient claims more than 30 days apart with an ICD-9 code of 174. Among patients with no history of RI (n=13,150), we calculated the cumulative incidence (CI) of ARF_the proportion with at least one inpatient or two outpatient claims with an ICD-9 code of 584 or 586 in the first year following cancer diagnosis. Treatment for BC patients with a history of RI (n=146) was also assessed. Results: Among BC patients with no history of RI, 0.3% were diagnosed with ARF within a year after cancer diagnosis. The CI of ARF was higher in patients with metastases: 0.7% for any metastasis, 2.3% for bone metastasis, and 0.1% for no metastasis. The CI of ARF among patients undergoing radiation or mastectomy was similar to the overall rate (0.3%) but was higher in patients receiving nephrotoxic chemotherapy (1.0%) or intravenous bisphosphonates (IV BPs) (2.1%). The CI of ARF was higher in patients with congestive heart failure (1.4%), diabetes (0.9%), and/or hypertension (0.8%) at cancer diagnosis compared to patients without these comorbidities (0.2%). Among BC patients with a history of RI, 7.5% were administered nephrotoxic chemotherapy, 30.1% received potentially nephrotoxic chemotherapy, and 1.4% were given IV BPs. Conclusions: Breast cancer patients who present with comorbidities, develop metastases, or are given nephrotoxic chemotherapy or IV bisphosphonates are at higher risk of acute renal failure in the first year after breast cancer diagnosis. More research is warranted on the treatment of breast cancer patients with a history of renal insufficiency. [Table: see text]

scholarly journals The “Burden” of Malignancy in a Tertiary Hospital Intensive Cardiovascular Care Unit

Cardiology ◽  
2017 ◽  
Vol 138 (3) ◽  
pp. 195-199
Author(s):  
Israel Mazin ◽  
Shlomi Matetzky ◽  
Linor Shemer ◽  
Dana Fourey ◽  
Paul Fefer ◽  
...  
Keyword(s):  
Renal Failure ◽  
Tertiary Hospital ◽  
Therapeutic Interventions ◽  
Multivariate Logistic Regression Model ◽  
Mortality And Morbidity ◽  
Tertiary Center ◽  
History Of ◽  
Causes Of Mortality ◽  
Patient Groups ◽  
Cardiovascular Care

Objectives: During the past decade, the most common causes of mortality and morbidity were cardiovascular diseases and malignancies. The aim of the current study was to describe the incidence, course of admission, and short-term (30-day) prognosis of patients with and without malignancy, admitted to a tertiary center intensive cardiovascular care unit (ICCU). Methods: A prospective observational study of 2,259 patients admitted to the ICCU was conducted between January 2014 and December 2015. Patients with malignancies (n = 256) were divided into 2 groups: those with solid and those with homogenous tumors. Results: The time of diagnosis was categorized into 3 patient groups: recent (<6 months), 59 patients (23%); late (6-24 months), 49 patients (19%), and very late (>24 months), 148 patients (58%). Those with a history of malignancy were older (73 ± 12 vs. 64 ± 15, p < 0.001) and were more likely to be female (p = 0.002). After using a multivariate logistic regression model analysis, no differences were found in therapeutic interventions and clinical outcomes, including major bleeding and acute renal failure, between patients with and without malignancies. Conclusions: Patients with a malignancy comprised about 10% of the entire ICCU population. While mortality was independently associated with advanced age, renal failure, and a diagnosis of ST-elevation myocardial infarction, malignancy alone was not found to be independently associated with a higher mortality rate at 30 days of follow-up.

scholarly journals A Rare Case of Acute Renal Failure Secondary to Rhabdomyolysis Probably Induced by Donepezil

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Osman Zikrullah Sahin ◽  
Teslime Ayaz ◽  
Suleyman Yuce ◽  
Fatih Sumer ◽  
Serap Baydur Sahin
Keyword(s):  
Emergency Department ◽  
Renal Failure ◽  
Creatine Kinase ◽  
Acute Renal Failure ◽  
Rare Case ◽  
Laboratory Studies ◽  
Case Presentation ◽  
History Of ◽  
One Year ◽  
Renal Function Tests

Introduction. Acute renal failure (ARF) develops in 33% of the patients with rhabdomyolysis. The main etiologic factors are alcoholism, trauma, exercise overexertion, and drugs. In this report we present a rare case of ARF secondary to probably donepezil-induced rhabdomyolysis.Case Presentation. An 84-year-old male patient was admitted to the emergency department with a complaint of generalized weakness and reduced consciousness for two days. He had a history of Alzheimer’s disease for one year and he had taken donepezil 5 mg daily for two months. The patient’s physical examination revealed apathy, loss of cooperation, and decreased muscle strength. Laboratory studies revealed the following: urea: 128 mg/dL; Creatinine 6.06 mg/dL; creatine kinase: 3613 mg/dL. Donepezil was discontinued and the patient’s renal function tests improved gradually.Conclusion. Rhabdomyolysis-induced acute renal failure may develop secondary to donepezil therapy.

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