scholarly journals The Effects of Administration of Exogenous Albumin Early after Non-cardiac Surgery on Postoperative AKI in Patients with Preoperative Hypoalbuminemia: A Prospective Propensity-score Matching Analysis

2021 ◽  
Author(s):  
Miao Yan ◽  
Wei-Jie Zhou ◽  
Min Xie ◽  
Sai-Nan Zhu ◽  
Nan Li ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Final Analysis ◽  
Surgical Intensive Care Unit ◽  
Control Group ◽  
Surgical Intensive Care ◽  
Postoperative Aki

Abstract BackgroundEvidence have shown that preoperative hypoalbuminemia is independently associated with acute kidney injury (AKI) after non-cardiac surgery. However, little study has investigated the effects of administration of exogenous albumin early after non-cardiac surgery on postoperative AKI in patients with preoperative hypoalbuminemia.MethodsThis study was a secondary analysis of the database of a previously conducted prospective cohort study. Data of 661 adult patients who underwent non-cardiac surgery and were admitted to Surgical Intensive Care Unit (SICU) after surgery from May 1, 2019 to November 30, 2020 were collected. 267 patients with preoperative hypoalbuminemia were screened, and divided into two groups according to whether they were administrated with exogenous albumin on the day of SICU admission. The demographic and perioperative data of the two groups were propensity-matched. ResultsAfter propensity score matching, 64 pairs of patients were included in the final analysis. The patients of albumin group showed relatively higher serum albumin level on postoperative day 1 than that in patients of control group (31.3±3.4 vs. 29.7±3.8, P=0.008), however, no difference was observed in postoperative AKI incidence in patients of the two groups (59.4% vs. 62.5%, P=0.717). Furthermore, there was no difference in other prognostic factors, such as the use of mechanical ventilation, occurrence of other postoperative complications, in-hospital mortality, length of SICU stay and postoperative hospital stay.ConclusionsFor patients with preoperative hypoalbuminemia following non-cardiac surgery, administration of exogenous albumin early after surgery had no beneficial effect on the incidence of postoperative AKI and other clinical outcomes.

scholarly journals Effect of Diabetes Mellitus on Acute Kidney Injury after Minimally Invasive Partial Nephrectomy: A Case-Matched Retrospective Analysis

2019 ◽  
Vol 8 (4) ◽  
pp. 468 ◽  
Author(s):  
Na Young Kim ◽  
Jung Hwa Hong ◽  
Dong Hoon Koh ◽  
Jongsoo Lee ◽  
Hoon Jae Nam ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Kidney Injury ◽  
Propensity Score ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Partial Nephrectomy ◽  
Kidney Injury ◽  
Invasive Technique ◽  
Male Sex ◽  
Postoperative Aki

Postoperative acute kidney injury (AKI) is still a concern in partial nephrectomy (PN), even with the development of minimally invasive technique. We aimed to compare AKI incidence between patients with and without diabetes mellitus (DM) and to determine the predictive factors for postoperative AKI. This case-matched retrospective study included 884 patients with preoperative creatinine levels ≤1.4 mg/dL who underwent laparoscopic or robot-assisted laparoscopic PN between December 2005 and May 2018. Propensity score matching was employed to match patients with and without DM in a 1:3 ratio (101 and 303 patients, respectively). Of 884 patients, 20.4% had postoperative AKI. After propensity score matching, the incidence of postoperative AKI in DM and non-DM patients was 30.7% and 14.9%, respectively (P < 0.001). In multivariate analysis, male sex and warm ischemia time (WIT) >25 min were significantly associated with postoperative AKI in patients with and without DM. In patients with DM, hemoglobin A1c (HbA1c) >7% was a predictive factor for AKI, odds ratio (OR) = 4.59 (95% CI, 1.47–14.36). In conclusion, DM increased the risk of AKI after minimally invasive PN; male sex, longer WIT, and elevated HbA1c were independent risk factors for AKI in patients with DM.

scholarly journals Diagnostic Performance of Cyclophilin A in Cardiac Surgery-Associated Acute Kidney Injury

2019 ◽  
Vol 9 (1) ◽  
pp. 108 ◽  
Author(s):  
Cheng-Chia Lee ◽  
Chih-Hsiang Chang ◽  
Ya-Lien Cheng ◽  
George Kuo ◽  
Shao-Wei Chen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Early Detection ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Cyclophilin A ◽  
University Hospital ◽  
Surgical Intensive Care ◽  
Postoperative Aki

Acute kidney injury (AKI) is associated with increased morbidity and mortality and is frequently encountered in cardiovascular surgical intensive care units (CVS-ICU). In this study, we aimed at investigating the utility of cyclophilin A (CypA) for the early detection of postoperative AKI in patients undergoing cardiac surgery. This was a prospective observational study conducted in a CVS-ICU of a tertiary care university hospital. All prospective clinical and laboratory data were evaluated as predictors of AKI. Serum and urine CypA, as well as urine neutrophil gelatinase-associated lipocalin (uNGAL), were examined within 6 h after cardiac surgery. The discriminative power for the prediction of AKI was evaluated using the area under the receiver operator characteristic curve (AUROC). We found that both serum CypA and urine CypA were significantly higher in the AKI group than in the non-AKI group. For discriminating AKI and dialysis-requiring AKI, serum CypA demonstrated acceptable AUROC values (0.689 and 0.738, respectively). The discrimination ability of urine CypA for predicting AKI was modest, but it was acceptable for predicting dialysis-requiring AKI (AUROC = 0.762). uNGAL best predicted the development of AKI, but its sensitivity was not good. A combination of serum CypA and uNGAL enhanced the overall performance for predicting the future development of AKI and dialysis-requiring AKI. Our results suggest that CypA is suitable as a biomarker for the early detection of postoperative AKI in CVS–ICU. However, it has better discriminating ability when combined with uNGAL for predicting AKI in CVS-ICU patients.

scholarly journals A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial of High-Dose, Short-Term Vitamin D Administration in the Prevention of Acute Kidney Injury after Cardiac Surgery

2021 ◽  
pp. 1-7
Author(s):  
Pegah Eslami ◽  
Manouchehr Hekmat ◽  
Mahmoud Beheshti ◽  
Ramin Baghaei ◽  
Seyed Mohsen Mirhosseini ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Vitamin D ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
High Dose ◽  
Double Blind ◽  
Postoperative Aki

<b><i>Background:</i></b> Acute kidney injury (AKI) after cardiac surgery is a relatively common complication affecting short- and long-term survival. The renoprotective effect of vitamin D (VitD) has been confirmed in several experimental models. This study was conducted to evaluate the effect of high-dose VitD administration in patients with VitD insufficiency on the incidence of postoperative AKI, the urinary level of tubular biomarkers, and serum anti-inflammatory biomarker after coronary artery bypass graft. <b><i>Design and Method:</i></b> In this randomized double-blind controlled clinical trial, the patients were randomly allocated to either the VitD group (<i>n</i> = 50), receiving 150,000 IU VitD tablets daily for 3 consecutive days before surgery or the control group (<i>n</i> = 61), receiving placebo tablets. <b><i>Results:</i></b> There was no difference in the incidence of postoperative AKI between the groups. Both of the urinary levels of interleukin-18 and kidney injury molecule-1 were significantly increased after the operation (<i>p</i> &#x3c; 0.001, for both). Also, the serum level of interleukin-10 was increased after 3 days of VitD supplementation (<i>p</i> = 0.001). In comparison with the control group, it remained on a higher level after the operation (<i>p</i> &#x3c; 0.001) and the next day (<i>p</i> = 0.03). The patients with AKI had more postoperative bleeding and received more blood transfusion. <b><i>Conclusion:</i></b> VitD pretreatment was unable to impose any changes in the incidence of AKI and the urinary level of renal biomarkers. However, high-dose administration of VitD may improve the anti-inflammatory state before and after the operation. Further studies are needed to assess the renoprotective effect of VitD on coronary surgery patients.

scholarly journals Elevated preoperative D-dimer is associated with acute kidney injury after non-cardiac surgery

2021 ◽  
Author(s):  
Yan Zhou ◽  
Hong-Yun Yang
Keyword(s):  
Cardiac Surgery ◽  
Propensity Score ◽  
Odds Ratio ◽  
Additive Model ◽  
Kidney Injury ◽  
P Value ◽  
Propensity Score Weighting ◽  
Before And After ◽  
Postoperative Aki ◽  
D Dimer

Abstract aimed to analyze the relationship between preoperative D-dimer level and AKI following non-cardiac surgery.Method: This was a single-center retrospective cohort study for elective non-cardiac surgery from January 1, 2012, to December 31, 2018. The endpoint was the occurrence of AKI 7 days postoperatively in the hospital. The non-linear relationship was described using the generalized additive model. ROC and minimum P-value approach identified possible cut-off points. D-dimer's odds ratio as continuous, quantile, and dichotomous variables by various cut-off points for postoperative AKI were calculated in multivariate logistic regression models before and after propensity score weighting.Results: Of the 55439 surgery, 5.0% (2779 cases) suffered postoperative AKI. Non-linearity was found between D-dimer and postoperative AKI. The odds ratio for D-dimer before and after propensity score weighting was (≤ 0.380 µg/mL as reference, minimum P-value cut-off point) 1.35 (1.20-1.49), P < 0.001 and 1.25 (1.09-1.43), P = 0.001, respectively; (≤ 0.165 µg/mL as reference, ROC cut-off point) 1.24 (1.12-1.37), P < 0.001 and 1.18 (1.06-1.31), P = 0.002, respectively. Sensitivity analysis showed similar results. Heterogeneity subgroup analysis showed that patients with normal preoperative creatinine, hemoglobin level, and intraperitoneal surgery or more complex surgery seemed to be more vulnerable to elevated D-dimer.Conclusions: Preoperative D-dimer was significantly associated with postoperative AKI following non-cardiac surgery. The optimal cut-off point for preoperative D-dimer was 0.165 µg/mL by ROC approach and 0.38 µg/mL by minimum P-value approach.

scholarly journals Effects of Polymyxin B Hemoperfusion on Septic Shock Patients Requiring Noradrenaline: Analysis of a Nationwide Administrative Database in Japan

2021 ◽  
pp. 1-6
Author(s):  
Kenji Fujimori ◽  
Kunio Tarasawa ◽  
Kiyohide Fushimi
Keyword(s):  
Septic Shock ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Polymyxin B ◽  
Administrative Database ◽  
Control Group ◽  
Continuous Hemodiafiltration ◽  
Significant Survival ◽  
Maximum Daily Dose ◽  
Polymyxin B Hemoperfusion

<b><i>Introduction:</i></b> Polymyxin B hemoperfusion (PMX) reduces endotoxin in septic shock patients’ blood and can improve hemodynamics and organ functions. However, its effects on the reduction of septic shock mortality are controversial. <b><i>Methods:</i></b> Using the Japanese diagnosis procedure combination database from April 2016 to March 2019, we identified adult septic shock patients treated with noradrenaline. This study used propensity score matching to compare the outcome between PMX-treated and non-treated patients. The primary endpoint was 28-day mortality, counting from the day of noradrenaline initiation. The secondary endpoints were noradrenaline-, ventilator-, and continuous hemodiafiltration (CHDF)-free days at day 28. <b><i>Results:</i></b> Of 30,731 eligible patients, 4,766 received PMX. Propensity score matching produced a matched cohort of 4,141 pairs with well-balanced patient backgrounds. The 28-day survival rate was 77.9% in the PMX group and 71.1% in the control group (<i>p</i> &#x3c; 0.0001). Median days of noradrenalin-, CHDF-, and ventilator-free days were 2 days (<i>p</i> &#x3c; 0.0001), 2 days (<i>p</i> &#x3c; 0.0001), and 6 days (<i>p</i> &#x3c; 0.0001) longer in the PMX group than in the control group, respectively. When stratified with the maximum daily dose of noradrenaline, the PMX group showed a statistically significant survival benefit in the groups with noradrenaline dose &#x3c;20 mg/day but not in the noradrenaline group dose ≥20 mg/day. <b><i>Conclusion:</i></b> Analysis of large Japanese databases showed that septic shock patients who received noradrenaline might benefit from PMX treatment.

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

scholarly journals Bicyclol for the treatment of drug-induced liver injury: a propensity score matching analysis using a nationwide inpatient database

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110059
Author(s):  
Yongfeng Wang ◽  
Rongtao Lai ◽  
Peilan Zong ◽  
Qingling Xu ◽  
Jia Shang ◽  
...  
Keyword(s):  
Liver Injury ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Statistical Significance ◽  
Control Group ◽  
Time Interval ◽  
Potential Candidate ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Propensity Score Matching Analysis

ObjectiveTo evaluate the efficacy and safety of bicyclol in patients with drug-induced liver injury (DILI) using a nationwide database.MethodsWe retrospectively analyzed the clinical data of DILI patients in the DILI-R database. Propensity score matching was performed to balance the bicyclol and control groups, and alanine aminotransferase (ALT) recovery was compared between the two groups. Factors associated with ALT recovery and safety were identified.ResultsThe analysis included the data of 25,927 patients. Eighty-seven cases were included in the bicyclol group, with 932 cases in the control group. One-to-one propensity score matching created 86 matched pairs. The ALT normalization rate in the bicyclol group was significantly higher than that in the control group (50.00% vs. 24.42%), and statistical significance was found in the superiority test. After adjustment of baseline ALT levels, baseline total bilirubin levels, sex, age, acute or chronic liver diseases, and suspected drugs in the multivariate logic regression analysis, the major influencing factors for ALT recovery included the time interval between ALT tests (days) and the group factor (bicyclol treatment). There were no differences in the proportion of renal function impairment or blood abnormalities between the two groups.ConclusionsBicyclol is a potential candidate for DILI.

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