scholarly journals Effects of Dexmedetomidine Administration on Outcomes in Critically Ill Patients with Acute Kidney Injury: A Propensity Score-Matching Analysis

2021 ◽  
Author(s):  
Aixiang Yang ◽  
Jing Yang ◽  
Biying Zhou ◽  
Jinxian Qian ◽  
Liyang Jiang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Information ◽  
Kidney Injury ◽  
Cox Proportional Hazards Model

Abstract Background Dexmedetomidine (DEX) had organ protection effects and could decrease mortality in animal models, but its association with mortality and length of stay (LOS) in ICU and hospital in critically ill patients was conflicting. Whether acute kidney injury (AKI) subgroup of critically ill patients could benefit from DEX was unknown. The present study aimed to evaluate the effects of DEX on clinical outcomes of critically ill patients with AKI. Methods Data were extracted from the Medical Information Mart for Intensive Care Ⅲ database (MIMIC Ⅲ). Propensity score matching (PSM) analysis (1:3), cox proportional hazards model, linear regression and logistic regression model were used to assess the effect of DEX on clinical outcomes. Results After PSM, 324 pairs of patients were matched between the patients with DEX administration and those without. DEX administration was associated with decreased in-hospital mortality [hazard ratio (HR) 0.287; 95% CI 0.151–0.542; P < 0.001] and 90-day mortality [HR 0.344; 95% CI 0.221–0.534; P < 0.001], and it was also associated with reduced length of stay (LOS) in ICU [4.54(3.13,7.72) versus 5.24(3.15,10.91), P < 0.001] and LOS in hospital [11.63(8.02,16.79) versus 12.09(7.83,20.44), P = 0.002]. Subgroup analysis showed the above associations existed only in mild and moderate AKI subgroups, but not in severe AKI subgroup. Nevertheless, DEX administration was not associated with the recovery of renal function [HR 1.199; 95% CI 0.851–1.688; P = 0.300]. Conclusions DEX administration improved outcomes in critically ill patients with mild and moderate AKI and could be a good choice of sedation.

scholarly journals Association of FIB-4 index and clinical outcomes in critically ill patients with acute kidney injury: a cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi-Yi Shi ◽  
Rui Zheng ◽  
Jie-Jie Cai ◽  
Zheng-Dong Fang ◽  
Wen-Jing Chen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Proportional Hazards Model ◽  
Kidney Injury ◽  
Continuous Variable ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
The Relationship

Abstract Background The relationship between fibrosis-4 (FIB-4) index and clinical outcomes in patients with acute kidney injury (AKI) is unclear. We aimed to investigate the association between FIB-4 index and all-cause mortality in critically ill patients with AKI. Methods We used data from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database (v1.4). The FIB-4 score was calculated using the existing formulas. logistic regression model, and Cox proportional hazards model were used to assessed the relationship between the FIB-4 index and in-hospital,28-day and 90-day mortality, respectively. Results A total of 3592 patients with AKI included in the data analysis. 395 (10.99%) patients died during hospitalization and 458 (12.74%) patients died in 28-day. During the 90-day follow-up, 893 (22.54%) patients were dead. An elevated FIB-4 value was significantly associated with increased in-hospital mortality when used as a continuous variable (odds ratio [OR] 1.183, 95% confidence interval [CI] 1.072–1.305, P = 0.002) and as a quartile variable (OR of Q2 to Q4 1.216–1.744, with Q1 as reference). FIB-4 was positively associated with 28-day mortality of AKI patients with hazard ratio (HR) of 1.097 (95% CI 1.008, 1.194) and 1.098 (95% 1.032, 1.167) for 90-day mortality, respectively. Conclusion This study demonstrated the FIB-4 index is associated with clinical outcomes in critically ill patients with acute kidney injury.

Associations between early thiamine administration and clinical outcomes in critically ill patients with acute kidney injury

2021 ◽  
pp. 1-27
Author(s):  
Xunliang Li ◽  
Hong Luan ◽  
Hui Zhang ◽  
Chenyu Li ◽  
Quandong Bu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Information ◽  
Kidney Injury ◽  
Term Survival ◽  
Stage 1 ◽  
Thiamine Treatment

Abstract Background: The effects of early thiamine use on clinical outcomes in critically ill patients with acute kidney injury (AKI) are unclear. The purpose of this study was to investigate the associations between early thiamine administration and clinical outcomes in critically ill patients with AKI. Methods: The data of critically ill patients with AKI within 48 hours after ICU admission were extracted from the Medical Information Mart for Intensive Care III (MIMIC III) database. Propensity score matching (PSM) was used to match patients early receiving thiamine treatment to those not early receiving thiamine treatment. The association between early thiamine use and in-hospital mortality due to AKI was determined using a logistic regression model. Results: A total of 15,066 AKI patients were eligible for study inclusion. After PSM, 734 pairs of patients who did and did not receive thiamine treatment in the early stage were established. Early thiamine use was associated with lower in-hospital mortality (OR 0.65; 95% CI 0.49-0.87; P < 0.001) and 90-day mortality (OR 0.58; 95% CI 0.45-0.74; P < 0.001), and it was also associated with the recovery of renal function (OR 1.26; 95% CI 1.17-1.36; P < 0.001). In the subgroup analysis, early thiamine administration was associated with lower in-hospital mortality in patients with stage 1 to 2 AKI. Conclusions: Early thiamine use was associated with improved short-term survival in critically ill patients with AKI. It was possible beneficial role in patients with stage 1 to 2 AKI according to the KDIGO criteria.

Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury

2009 ◽  
Vol 24 (1) ◽  
pp. 129-140 ◽  
Author(s):  
Sean M. Bagshaw ◽  
Shigehiko Uchino ◽  
Rinaldo Bellomo ◽  
Hiroshi Morimatsu ◽  
Stanislao Morgera ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury

scholarly journals Evaluation of Zinc Sulfate as an Adjunctive Therapy in COVID-19 Critically Ill Patients: a Two Center Propensity-score Matched Study

2021 ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Ohoud Al Juhani ◽  
Abdulrahman I Al Shaya ◽  
Abdullah Kharbosh ◽  
Raed Kensara ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Adjunctive Therapy ◽  
Zinc Sulfate ◽  
Kidney Injury ◽  
Icu Stay ◽  
Increased Risk ◽  
Beta Coefficient

Abstract Background: Zinc is a trace element that plays a role in stimulating innate and acquired immunity. The role of zinc in critically ill patients with COVID-19 remains unclear. This study aims to evaluate the efficacy and safety of zinc sulfate as adjunctive therapy in critically ill patients with COVID-19.Methods: Patients aged ≥ 18 years with a COVID-19 who were admitted to the intensive care unit (ICU) in two tertiary hospitals in Saudi Arabia were retrospectively assessed for zinc use, from 01 March 2020 until 31-December 2020. We assessed the association of zinc use as adjunctive therapy with the in-hospital and 30-day mortality after propensity score matching. Secondary outcomes included mechanical ventilation (MV) duration, ICU length of stay (LOS), hospital LOS, and complication (s) during ICU stay. Results: A total of 266 patients were included in this study after using propensity score matching. Zinc sulfate as adjunctive therapy during ICU stay was not associated with statistically significant reduction in 30-day mortality nor in-hospital mortality compared to those who did not receive zinc (HR= 0.65 CI = 0.41,1.01; p= 0.05 and HR= 0.67 CI = 0.45,1.00; p= 0.05; respectively). Moreover, MV duration (Beta coefficient 0.10 CI = -0.19,0.39; p= 0.48), ICU LOS (Beta coefficient 0.19 CI = -0.02,0.40; p=0.08) and hospital LOS (Beta coefficient 0.15 CI = -0.02,0.32; p=0.08) were not statistically significant between the two groups. Patients who received zinc have a higher odds of acute kidney injury (AKI) during ICU stay (OR= 1.80 CI = 1.08-3.0; p= 0.02). Conclusion: Zinc sulfate as adjunctive therapy in critically ill patients with COVID-19 may have survival benefit; however, was not statistically significant. Zinc use was linked with an increased risk of AKI development during ICU stay.

scholarly journals Acute Kidney Injury Associated with Combination Antimicrobial Therapy in the Medical Information Mart for Intensive Care (MIMIC) III Database

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S344-S344
Author(s):  
W Cliff Rutter ◽  
David S Burgess
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Hepatorenal Syndrome ◽  
Medical Information ◽  
Kidney Injury ◽  
Rifle Criteria ◽  
Multivariable Logistic Regression

Abstract Background Increased acute kidney injury (AKI) incidence is linked with coadministration of vancomycin (VAN) and piperacillin-tazobactam (TZP) in the general hospital population when compared with VAN and cefepime (FEP); however, this phenomenon was not found in critically ill patients. Methods Patients receiving VAN in combination with FEP or TZP for at least 48 hours during an intensive care unit stay were included in this retrospective review. AKI was defined with the Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria. Exposure to common nephrotoxins was captured within 24 hours of combination therapy initiation through the entire treatment window. Basic descriptive statistics were performed, along with bivariable and multivariable logistic regression models of AKI odds. Results In total, 2230 patients were included, with 773 receiving FEP+VAN and 1457 receiving TZP+VAN. The groups were well balanced at baseline in most covariates, with the exception of hepatorenal syndrome diagnosis (TZP+VAN 1.4% vs. FEP+VAN 0.3%, P = 0.02) and vasopressor exposure (TZP+VAN 26.2% vs 21.5%, P = 0.01) being more common in the TZP+VAN group. Patients in the FEP+VAN group had a higher underlying severity of disease (Charlson comorbidity index [CCI] 2.7 vs. 2.3, P =0.0002). AKI incidence was higher in the TZP+VAN cohort (35.1% vs. 26.5%, P = 0.00004), with each stratification of the RIFLE criteria being higher. The time until onset of AKI was similar between groups (TZP+VAN median 1 [0–3] days vs. FEP+VAN 1 [0–4] days, P =0.2). After multivariable logistic regression, TZP+VAN therapy was associated with an adjust odds ratio (aOR) of AKI of 1.54 (95% confidence interval [CI] 1.25–1.89) compared with FEP+VAN. Other variables associated with increased odds of AKI included: age &gt;= 65, duration of antibiotic therapy, higher baseline renal function, sepsis, endocarditis, hepatorenal syndrome, thiazide diuretic exposure, and increased CCI. Conclusion Treatment with TZP+VAN is associated with significant increases in AKI incidence among critically ill patients, independent of other risks for AKI. Disclosures All authors: No reported disclosures.

scholarly journals Septic versus non-septic acute kidney injury in critically ill patients: characteristics and clinical outcomes

2014 ◽  
Vol 26 (4) ◽  
Author(s):  
Marília Galvão Cruz ◽  
João Gabriel A. de Oliveira Dantas ◽  
Talita Machado Levi ◽  
Mário de Seixas Rocha ◽  
Sérgio Pinto de Souza ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Septic Acute Kidney Injury

scholarly journals Early oseltamivir treatment improves survival in critically ill patients with influenza pneumonia

2021 ◽  
pp. 00888-2020
Author(s):  
Gerard Moreno ◽  
Alejandro Rodríguez ◽  
Jordi Sole-Violán ◽  
Ignacio Martín-Loeches ◽  
Emili Díaz ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Treatment ◽  
Survival Rates ◽  
Icu Mortality ◽  
Icu Length Of Stay ◽  
Influenza Pneumonia

Background and aimsThe relationship between early oseltamivir treatment (within 48 h of symptom onset) and mortality in patients admitted to intensive care units (ICUs) with severe influenza is disputed. This study aimed to investigate the association between early oseltamivir treatment and ICU mortality in critically ill patients with influenza pneumonia.MethodsThis was an observational study of patients with influenza pneumonia admitted to 184 ICUs in Spain. The primary outcome was to evaluate the association between early oseltamivir treatment and ICU mortality compared to later treatment. Secondary outcomes were to compare the duration of mechanical ventilation (MV) and the ICU length of stay between the early and later oseltamivir treatment groups. To reduce biases related to observational studies, propensity score matching and a competing risk analysis were performed.ResultsDuring the study period, 2124 met the inclusion criteria. All patients had influenza pneumonia and received oseltamivir before ICU admission. Of these, 529 (24.9%) received early oseltamivir treatment. In the multivariate analysis, early treatment was associated with reduced ICU mortality (OR 0.69, 95% CI 0.51–0.95). After propensity score matching, early oseltamivir treatment was associated with improved survival rates in the Cox regression (HR 0.77, 95% CI 0.61–0.99) and competing risk (sHR 0.67, 95% CI 0.53–0.85) analyses. The ICU length of stay and duration of MV were shorter in patients receiving early treatment.ConclusionsEarly oseltamivir treatment is associated with improved survival rates in critically ill patients with influenza pneumonia and may decrease ICU length of stay and MV duration.

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