Prompting With Checklist for Early Recognition and Treatment of Acute Illness On The Prevention of Acute Kidney Injury in Patients With Septic Shock

Abstract Background: Early identification of septic patients at high risk for acute kidney injury (AKI), followed by timely and appropriate interventions, is crucial for improving patients’ outcomes. Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) is a tool for evaluating and treating acute illness promptly based on best practices. We hypothesized that the use of CERTAIN would prevent the occurrence of AKI after septic shock. Methods: This was a before-and-after study. CERTAIN, included the care bundles recommended in the Sepsis 3.0 and Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines, used in daily practice to manage patients with septic shock. The primary outcome was the incidence of AKI within 72 hours in patients with septic shock. Secondary outcomes were mortality and major adverse kidney events (MAKEs) at 90 days after exposure to AKI. Results: 124 patients had been treated with CERTAIN, and 112 patients were in the Pre-CERTAIN group. AKI reduced significantly in the Post-CERTAIN group compared to the Pre-CERTAIN group within 72h after enrollment (55.7% vs 68.8%, P=0.045). CERTAIN prolonged ventilator-free days and vasoactive agents free days at 28 days (22 vs 17, P<0.001; 23 vs 19, P=0.044; respectively). The mortality and MAKEs at 90 days were reduced in the Post-CERTAIN group compared to the Pre-CERTAIN group (17.7% vs 29.5%, P=0.045; 41.9% vs 56.3%, P=0.039; respectively). Conclusions: Implementation of CERTAIN reduced the AKI frequency, mortality at 90 days, and the rate of MAKEs at 90 days in septic shock patients. Trial registration: NCT01973829. Date of registration: 1st November 2013.

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The Impact of The [TIMP-2] × [IGFBP7]-Guided Checklist for Early Recognition and Treatment of Acute Illness on The Prevention of Acute Kidney Injury In Patients With Septic Shock

10.21203/rs.3.rs-251411/v1 ◽

2021 ◽

Author(s):

Jingjing Wang ◽

Jing Li ◽

Dongqiang Wang ◽

Yongqiang Wang ◽

Lin Dou ◽

...

Keyword(s):

Septic Shock ◽

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Length Of Stay ◽

Kidney Function ◽

Early Recognition ◽

Kidney Injury ◽

Acute Illness ◽

Lower Proportion ◽

Icu Length Of Stay

Abstract Background: Sepsis is the main aetiology of acute kidney injury (AKI) in critically ill patients, with high morbidity and mortality. The early identification of septic patients at high risk for AKI, followed by the timely implementation of appropriate interventions, is crucial for improving patient outcomes. Tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 ([TIMP-2] × [IGFBP7]) are promising biomarkers for AKI. Furthermore, the Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) is a tool for evaluating and treating acute illness in a timely manner based on best practices. We hypothesized that the use of this biomarker-guided point-of-care tool would improve the prognosis of patients with sepsis-associated acute kidney injury (SA-AKI).Methods: This was a single-centre prospective before-and-after study in the ICU of a comprehensive tertiary hospital. From June 2015 to December 2020, we assessed and managed patients with septic shock based on the biomarker-guided CERTAIN checklist. A checklist based on the Sepsis 3.0 bundle and urinary [TIMP-2] × [IGFBP7]>0.3(ng/mL)2/1000 within 12 hours were used as the inclusion criteria. The CERTAIN checklist includes the care bundles recommended in the Sepsis 3.0 bundle and Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines. The primary outcome was the incidence of moderate-to-severe AKI on the first day and within seven days after enrolment and mortality at 90 days after discharge from the hospital. The secondary outcomes were the ICU length of stay, non-mechanical ventilation duration, and the proportions of patients with the recovery of renal function and major adverse kidney events (MAKEs) at 90 days after exposure to events initiating AKI.Results: At the end of the study, 124 patients had been treated based on the checklist. When compared to a cohort of 112 patients matched for disease, the CERTAIN group had a lower proportion of patients needing mechanical ventilation, a lower proportion of patients needing vasoactive agents, a shorter ICU length of stay, and a higher proportion of patients with recovered kidney function. Furthermore, there was a trend towards a higher 90-day survival rate in the CERTAIN group.Conclusions: Implementation of the CERTAIN checklist was associated with improvements in the short-term recovery of kidney function, airway and haemodynamic management and mortality in patients with SA-AKI.Trial registration: NCT01973829; Date of registration: November 1, 2013.

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Removal of Procalcitonin and Selected Cytokines during Continuous Veno-Venous Hemodialysis Using High Cutoff Hemofilters in Patients with Sepsis and Acute Kidney Injury

Blood Purification ◽

10.1159/000488929 ◽

2018 ◽

Vol 46 (2) ◽

pp. 153-159 ◽

Cited By ~ 5

Author(s):

Grzegorz Kade ◽

Sławomir Literacki ◽

Agnieszka Rzeszotarska ◽

Stanisław Niemczyk ◽

Arkadiusz Lubas

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Interleukin 12 ◽

Interleukin 17 ◽

Reactive Protein ◽

Before And After ◽

Factor Α ◽

The Impact ◽

Necrosis Factor

Introduction: The purpose of this study was to evaluate the impact of continuous veno-venous hemodialysis (CVVHD) using high cutoff (HCO) hemofilters on the removal of procalcitonin (PCT), and other inflammatory markers in the treatment of patients during septic shock with acute kidney injury (AKI). Materials and Methods: Thirty-six patients with septic shock and AKI were included in the study. Before and after the 24-h HCO-CVVHD, PCT, native C-reactive protein (CRP) and cytokines (interleukin-1β, interleukin-6, interleukin-12, interleukin-17, tumor necrosis factor-α) in serum and effluent were assessed. Results: After the HCO-CVVHD serum concentrations of PCT, CRP and selected cytokines were significantly lower. The decrease in PCT was bigger than in CRP (p = 0.007). The change in PCT concentration was significantly influenced by PCT and IL-17 clearances (R2 = 0.525; p < 0.001). Conclusion: In contrast to the native CRP, monitoring of PCT during HCO-CVVHD is less useful because it reflects the clearance of this marker and anti-inflammatory effectiveness of the method.

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Faculty Opinions recommendation of Haemodynamic Impact of a slower pump speed at start of continuous renal replacement therapy in critically Ill adults with acute kidney injury: a prospective before-and-after study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14267141.15779286 ◽

2012 ◽

Author(s):

Ashita Tolwani ◽

Keith Wille

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Pump Speed ◽

Before And After ◽

Critically Ill Adults ◽

Ill Adults ◽

Before And After Study

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The Association Between Pulsatile Cardiopulmonary Bypass and Acute Kidney Injury After Cardiac Surgery: A Before-and-After Study

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2019.05.021 ◽

2020 ◽

Vol 34 (1) ◽

pp. 108-113 ◽

Cited By ~ 2

Author(s):

Tim G. Coulson ◽

Eve McPhilimey ◽

Florian Falter ◽

Yasir Abu-Omar ◽

Andrew A. Klein

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Kidney Injury ◽

Before And After ◽

Before And After Study

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Haemodynamic Impact of a Slower Pump Speed at Start of Continuous Renal Replacement Therapy in Critically Ill Adults with Acute Kidney Injury: A Prospective Before-and-After Study

Blood Purification ◽

10.1159/000333838 ◽

2012 ◽

Vol 33 (1-3) ◽

pp. 52-58 ◽

Cited By ~ 5

Author(s):

Glenn M. Eastwood ◽

Leah Peck ◽

Helen Young ◽

Michael Bailey ◽

Michael C. Reade ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Pump Speed ◽

Before And After ◽

Critically Ill Adults ◽

Ill Adults ◽

Before And After Study

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Faculty Opinions recommendation of Histopathology of septic shock induced acute kidney injury: apoptosis and leukocytic infiltration.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1168327.630494 ◽

2009 ◽

Author(s):

Matthieu Legrand

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Leukocytic Infiltration

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Faculty Opinions recommendation of BCL2 genetic variants are associated with acute kidney injury in septic shock*.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717952982.793458534 ◽

2012 ◽

Author(s):

Nigel Webster

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Genetic Variants ◽

Kidney Injury

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Association between Procalcitonin and Acute Kidney Injury in Patients with Bacterial Septic Shock

Blood Purification ◽

10.1159/000512351 ◽

2021 ◽

pp. 1-10

Author(s):

Guang Fu ◽

Hai-chao Zhan ◽

Hao-li Li ◽

Jun-fu Lu ◽

Yan-hong Chen ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Piecewise Linear ◽

Kidney Injury ◽

Multiple Logistic Regression ◽

Primary Analysis ◽

Female Patients ◽

Potential Biomarker ◽

The Relationship

Objective: The objective of this study was to assess the relationship between serum procalcitonin (PCT) and acute kidney injury (AKI) induced by bacterial septic shock. Methods: A retrospective study was designed which included patients who were admitted to the ICU from January 2015 to October 2018. Multiple logistic regression and receiver operating characteristic (ROC) as well as smooth curve fitting analysis were used to assess the relationship between the PCT level and AKI. Results: Of the 1,631 patients screened, 157 patients were included in the primary analysis in which 84 (53.5%) patients were with AKI. Multiple logistic regression results showed that PCT (odds ratio [OR] = 1.017, 95% confidence interval [CI] 1.009–1.025, p < 0.001) was associated with AKI induced by septic shock. The ROC analysis showed that the cutoff point for PCT to predict AKI development was 14 ng/mL, with a sensitivity of 63% and specificity 67%. Specifically, in multivariate piecewise linear regression, the occurrence of AKI decreased with the elevation of PCT when PCT was between 25 ng/mL and 120 ng/mL (OR 0.963, 95% CI 0.929–0.999; p = 0.042). The AKI increased with the elevation of PCT when PCT was either <25 ng/mL (OR 1.077, 95% CI 1.022–1.136; p = 0.006) or >120 ng/mL (OR 1.042, 95% CI 1.009–1.076; p = 0.013). Moreover, the PCT level was significantly higher in the AKI group only in female patients aged ≤75 years (p = 0.001). Conclusions: Our data revealed a nonlinear relationship between PCT and AKI in septic shock patients, and PCT could be used as a potential biomarker of AKI in female patients younger than 75 years with bacterial septic shock.

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