Earlier nephrology consultation may not be associated with improved short-term survival of acute kidney injury in very elderly men

Abstract Background Recent evidence cautions against the use of non-selective beta-blockers (NSBB) in patients with refractory ascites or spontaneous bacterial peritonitis while other data suggests a survival benefit in patients with advanced liver disease. The aim of this study was to describe the use and impact of NSBB in patients with cirrhosis referred for liver transplantation. Methods A single-center cohort of patients with cirrhosis, who were referred and evaluated for liver transplantation between January and June 2012 were studied for baseline characteristics and clinical outcomes. Patients were grouped according to the use of NSBB at initial evaluation, with the endpoint of 90-day mortality. Results Sixty-five (38%) of 170 consecutive patients evaluated for liver transplantation were taking NSBB. Patients taking NSBB had higher MELD and Child Pugh score. NSBB use was associated with lower 90-day mortality (6% vs. 15%) with a risk adjusted hazard ratio of 0.27 (95%CI .09–0.88, p = .03). Patients taking NSBB developed acute kidney injury (AKI) within 90 days more frequently than patients not taking NSBB (22% vs 11%), p = 0.048). However, this was related to increased stage 1 AKI episodes, all of which resolved. Twelve (27%) of 45 patients with > 90 day follow up discontinued NSBB, most commonly for hypotension and AKI, had increased subsequent MELD and mortality. Conclusions NSBB use in patients with cirrhosis undergoing liver transplant evaluation is associated with better short-term survival. Nevertheless, ongoing tolerance of NSBB in this population is dynamic and may select a subset of patients with better hemodynamic reserve.

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The Effect of Treatment on Short-Term Outcomes in Elderly Patients with Acute Kidney Injury

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2017.148 ◽

2017 ◽

Vol 5 (5) ◽

pp. 635-640 ◽

Cited By ~ 1

Author(s):

Zvezdana Petronijevic ◽

Gjulsen Selim ◽

Lidija Petkovska ◽

Ljubica Georgievska-Ismail ◽

Goce Spasovski ◽

...

Keyword(s):

Acute Kidney Injury ◽

Elderly Patients ◽

Kidney Injury ◽

Charlson Comorbidity Index Score ◽

Short Term ◽

Term Outcome ◽

Term Survival ◽

Long Term Outcome ◽

Effect Of Treatment

BACKGROUND: Elderly population (≥ 65) are more prone to develop acute kidney injury (AKI) compared to younger, also elderly with AKI have an increased requirement for dialysis treatment and an elevated risk of short-term and long-term mortality.AIM: The objectives of this study were to examine the effect of treatment of short-term outcomes and mortality in elderly patients with AKI.MATERIAL AND METHODS: Seventy elderly AKI patients, that filled one of the criteria of AKI definition and had hospitalization over 24 hours, were enrolled in the study.RESULTS: The median age of patients was 74.28 ± 6.64, with mean CCI (Charlson Comorbidity Index) score of 6.94 ± 1.94. The majority of patients (70%) were classified at stage 3 of AKIN, 20% of patients were classified at stage 2 and 10% at stage 1. In the groups of patients with death outcome, the chronic cardiomyopathy was more frequently present (p = 0.034). Regarding treatment, 58.6% of the AKI patients underwent hemodialysis while 41.4% received conservative treatment. Mortality rate was 52.8%, out of which 28.6% was in-hospital mortality, while in 24.3% of patients death occurred in the follow-up period of 90 days.CONCLUSION: In our study, short- term survival is not related to different treatment options. Applied treatment in elderly patients with AKI should be assessed by measuring the long term outcome.

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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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Hospital-acquired acute kidney injury in very elderly men: clinical characteristics and short-term outcomes

Aging Clinical and Experimental Research ◽

10.1007/s40520-019-01196-5 ◽

2019 ◽

Vol 32 (6) ◽

pp. 1121-1128

Author(s):

Qinglin Li ◽

Meng Zhao ◽

Feihu Zhou

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Clinical Characteristics ◽

Causes Of Death ◽

Kidney Injury ◽

Final Analysis ◽

Multiple Organ ◽

Elderly Men ◽

Very Elderly ◽

Using Data

Abstract Objectives We explored the risk factors for, and the clinical characteristics of, acute kidney injury (AKI), and the causes of death 28 days after such injury, in very elderly men. Methods This was a retrospective cohort study using data from the Geriatric Department of the Chinese PLA General Hospital. A total of 3464 elderly patients (≥ 75 years) were enrolled from January 2007 to December 2015. All patients were followed for 28 days or until death after AKI. Results In total, 668 patients (39.0%) developed AKI, and 623 men were included for the final analysis. The median age was 87 years. The 28-day mortality rate was 25.7%. The AKI etiologies were infections (39.6%), hypovolemia (23.8%), cardiovascular events (15.9%), nephrotoxicity (12.0%), and surgery (7.1%). Multiple organ dysfunction syndrome (46.4%) and pulmonary infection (22.5%) were the principal causes of death. Multivariate analysis revealed that time for AKI to develop (HR = 0.865; 95% CI 0.799–0.937; P < 0.001), low mean arterial pressure (HR = 0.970; 95% CI 0.958–0.981; P < 0.001), low serum prealbumin (HR = 0.924; 95% CI 0.894–0.955; P < 0.001) level, oliguria (HR = 2.261; 95% CI 1.424–3.590; P = 0.001), mechanical ventilation (HR = 1.492; 95% CI 1.047–2.124; P = 0.027), blood urea nitrogen (HR = 1.037; 95% CI 1.025–1.049; P < 0.001) level, magnesium (HR = 2.512; 95% CI 1.243–5.076; P = 0.010) level, and more severe AKI stages (stage 2: HR = 3.709; 95% CI 1.926–7.141; P < 0.001 and stage 3: HR = 5.660; 95% CI 2.990–10.717; P < 0.001) were independent risk factors for 28-day mortality. Conclusions The incidence of AKI increases significantly as age advanced. Identification of risk factors might lead to more intensive monitoring and early prevention, and might improve AKI patients’ outcomes in the very elderly.

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The impact of transient and persistent acute kidney injury on short-term outcomes in very elderly patients

Clinical Interventions in Aging ◽

10.2147/cia.s135241 ◽

2017 ◽

Vol Volume 12 ◽

pp. 1013-1020 ◽

Cited By ~ 2

Author(s):

Qinglin Li ◽

Meng Zhao ◽

Xiaodan Wang

Keyword(s):

Acute Kidney Injury ◽

Elderly Patients ◽

Kidney Injury ◽

Very Elderly ◽

Short Term ◽

The Impact

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Relationship between the time of day lung transplantation is performed during 24-hours shifts and short-term survival

10.26226/morressier.57108e2fd462b80290b4a68c ◽

2016 ◽

Author(s):

Johannes Menger

Keyword(s):

Lung Transplantation ◽

Time Of Day ◽

Short Term ◽

Term Survival ◽

Short Term Survival

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Influence of age and shock severity on short-term survival in patients with cardiogenic shock

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuaa035 ◽

2021 ◽

Author(s):

Jacob C Jentzer ◽

Benedikt Schrage ◽

David R Holmes ◽

Salim Dabboura ◽

Nandan S Anavekar ◽

...

Keyword(s):

Cardiogenic Shock ◽

Mayo Clinic ◽

Older Patients ◽

Cox Proportional Hazards ◽

Circulatory Support ◽

Short Term ◽

Term Survival ◽

Risk Of Death ◽

Coronary Syndrome ◽

Short Term Survival

Abstract Aims Cardiogenic shock (CS) is associated with poor outcomes in older patients, but it remains unclear if this is due to higher shock severity. We sought to determine the associations between age and shock severity on mortality among patients with CS. Methods and results Patients with a diagnosis of CS from Mayo Clinic (2007–15) and University Clinic Hamburg (2009–17) were subdivided by age. Shock severity was graded using the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages. Predictors of 30-day survival were determined using Cox proportional-hazards analysis. We included 1749 patients (934 from Mayo Clinic and 815 from University Clinic Hamburg), with a mean age of 67.6 ± 14.6 years, including 33.6% females. Acute coronary syndrome was the cause of CS in 54.0%. The distribution of SCAI shock stages was 24.1%; C, 28.0%; D, 33.2%; and E, 14.8%. Older patients had similar overall shock severity, more co-morbidities, worse kidney function, and decreased use of mechanical circulatory support compared to younger patients. Overall 30-day survival was 53.3% and progressively decreased as age or SCAI shock stage increased, with a clear gradient towards lower 30-day survival as a function of increasing age and SCAI shock stage. Progressively older age groups had incrementally lower adjusted 30-day survival than patients aged <50 years. Conclusion Older patients with CS have lower short-term survival, despite similar shock severity, with a high risk of death in older patients with more severe shock. Further research is needed to determine the optimal treatment strategies for older CS patients.

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Parenteral Nutrition and Oxidant Load in Neonates

Nutrients ◽

10.3390/nu13082631 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2631

Author(s):

Kandeepan Karthigesu ◽

Robert F. Bertolo ◽

Robert J. Brown

Keyword(s):

Parenteral Nutrition ◽

Storage Temperature ◽

Oral Feeding ◽

Published Data ◽

Short Term ◽

Antioxidant Defences ◽

Term Survival ◽

Nutrient Sources ◽

Short Term Survival

Neonates with preterm, gastrointestinal dysfunction and very low birth weights are often intolerant to oral feeding. In such infants, the provision of nutrients via parenteral nutrition (PN) becomes necessary for short-term survival, as well as long-term health. However, the elemental nutrients in PN can be a major source of oxidants due to interactions between nutrients, imbalances of anti- and pro-oxidants, and environmental conditions. Moreover, neonates fed PN are at greater risk of oxidative stress, not only from dietary sources, but also because of immature antioxidant defences. Various interventions can lower the oxidant load in PN, including the supplementation of PN with antioxidant vitamins, glutathione, additional arginine and additional cysteine; reduced levels of pro-oxidant nutrients such as iron; protection from light and oxygen; and proper storage temperature. This narrative review of published data provides insight to oxidant molecules generated in PN, nutrient sources of oxidants, and measures to minimize oxidant levels.

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