scholarly journals Interaction of Acute Respiratory Failure and Acute Kidney Injury on in-Hospital Mortality of Patients with Acute Exacerbation COPD

2021 ◽  
Vol Volume 16 ◽  
pp. 3309-3316
Author(s):  
Dawei Chen ◽  
Linglin Jiang ◽  
Jing Li ◽  
Yan Tan ◽  
Mengqing Ma ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Acute Exacerbation ◽  
Kidney Injury

In-Hospital Complications and Mortality after Autologous Peripheral Blood Stem Cell Transplantation in Older Vs. Younger Multiple Myeloma Patients: An Analysis of the National Inpatient Sample

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1783-1783
Author(s):  
Larysa Sanchez ◽  
Michael Sylvester ◽  
Yucai Wang ◽  
Shijia Zhang ◽  
Jean Eloy ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Stem Cell ◽  
Respiratory Failure ◽  
Stem Cell Transplantation ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Cell Transplantation ◽  
Kidney Injury ◽  
Total Hospital ◽  
Complications And Mortality

Abstract Background: Autologous hematopoietic stem cell transplantation (Auto HSCT) has improved survival in patients (pts) with multiple myeloma (MM). Based upon clinical trials, auto HSCT is preferred for patients under the age of 65, as older pts are thought to be at higher risk for transplant complications and mortality. The aim of this population based study was to evaluate in-hospital complications and mortality after autologous peripheral blood stem cell transplantation (auto PBSCT) in younger (< age 65) vs. older (> or equal to age 65) MM pts utilizing the Nationwide Inpatient Sample (NIS). Methods: Data for the study were drawn from the NIS, a component of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. The NIS database was used to identify all MM pts admitted to US Hospitals for auto PBSCT over a three-year period (2008-2010). Patient characteristics were extracted from the NIS and adverse outcomes were identified by ICD-9-CM codes. We analyzed the relationship of age to in-hospital mortality, length of stay (LOS), total hospital costs, and adverse outcomes. We then performed multivariate logistic regression to determine predictors of in-hospital mortality. Data was analyzed with SPSS v 22. Results: We identified 2209 pts. The median (M) age was 59 yrs, with 1650 pts (74.7%) < age 65 and 559 pts (25.3%) ≥ to age 65. Pt demographics included: 1262 pts (57.1%) male, 1246 (56.4%) Caucasian, 280 (12.7%) African-American, 157 (7.1%) Hispanic, 37 (1.7%) Asian Pacific Islander, and 489 (22%) unknown race. Overall in-hospital mortality following auto PBSCT was 1.5% and 2.3% in older pts vs. 1.2% in younger pts (p=0.061). Mean LOS was 18.6 ± 10.8 days (standard deviation) in older pts vs. 16.8 ± 7.2 days in younger pts (p < 0.001). Mean total hospital charges were $161,117 ± $105,008 in older pts vs. $151,192 ± $78,342 in younger pts (p < 0.001). There was no significant difference in hematologic toxicities such as neutropenia between older and younger pts. In-hospital complications that were more likely to occur in older vs. younger pts were severe sepsis (23 (4.1%) vs. 22 (1.3%), p <0.001), septic shock (18 (3.2%) vs. 15 (0.9%), p <0.001), acute kidney injury (44 (7.9%) vs. 61 (3.7%), p <0.001), pneumonia (36 (6.4%) vs. 67 (4.1%), p = 0.021), acute respiratory failure (22 (3.9%) vs. 18 (1.1%), p <0.001), and endotracheal intubation requiring prolonged mechanical ventilation (18 (3.2%) vs. 21 (1.3%), p = 0.003). Interestingly, stomatitis/mucositis occurred less often in older pts (183 (32.7%) vs. 659 (39.9%), p = 0.002). In univariate analysis for risk factors for in-hospital mortality, neutropenia (OR 0.369, 95% CI: 0.15 - 0.89, p = 0.028), febrile neutropenia (OR 0.24, 95% CI: 0.06 - 0.99, p=0.05), sepsis (OR 19.57, 95% CI: 9.64 - 39.75, p <0.001), Clostridium difficile infection (OR 4.91, 95% CI: 2.09 - 11.56, p < 0.001), acute kidney injury (OR 8.12, 95% CI: 3.67 - 17.95, p < 0.001), pneumonia (OR 11.32, 95% CI: 5.33 - 24.05, p <0.001), and acute respiratory failure (OR 71.67, 95% CI: 32.51 - 157.99, p < 0.001) were predictors of in-hospital mortality. In a multivariate analysis accounting for age and gender, sepsis (OR 0.12, 95% CI: 0.05 - 0.29, p < 0.001), Clostridium difficile infection (OR 0.32, 95% CI: 0.11 - 0.92, p = 0.03), acute kidney injury (OR 0.31, 95% CI: 0.11 - 0.90, p = 0.03), and acute respiratory failure (OR 0.03, 95% CI: 0.01 - 0.09, p < 0.001) remained independent predictors of in-hospital mortality. Conclusions: Overall, in-hospital mortality in MM pts following auto PBSCT was rare (1.5%) and there was no significant difference in mortality between older vs. younger pts. This is consistent with other recent findings that chronological age does not increase mortality in recipients of ASCT, which is possibly the result of advances in auto PBSCT, such as less toxic conditioning regimens and improvements in supportive care. Older pts did have significantly increased LOS and total hospital charges compared to younger pts, and were at increased risk for severe sepsis/septic shock and respiratory complications including pneumonia and acute respiratory failure. Such in-hospital complications in older MM pts undergoing auto PBSCT should be of particular attention to physicians caring for this pt population. Further research is needed in other populations and datasets to confirm these findings. Disclosures Chang: Johnson & Johnson: Other: Stock.

scholarly journals Prediction of community-acquired pneumonia complications in military men

2012 ◽  
Vol 93 (6) ◽  
pp. 864-870
Author(s):  
I M Borisov ◽  
T G Shapovalova
Keyword(s):  
Acute Kidney Injury ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Toxic Shock Syndrome ◽  
Comparison Group ◽  
Kidney Injury ◽  
Community Acquired Pneumonia ◽  
Main Group ◽  
Prediction Algorithm ◽  
Toxic Shock

Aim. To develop diagnostic algorithm to predict the risk of community-acquired pneumonia development. Methods. 2000 patients with community-acquired pneumonia (male conscripts aged 18 to 22 years, mean age 19.2±0.19). A comparative analysis of two groups of patients to assess the algorithm for toxic shock syndrome, acute respiratory failure and acute kidney injury prediction was performed. In the comparison group (n=782, 1998 to 2003), prediction of complications was based on doctors’ personal knowledge and experience without using the prediction algorithms. In the main group (n=1218, 2003 to 2008), the established prediction algorithm was used. Results. The introduction of community-acquired pneumonia complications prediction algorithm allowed to decrease the incidence of such complications significantly. Toxic shock syndrome was diagnosed in 8.8% of patients in the comparison group and in 3.7% of patients of the main group (р 0.05), acute respiratory failure - in 43.1% of patients of the comparison group and in 19.5% of patients of the main group (р 0.05). The effectiveness of the algorithm for toxic shock syndrome prognosis was 90.8%, sensitivity - 91.8%, specificity - 89.7%, accuracy - 94.5%. The effectiveness of the algorithm for acute kidney injury prognosis was 90.7%, sensitivity - 90.7%, specificity - 90.8%, accuracy - 95.1%. Conclusion. Offered prediction algorithms can help a physician to suspect a possibility of potentially dangerous and lethal complications development in patients with community-acquired pneumonia at the early stages of the disease. It allows to adjust the treatment, to simplify the estimate for transportation need, to detect the indications for patients admission, including the admission to intensive care unit, and improve the results of treatment.

Abstract 17260: In Hospital Outcomes and Prevalence of Comorbidities in Patients With ST Elevation Myocardial Infarction With and Without Infective Endocarditis - Insight From National Inpatient Sample (2013-2014)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shakeel Jamal ◽  
farah Wani ◽  
Amina Khan ◽  
Asim Kichloo ◽  
Beth Bailey ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Respiratory Failure ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Valve Replacement ◽  
Kidney Injury ◽  
St Elevation Myocardial Infarction ◽  
National Inpatient Sample ◽  
St Elevation

Introduction: In infective endocarditis (IE), embolization to the coronary arteries is an uncommon phenomenon but can contribute to transmural infarction presenting as ST elevation myocardial infarction (STEMI). Due to limited date, we intend to evaluate the clinical outcomes in hospitalized patients with STEMI with and without underlying IE. Hypothesis: Morbidity and morbidity exponentiates in STEMI with comorbid IE when compared to without IE. Methods: Patients with primary diagnosis of STEMI with and without IE were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, National Inpatient Sample for year 2013 and 2014 based on ICD9 codes Results: During 2013 and 2014, a total of 117, 386 patients were admitted with the principle diagnosis of STEMI, out of whom 305 had comorbid IE. There was an increased in-hospital mortality (27.5% vs 10.8%, increased length of stay (14 vs 5 days), acute kidney injury (44.9% vs 18.7%), stroke (23.6% vs 3%), aortic valve replacement (9.5% vs 0.3%), mitral valve replacement (0.2%-5.2%), sepsis (50% vs 6%) and acute respiratory failure (36.7% vs 16.7%) in patients with STEMI with IE when compared to patients with STEMI and without comorbid IE. STEMI without IE had higher number of angiographies (58.7% vs 25.9%) and percutaneous coronary interventions (50.7% vs 14.4%) during their hospital course when compared to STEMI with IE. Conclusions: We conclude that hospitalized STEMI patients with concomitant diagnosis of IE are at higher risk of in-hospital mortality, increased LOS, AKI, stroke, valve replacements, and acute respiratory failure. Clinical trials that compare optimal interventions in these patients would be needed in future.

scholarly journals Long-term ACE Inhibitor/ARB Use Is Associated With Severe Renal Dysfunction and Acute Kidney Injury in Patients With Severe COVID-19: Results From a Referral Center Cohort in the Northeast of France

2020 ◽  
Author(s):  
Abderrahim Oussalah ◽  
Stanislas Gleye ◽  
Isabelle Clerc Urmes ◽  
Elodie Laugel ◽  
Jonas Callet ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Multilevel Modeling ◽  
Repeated Measures ◽  
Kidney Injury ◽  
Characteristic Analysis ◽  
Disease Outcomes ◽  
Increased Risk ◽  
Acute Kidney Injury Stage

Abstract Background In patients with severe coronavirus disease 2019 (COVID-19), data are scarce and conflicting regarding whether chronic use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) influences disease outcomes. In patients with severe COVID-19, we assessed the association between chronic ACEI/ARB use and the occurrence of kidney, lung, heart, and liver dysfunctions and the severity of the inflammatory reaction as evaluated by biomarkers kinetics, and their association with disease outcomes. Methods We performed a retrospective longitudinal cohort study on consecutive patients with newly diagnosed severe COVID-19. Independent predictors were assessed through receiver operating characteristic analysis, time-series analysis, logistic regression analysis, and multilevel modeling for repeated measures. Results On the 149 patients included in the study 30% (44/149) were treated with ACEI/ARB. ACEI/ARB use was independently associated with the following biochemical variations: phosphorus &gt;40 mg/L (odds ratio [OR], 3.35, 95% confidence interval [CI], 1.83–6.14), creatinine &gt;10.1 mg/L (OR, 3.22, 2.28–4.54), and urea nitrogen (UN) &gt;0.52 g/L (OR, 2.65, 95% CI, 1.89–3.73). ACEI/ARB use was independently associated with acute kidney injury stage ≥1 (OR, 3.28, 95% CI, 2.17–4.94). The daily dose of ACEI/ARB was independently associated with altered kidney markers with an increased risk of +25 to +31% per each 10 mg increment of lisinopril-dose equivalent. In multivariable multilevel modeling, UN &gt;0.52 g/L was independently associated with the risk of acute respiratory failure (OR, 3.54, 95% CI, 1.05–11.96). Conclusions Patients chronically treated with ACEI/ARB who have severe COVID-19 are at increased risk of acute kidney injury. In these patients, the increase in UN associated with ACEI/ARB use could predict the development of acute respiratory failure.

scholarly journals Severe Acute Kidney Injury in Critically Ill Patients with COVID-19 Admitted to ICU: Incidence, Risk Factors, and Outcomes

2021 ◽  
Vol 10 (6) ◽  
pp. 1217
Author(s):  
Muriel Ghosn ◽  
Nizar Attallah ◽  
Mohamed Badr ◽  
Khaled Abdallah ◽  
Bruno De Oliveira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Incidence Risk

Background: Critically ill patients with COVID-19 are prone to develop severe acute kidney injury (AKI), defined as KDIGO (Kidney Disease Improving Global Outcomes) stages 2 or 3. However, data are limited in these patients. We aimed to report the incidence, risk factors, and prognostic impact of severe AKI in critically ill patients with COVID-19 admitted to the intensive care unit (ICU) for acute respiratory failure. Methods: A retrospective monocenter study including adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection admitted to the ICU for acute respiratory failure. The primary outcome was to identify the incidence and risk factors associated with severe AKI (KDIGO stages 2 or 3). Results: Overall, 110 COVID-19 patients were admitted. Among them, 77 (70%) required invasive mechanical ventilation (IMV), 66 (60%) received vasopressor support, and 9 (8.2%) needed extracorporeal membrane oxygenation (ECMO). Severe AKI occurred in 50 patients (45.4%). In multivariable logistic regression analysis, severe AKI was independently associated with age (odds ratio (OR) = 1.08 (95% CI (confidence interval): 1.03–1.14), p = 0.003), IMV (OR = 33.44 (95% CI: 2.20–507.77), p = 0.011), creatinine level on admission (OR = 1.04 (95% CI: 1.008–1.065), p = 0.012), and ECMO (OR = 11.42 (95% CI: 1.95–66.70), p = 0.007). Inflammatory (interleukin-6, C-reactive protein, and ferritin) or thrombotic (D-dimer and fibrinogen) markers were not associated with severe AKI after adjustment for potential confounders. Severe AKI was independently associated with hospital mortality (OR = 29.73 (95% CI: 4.10–215.77), p = 0.001) and longer hospital length of stay (subhazard ratio = 0.26 (95% CI: 0.14–0.51), p < 0.001). At the time of hospital discharge, 74.1% of patients with severe AKI who were discharged alive from the hospital recovered normal or baseline renal function. Conclusion: Severe AKI was common in critically ill patients with COVID-19 and was not associated with inflammatory or thrombotic markers. Severe AKI was an independent risk factor of hospital mortality and hospital length of stay, and it should be rapidly recognized during SARS-CoV-2 infection.

scholarly journals Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1243
Author(s):  
Chi-Hua Ko ◽  
Ying-Wei Lan ◽  
Ying-Chou Chen ◽  
Tien-Tsai Cheng ◽  
Shan-Fu Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Respiratory Failure ◽  
Mean Arterial Pressure ◽  
Mortality Rate ◽  
Arterial Pressure ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Blood Ph

Background and Objectives: In the intensive care unit (ICU), renal failure and respiratory failure are two of the most common organ failures in patients with systemic inflammatory response syndrome (SIRS). These clinical symptoms usually result from sepsis, trauma, hypermetabolism or shock. If this syndrome is caused by septic shock, the Surviving Sepsis Campaign Bundle suggests that vasopressin be given to maintain mean arterial pressure (MAP) > 65 mmHg if the patient is hypotensive after fluid resuscitation. Nevertheless, it is important to note that some studies found an effect of various mean arterial pressures on organ function; for example, a MAP of less than 75 mmHg was associated with the risk of acute kidney injury (AKI). However, no published study has evaluated the risk factors of mortality in the subgroup of acute kidney injury with respiratory failure, and little is known of the impact of general risk factors that may increase the mortality rate. Materials and Methods: The objective of this study was to determine the risk factors that might directly affect survival in critically ill patients with multiple organ failure in this subgroup. We retrospectively constructed a cohort study of patients who were admitted to the ICUs, including medical, surgical, and neurological, over 24 months (2015.1 to 2016.12) at Chiayi Chang Gung Memorial Hospital. We only considered patients who met the criteria of acute renal injury according to the Acute Kidney Injury Network (AKIN) and were undergoing mechanical ventilator support due to acute respiratory failure at admission. Results: Data showed that the overall ICU and hospital mortality rate was 63.5%. The most common cause of ICU admission in this cohort study was cardiovascular disease (31.7%) followed by respiratory disease (28.6%). Most patients (73%) suffered sepsis during their ICU admission and the mean length of hospital stay was 24.32 ± 25.73 days. In general, the factors independently associated with in-hospital mortality were lactate > 51.8 mg/dL, MAP ≤ 77.16 mmHg, and pH ≤ 7.22. The risk of in-patient mortality was analyzed using a multivariable Cox regression survival model. Adjusting for other covariates, MAP ≤ 77.16 mmHg was associated with higher probability of in-hospital death [OR = 3.06 (1.374–6.853), p = 0.006]. The other independent outcome predictor of mortality was pH ≤ 7.22 [OR = 2.40 (1.122–5.147), p = 0.024]. Kaplan-Meier survival curves were calculated and the log rank statistic was highly significant. Conclusions: Acute kidney injury combined with respiratory failure is associated with high mortality. High mean arterial pressure and normal blood pH might improve these outcomes. Therefore, the acid–base status and MAP should be considered when attempting to predict outcome. Moreover, the blood pressure targets for acute kidney injury in critical care should not be similar to those recommended for the general population and might prevent mortality.

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