scholarly journals Variable Creatinine Levels in Critical Care Patients: A Concerning Knowledge Gap

2021 ◽  
Vol 10 (8) ◽  
pp. 1689
Author(s):  
Trushil Shah ◽  
Madhusudhanan Narasimhan ◽  
Mary Latha Rathinam ◽  
Karen Relle ◽  
Melanie Kim ◽  
...  
Keyword(s):  
Critical Care ◽  
Serum Creatinine ◽  
Clinical Laboratory ◽  
Test Accuracy ◽  
Longitudinal Assessment ◽  
Cross Sectional ◽  
Negative Interference ◽  
Survey Results ◽  
Picc Line ◽  
Critical Care Patients

An accurate creatinine (Cr) estimate is pivotal for the assessment of renal function. Both patient- and practice-spawned factors palliate the test accuracy of serum creatinine (sCr) and can erratically represent actual kidney function. This study evaluated the caregivers’ awareness of enzymatic serum creatinine (E-sCr) assay interfering in dopamine/dobutamine (DD)-infused patient samples and the frequency of such interference in a critical care setting. We conducted an sCr awareness survey among UT Southwestern physicians, nurses, and pharmacists. We then performed a cross-sectional E-sCr comparison against the kinetic Jaffe method using the DD-infused patient samples collected from central venous catheters (CVC), peripherally inserted central catheter (PICC) lines, and the peripheral vein (PV). We retrospectively compared the longitudinal E-sCr results of the CVC/PICC draws with the corresponding blood urea nitrogen (BUN) levels. The survey results show a significant lack of awareness among caregivers about the negative interference of DD infusions on E-sCr. Cross-sectional E-sCr assessment relative to the Jaffe method displayed a negative interference in 12% of CVC/PICC line samples (7/57 DD-infused patients) compared to none in the PV draws. A longitudinal assessment of E-sCr, BUN, and potassium (K) levels from CVC/PICC line samples further confirmed a spurious decrease for E-sCr in about 12/50 (24%) patients who did not show a concurrent BUN or K decrease. The results suggest that a direct PV sampling accompanied by clinical laboratory-directed proactive discussion/activities can foster awareness among caregivers and eschew the false E-sCr estimates in DD-infused patients.

scholarly journals Clinical characteristics of confirmed cases of COVID-19 admitted at Al-Nahdha hospital, Oman: a cross-sectional descriptive study

2020 ◽  
Author(s):  
Saud Al Harthi ◽  
Magdi AlOsali ◽  
Ruwaida Al Ismaili ◽  
Sultan Al Lawati ◽  
Bina Kamble ◽  
...  
Keyword(s):  
Critical Care ◽  
Clinical Characteristics ◽  
Clinical Laboratory ◽  
Arabian Gulf ◽  
Health Information System ◽  
Cross Sectional ◽  
Factors Associated ◽  
Gulf Countries ◽  
Fundamental Information ◽  
Artery Disease

Abstract Background: With the coronavirus disease 19 (COVID-19) pervading the world, little has been published regarding the hospitalized cases of COVID-19 (confirmed) in the Arabian Gulf countries. This paper describes the socio-demographic, clinical, laboratory, and radiological characteristics, treatment and clinical outcomes of these cases in Al-Nahdha hospital, Oman. Additionally, factors associated with requiring critical care were identified.Methods: Data of all the positive cases in Al-Nahdha hospital were retrieved from the electronic health information system retrospectively from 3rd of March to 9th May 2020. Required information was recorded in a bespoke sheet and exported to SPSS for further analysis. The primary outcome was defined as requiring vs not requiring critical care.Results:Out of 102 total admissions, 19 cases required critical care (18.6%). Compared to the non-critical cases, majority of the severe cases requiring critical care were older [54.1(13.4) years vs 48.9(14.9) years], males [89.5% vs 74.7%] and non-nationals [63.2 vs 55.4%]. Significant factors associated with requiring critical care were symptoms of shortness of breath (89.5% vs 65.1%, P=0.03), diabetes (68.4% vs 32.5%, OR=1.5, P=0.004), chronic artery disease (15.8% vs 3.6%, OR=1.7, P=0.04), diagnosis of ARDS (63.2% vs 6.0%, P<0.001). Additionally, the mean ferritin levels was significantly higher in cases requiring critical care compared to their counter cases (2350.4(423.8) vs 795.7(554.3), P=0.005). Depending on disease severity, treatment included anti-bacterial, anti-viral, heparin and steroids. The utilization of steroids was significantly higher in the cases requiring critical care (63.2% vs 26.5%, P=0.001). Out of cases who required critical care (n=19), nine died (death rate= 47.4%). Conclusions:Results from this study provides fundamental information about the non-clinical and clinical characteristics of confirmed COVID-19 cases in Oman. The information obtained can be utilized to follow up the clinical progress of hospitalized patients with COVID-19 in the Arabic speaking countries where such reports are limited.

scholarly journals MO401RENAL ANGINA INDEX IN ADULT CRITICAL CARE PATIENTS IN A POPULATION FROM BOGOTÁ – COLOMBIA

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Alejandra Molano-Triviño ◽  
Eduardo Zúñiga ◽  
José Garcia-Habeych ◽  
Juan Camilo Castellanos De la Hoz ◽  
Noelia Niño Caro ◽  
...  
Keyword(s):  
Critical Care ◽  
Serum Creatinine ◽  
Ventilatory Support ◽  
Negative Likelihood Ratio ◽  
Predictive Capacity ◽  
Icu Admission ◽  
Renal Angina Index ◽  
Renal Angina ◽  
The Impact ◽  
Critical Care Patients

Abstract Background and Aims Clinical outcomes of Acute Kidney Injury (AKI) in ICU mainly depend on opportune preventive strategies. Thus, early identification of AKI is mandatory, and alternative diagnostic strategies become plausible: one of them, Renal Angina Index (RAI), described by Matsuura1, predicts the development of AKI KDIGO 2-3, at 7th day after admission to the intensive care unit according to a cut-off point &gt;6 on a scale with a “creatinine score” (determined by the difference in serum creatinine between that at ICU admission and the first 24 hours in the ICU) and the impact of the patients medical history. 1Kidney Int Rep (2018) 3, 677-683. Our aim is to describe predictive capacity of the Renal Angina Index (RAI) in adult critical care patients in our population. Method We retrospectively selected from our Critical Care Nephrology database adult patients admitted in any of our hospital`s ICU between February to August 2020, excluding those at admission with diagnosis of AKI, serum creatinine &gt; 2.5 mg/dl, or those receiving dialysis (acute or chronic) or kidney transplantation. We defined AKI according to KDIGO criteria. The RAI score was defined as the worst condition score multiplied by the creatinine score. The performance of the RAI score was assessed by Receiver Operating Characteristic (ROC) analysis power to detect a difference of 0.2 between the area under the curve (AUC), under the null hypothesis of AUC = 0.5 (no diagnostic accuracy). The optimal cut point was estimated with the Youden method. Results From 1204 new ICU patients, we included 372 patients (women 40.3%), with mean age 60.9 (18-98) (table 1). Main indication for ICU admission was medical conditions. Mean APACHE II was 22.9, hemodinamic support was required in 41,1% patients, mechanical ventilation in 58.6% patients and diabetes mellitus was present in 21.5% patients. AKI KDIGO 2-3 developed in 26.8% of patients. Mean creatinine at admission was statistically different in patients with AKI (CI 0.95 –0.51 - --0.15 mg/dl, p=0.0004). The requirement of hemodynamic (p = 0.003) and ventilatory support (p = 0.009), sepsis (p = 0.003), and COVID-19 (p = 0.03) were more frequent in patients who developed AKI. Renal replacement therapy was required in 39 (60%) of patients with severe AKI (incidence 10,5%). RAI cutt-off point determined by Youden method in the overall sample was 24, being significantly higher in patients who developed AKI (16.54 Vs 7.47, CI 0.95 –13.5--4.99, p &lt;0.001). A cut-off point of 24 was required for the Best predictive capacity for severe AKI, with sensitivity, specificity, positive and negative likelihood ratio of 34%, 94%, 5.5 and 0.7 respectively. Conclusion In our population, RAI score requires a cutoff point much higher than that originally described to predict the development of severe AKI. Losing its discriminatory capacity.

Internalizing Behavior During the Transition from Childhood to Adolescence

2010 ◽  
Vol 26 (3) ◽  
pp. 187-193 ◽  
Author(s):  
Marc Vierhaus ◽  
Arnold Lohaus ◽  
Indra Shah
Keyword(s):  
Research Design ◽  
Internalizing Symptoms ◽  
Fourth Graders ◽  
Cross Sectional Study ◽  
Second Graders ◽  
Internalizing Behavior ◽  
Longitudinal Assessment ◽  
Sectional Study ◽  
Cross Sectional ◽  
The One

This investigation focuses on the question whether assessments of the development of internalizing behavior from childhood to adolescence are affected by the kind of research design (longitudinal versus cross-sectional). Two longitudinal samples of 432 second-graders and 366 fourth graders participated in a longitudinal study with subsequent measurements taken 1, 2, and 3 years later. A third sample consisting of 849 children covering the same range of grades participated in a cross-sectional study. The results show that the development of internalizing symptoms in girls – but not in boys – varies systematically with the research design. In girls, there is a decrease of internalizing symptoms (especially between the first two timepoints) in the longitudinal assessment, which may reflect, for example, the influence of strain during the first testing situation. Both longitudinal trajectories converge to a common trajectory from grade 2 to grade 7 when controlling for this “novelty-distress effect.” Moreover, when we control this effect, the slight but significant decrease characterizing the common trajectory becomes similar to the one obtained in the cross-sectional study. Therefore, trajectories based on longitudinal assessments may suggest more changes with regard to internalizing symptoms over time than actually take place, while trajectories based on cross-sectional data may be characterized by an increased level of internalizing symptoms. Theoretical and practical implications of these results are discussed.

Faktor yang Berhubungan dengan Penggunaan Partograf dalam Persalinan oleh Bidan Praktik Mandiri

2020 ◽  
Vol 2 (2) ◽  
pp. 72-80
Author(s):  
Niluh Nita Silfia
Keyword(s):  
Total Population ◽  
Sampling Technique ◽  
Population Data ◽  
Statistical Test ◽  
Influential Factor ◽  
Test Results ◽  
Cross Sectional ◽  
Factors Associated ◽  
Survey Results ◽  
Research Criteria

Partographs are guidelines for childbirth observations that will facilitate labor assistants in first identifying emergency cases and complications for mothers and fetuses. Preliminary survey at the Sigi Community Health Sub-Center (Pustu) of the 8 Pustu midwives found two midwives (25%) to complete a complete partograph, six midwives (75%) incomplete. The purpose of this study was to determine the determinant factors associated with the use of partographs in labor. The design of this study used observational analytic methods with a cross-sectional approach. 24 BPM survey results were obtained with 30 samples of midwives who met the research criteria and data completeness. The sampling technique was by the total population. Data analysis used logistic regression. The multivariate analysis results showed that APN training was the most influential factor in the use of partographs in labor by midwives. Statistical test results obtained a POR value of 37.7 (95% CI 12.1 - 60.2). This study suggests that midwives must have APN certificates to be valid in providing services.

THE CLINICAL, LABORATORY MANIFESTATIONS AND HISTOPATHOLOGY IN NEPHROTIC PATIENTS WITH LUPUS NEPHRITIS

2018 ◽  
pp. 52-58
Author(s):  
Le Thuan Nguyen ◽  
Bui Bao Hoang
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Clinical Laboratory ◽  
Activity Index ◽  
Clinical Manifestations ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Organ Systems ◽  
Tubulointerstitial Lesions

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organ systems. The kidney appears to be the most commonly affected organ, especially nephrotic is a serious kidney injury. The clinical, laboratory manifestations and histopathology are very useful for diagnosis, provide the means of predicting prognosis and guiding therapy in nephrotic patients with lupus nephritis. Methods: Descriptive cross-sectional study of nephrotic patients with lupus treated in the Department of Nephrology Trung Vuong Hospital and Cho Ray Hospital between May/2014 and May/2017. Renal histopathological lesions were classified according to International Society of Nephrology/Renal Pathology Society - ISN/RPS ’s 2003. The clinical, laboratory manifestations and histopathological features were described. Results: Of 32 LN with nephritic range proteinuria cases studied, 93.7% were women. The 3 most common clinical manifestations were edema (93.8%), hypertension (96.8%) and pallor (68.9%), musculoskeletal manifestions (46.9%), malar rash (40.6%). There was significant rise in laboratory and immunological manifestions with hematuria (78.1%), Hb < 12g/dL (93.5%), increased Cholesterol (100%), and Triglycerid (87.5%), Creatinine > 1.4 mg/dL (87.5%), increased BUN 71.9%, ANA (+) 93.8%, Anti Ds DNA(+) 96.9%, low C3: 96.9%, low C4: 84.4%. The most various and severe features were noted in class IV with active tubulointerstitial lesions and high activity index. Conclusion: Lupus nephritis with nephrotic range proteinuria has the more severity of histopathological feature and the more severity of the more systemic organ involvements and laboratory disorders were noted. Key words: Systemic lupus, erythematosus (SLE) lupus nepphritis, clinical

scholarly journals Cardio-Pulmonary Sequelae in Recovered COVID-19 Patients: Considerations for Primary Care

2021 ◽  
Vol 12 ◽  
pp. 215013272110237
Author(s):  
Zouina Sarfraz ◽  
Azza Sarfraz ◽  
Alanna Barrios ◽  
Radhika Garimella ◽  
Asimina Dominari ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Infection ◽  
Clinical Laboratory ◽  
Point Of Care ◽  
Case Reports ◽  
Case Series ◽  
Infectious Complications ◽  
Care Physician ◽  
Cross Sectional ◽  
Infection Period

Background: Current literature lacks characterization of the post-recovery sequelae among COVID-19 patients. This review characterizes the course of clinical, laboratory, radiological findings during the primary infection period, and the complications post-recovery. Primary care findings are presented for long-COVID care. Methods: Adhering to PRISMA guidelines, 4 databases were searched (PubMed, Embase, CINAHL Plus, Scopus) through December 5, 2020, using the keywords “COVID-19 and/or recovered and/or cardiovascular and/or long-term and/or sequelae and/or sub-acute and/or complication.” We included published peer-reviewed case reports, case series, and cross-sectional studies providing the clinical course of COVID-19 infection, and cardiopulmonary complications of patients who recovered from COVID-19, while making healthcare considerations for primary care workers. Results: We identified 29 studies across 9 countries including 37.9% Chinese and 24.1% U.S. studies, comprising 655 patients (Mean Age = 45) with various ethnical backgrounds including Asian and European. Based on the WHO COVID-19 severity classification scale, initial disease severity was mild for 377 patients and severe for 52 patients. Treatments during primary infection included corticosteroids, oxygen support, and antivirals. The mean value (in days) for complication onset after acute recovery was 28 days. Complete blood counts and RT-PCR tests were the most common laboratory results described. In 22 of the studies, patients showed signs of clinical improvement and were prescribed medications such as anticoagulants or corticosteroids. Conclusion: Post-recovery infectious complications are common in long-COVID-19 patients ranging from mild infections to life-threatening conditions. International thoracic and cardiovascular societies need to develop guidelines for patients recovering from COVID-19 pneumonia, while focused patient care by the primary care physician is crucial to curb preventable adverse events. Recommendations for real-time and lab-quality diagnostic tests are warranted to establish point-of-care testing, detect early complications, and provide timely treatment.

scholarly journals The association between clinical laboratory data and chest CT findings explains disease severity in a large Italian cohort of COVID-19 patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Simone Canovi ◽  
◽  
Giulia Besutti ◽  
Efrem Bonelli ◽  
Valentina Iotti ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Laboratory Data ◽  
Organ Damage ◽  
Cross Sectional Study ◽  
Chest Ct ◽  
Arterial Oxygen ◽  
Emergency Rooms ◽  
Cross Sectional ◽  
Ct Findings ◽  
Patient Prognosis

Abstract Background Laboratory data and computed tomography (CT) have been used during the COVID-19 pandemic, mainly to determine patient prognosis and guide clinical management. The aim of this study was to evaluate the association between CT findings and laboratory data in a cohort of COVID-19 patients. Methods This was an observational cross-sectional study including consecutive patients presenting to the Reggio Emilia (Italy) province emergency rooms for suspected COVID-19 for one month during the outbreak peak, who underwent chest CT scan and laboratory testing at presentation and resulted positive for SARS-CoV-2. Results Included were 866 patients. Total leukocytes, neutrophils, C-reactive protein (CRP), creatinine, AST, ALT and LDH increase with worsening parenchymal involvement; an increase in platelets was appreciable with the highest burden of lung involvement. A decrease in lymphocyte counts paralleled worsening parenchymal extension, along with reduced arterial oxygen partial pressure and saturation. After correcting for parenchymal extension, ground-glass opacities were associated with reduced platelets and increased procalcitonin, consolidation with increased CRP and reduced oxygen saturation. Conclusions Pulmonary lesions induced by SARS-CoV-2 infection were associated with raised inflammatory response, impaired gas exchange and end-organ damage. These data suggest that lung lesions probably exert a central role in COVID-19 pathogenesis and clinical presentation.

scholarly journals Glomerular function in relation to fine airborne particulate matter in a representative population sample

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ying-Mei Feng ◽  
Lutgarde Thijs ◽  
Zhen-Yu Zhang ◽  
Esmée M. Bijnens ◽  
Wen-Yi Yang ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Population Sample ◽  
Airborne Particulate Matter ◽  
Blood Stream ◽  
Renal Outcome ◽  
Cross Sectional ◽  
Cholesterol Ratio ◽  
Median Serum ◽  
Renal Responses

AbstractFrom 1990 until 2017, global air-pollution related mortality increased by 40%. Few studies addressed the renal responses to ultrafine particulate [≤ 2.5 µm (PM2.5)], including black carbon (BC), which penetrate into the blood stream. In a Flemish population study, glomerular filtration estimated from serum creatinine (eGFR) and the urinary albumin-to-creatinine ratio were measured in 2005–2009 in 820 participants (women, 50.7%; age, 51.1 years) with follow-up of 523 after 4.7 years (median). Serum creatinine, eGFR, chronic kidney disease (eGFR < 60 mL/min/1.73 m2) and microalbuminuria (> 3.5/> 2.5 mg per mmol creatinine in women/men) were correlated in individual participants via their residential address with PM2.5 [median 13.1 (range 0.3–2.9) μg/m3] and BC [1.1 (0.3–18) μg/m3], using mixed models accounting for address clusters. Cross-sectional and longitudinally, no renal outcome was associated with PM2.5 or BC in models adjusted for sex and baseline or time varying covariables, including age, blood pressure, heart rate, body mass index, plasma glucose, the total-to-HDL serum cholesterol ratio, alcohol intake, smoking, physical activity, socioeconomic class, and antihypertensive treatment. The subject-level geocorrelations of eGFR change with to BC and PM2.5 were 0.13 and 0.02, respectively (P ≥ 0.68). In conclusion, in a population with moderate exposure, renal function was unrelated to ultrafine particulate.

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