scholarly journals Clinical Characteristics and Predictors of Mortality in Critically Ill Influenza Adult Patients

2020 ◽  
Vol 9 (4) ◽  
pp. 1073
Author(s):  
Jui-Chi Hsu ◽  
Ing-Kit Lee ◽  
Wen-Chi Huang ◽  
Yi-Chun Chen ◽  
Ching-Yen Tsai
Keyword(s):  
Acute Kidney Injury ◽  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Kidney Injury ◽  
Adult Patients ◽  
Chang Gung Memorial Hospital ◽  
High Morbidity ◽  
Predictive Tool ◽  
Predictors Of Mortality ◽  
Lactate Levels

Severe influenza is associated with high morbidity and mortality. The aim of this study was to investigate the factors affecting the clinical outcomes of critically ill influenza patients. In this retrospective study, we enrolled critically ill adult patients with influenza at the Kaohsiung Chang Gung Memorial Hospital in Taiwan. We evaluated the demographic, clinical, and laboratory findings and examined whether any of these measurements correlated with mortality. We then created an event-based algorithm as a simple predictive tool using two variables with statistically significant associations with mortality. Between 2015 and 2018, 102 critically ill influenza patients (median age, 62 years) were assessed; among them, 41 (40.1%) patients died. Of the 94 patients who received oseltamivir therapy, 68 (72.3%) began taking oseltamivir 48 h after the onset of illness. Of the 102 patients, the major influenza-associated complications were respiratory failure (97%), pneumonia (94.1%), acute kidney injury (65.7%), adult respiratory distress syndrome (ARDS) (51%), gastrointestinal bleeding (35.3%), and bacteremia (16.7%). In the multivariate regression model, high lactate levels, ARDS, acute kidney injury, and gastrointestinal bleeding were independent predictors of mortality in critically ill influenza patients. The optimal lactate level cutoff for predicting mortality was 3.7 mmol/L with an area under curve of 0.728. We constructed an event-associated algorithm that included lactate and ARDS. Fifteen (75%) of 20 patients with lactate levels 3.7 mmol/L and ARDS died, compared with only 1 (7.7%) of 13 patients with normal lactate levels and without ARDS. We identified clinical and laboratory predictors of mortality that could aid in the care of critically ill influenza patients. Identification of these prognostic markers could be improved to prioritize key examinations that might be useful in determining patient outcomes.

scholarly journals Clinical characteristics and predictors of mortality in critically ill influenza adult patients

2020 ◽  
Author(s):  
Jui-Chi Hsu ◽  
Ing-Kit Lee ◽  
Wen-Chi Huang ◽  
Yi-Chun Chen ◽  
Ching-Yen Tsai
Keyword(s):  
Acute Kidney Injury ◽  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Kidney Injury ◽  
Adult Patients ◽  
Chang Gung Memorial Hospital ◽  
High Morbidity ◽  
Predictive Tool ◽  
Predictors Of Mortality ◽  
Lactate Levels

Abstract Background Severe influenza is associated with high morbidity and mortality. The aim of this study was to investigate the factors affecting the clinical outcomes of critically ill influenza patients. Methods In this retrospective study, we enrolled critically ill adult patients with influenza at the Kaohsiung Chang Gung Memorial Hospital in Taiwan. We evaluated the demographic, clinical, and laboratory findings and examined whether any of these measurements correlated with mortality. We then created an event-based algorithm as a simple predictive tool using 2 variables with statistically significant associations with mortality. Results Between 2015 and 2018, 102 critically ill influenza patients (median age, 62 years) were assessed; among them, 41 (40.1%) patients died. Of the 94 patients who received oseltamivir therapy, 68 (72.3%) began taking oseltamivir 48 hours after the onset of illness. Of the 102 patients, the major influenza-associated complications were respiratory failure (97%), pneumonia (94.1%), acute kidney injury (65.7%), adult respiratory distress syndrome (ARDS) (51%), gastrointestinal bleeding (35.3%), and bacteremia (16.7%). In the multivariate regression model, high lactate levels, ARDS, acute kidney injury, and gastrointestinal bleeding were independent predictors of mortality in critically ill influenza patients. The optimal lactate level cutoff for predicting mortality was 33 mg/dL with an area under curve of 0.728. We constructed an event-associated algorithm that included lactate and ARDS. Fifteen (75%) of 20 patients with lactate levels ≥33 mg/dL and ARDS died, compared with only 1 (7.7%) of 13 patients with normal lactate levels and without ARDS. Conclusions We identified clinical and laboratory predictors of mortality at hospital admission that could aid in the care of critically ill influenza patients. Identification of these prognostic markers could be improved to prioritize key examinations that might be useful in determining patient outcomes.

scholarly journals Predictive value of urine interleukin-18 in the evolution and outcome of acute kidney injury in critically ill adult patients

2015 ◽  
Vol 114 (3) ◽  
pp. 460-468 ◽  
Author(s):  
S. Nisula ◽  
R. Yang ◽  
M. Poukkanen ◽  
S.T. Vaara ◽  
K.M. Kaukonen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Predictive Value ◽  
Kidney Injury ◽  
Adult Patients ◽  
Interleukin 18

Acute kidney injury in critically-ill adult patients with seasonal influenza infection

2017 ◽  
Vol 88 (S1) ◽  
pp. 18-21
Author(s):  
Ana Dovč ◽  
Vladimir Premru ◽  
Blaž Pečavar ◽  
Rafael Ponikvar
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Seasonal Influenza ◽  
Influenza Infection ◽  
Kidney Injury ◽  
Adult Patients

scholarly journals Vancomycin-Associated Acute Kidney Injury in Critically Ill Adolescent and Young Adult Patients

2019 ◽  
Vol 33 (6) ◽  
pp. 749-753 ◽  
Author(s):  
William B. Hays ◽  
Emma Tillman
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Young Adult ◽  
Critically Ill ◽  
Kidney Injury ◽  
Adult Patients ◽  
Adolescent And Young Adult ◽  
Daily Dose ◽  
Vancomycin Trough ◽  
Trough Levels

Background: Risk factors for the development of vancomycin-associated acute kidney injury (AKI) have been evaluated in both pediatric and adult populations; however, no previous studies exist evaluating this in the critically ill adolescent and young adult patients. Objective: Identify the incidence of AKI and examine risk factors for the development of AKI in critically ill adolescents and young adults on vancomycin. Methods: This retrospective review evaluated the incidence of AKI in patients 15 to 25 years of age who received vancomycin, while admitted to an intensive care unit. Acute kidney injury in this population was defined as an increase in serum creatinine by 0.5 mg/dL or 50% from baseline. Patients who developed AKI were evaluated for specific risk factors compared to those who did not develop AKI. Results: A total of 50 patients (20 developed AKI) were included in the study. There was no difference in vancomycin daily dose or duration of vancomycin therapy. Maximum vancomycin trough (31.15 mg/dL vs 12.5 mg/dL, P = .006), percentage of patients with concurrent nephrotoxic medication (95% vs 60%, P = .012) and concurrent vasopressor (55% vs 23%, P = .029) were higher in those who developed AKI. Percentage of patients who underwent a procedure while on vancomycin (35% vs 6.7%, P = .021) was also higher within the AKI group. Conclusions: Vancomycin-associated AKI occurred in 40% of critically ill adolescent and young adult patients. These patients may be more likely to develop vancomycin-associated AKI if they had undergone a procedure, as well as in the presence of high vancomycin trough levels, concurrent nephrotoxic agents, and concurrent vasopressor therapy.

The Urine Protein NGAL Predicts Renal Replacement Therapy, but Not Acute Kidney Injury or 90-Day Mortality in Critically Ill Adult Patients

2014 ◽  
Vol 119 (1) ◽  
pp. 95-102 ◽  
Author(s):  
Sara Nisula ◽  
Runkuan Yang ◽  
Kirsi-Maija Kaukonen ◽  
Suvi T. Vaara ◽  
Anne Kuitunen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Kidney Injury ◽  
Adult Patients ◽  
Urine Protein

scholarly journals A novel risk-predicted nomogram for sepsis associated-acute kidney injury among critically ill patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shanglin Yang ◽  
Tingting Su ◽  
Lina Huang ◽  
Lu-Huai Feng ◽  
Tianbao Liao
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Validation Cohort ◽  
Kidney Injury ◽  
Curve Analysis ◽  
High Morbidity ◽  
Baseline Serum ◽  
Decision Curve Analysis

Abstract Background Acute kidney injury (AKI) is a prevalent and severe complication of sepsis contributing to high morbidity and mortality among critically ill patients. In this retrospective study, we develop a novel risk-predicted nomogram of sepsis associated-AKI (SA-AKI). Methods A total of 2,871 patients from the Medical Information Mart for Intensive Care III (MIMIC-III) critical care database were randomly assigned to primary (2,012 patients) and validation (859 patients) cohorts. A risk-predicted nomogram for SA-AKI was developed through multivariate logistic regression analysis in the primary cohort while the nomogram was evaluated in the validation cohort. Nomogram discrimination and calibration were assessed using C-index and calibration curves in the primary and external validation cohorts. The clinical utility of the final nomogram was evaluated using decision curve analysis. Results Risk predictors included in the prediction nomogram included length of stay in intensive care unit (LOS in ICU), baseline serum creatinine (SCr), glucose, anemia, and vasoactive drugs. Nomogram revealed moderate discrimination and calibration in estimating the risk of SA-AKI, with an unadjusted C-index of 0.752, 95 %Cl (0.730–0.774), and a bootstrap-corrected C index of 0.749. Application of the nomogram in the validation cohort provided moderate discrimination (C-index, 0.757 [95 % CI, 0.724–0.790]) and good calibration. Besides, the decision curve analysis (DCA) confirmed the clinical usefulness of the nomogram. Conclusions This study developed and validated an AKI risk prediction nomogram applied to critically ill patients with sepsis, which may help identify reasonable risk judgments and treatment strategies to a certain extent. Nevertheless, further verification using external data is essential to enhance its applicability in clinical practice.

scholarly journals A Simple Scoring Method for Predicting the Low Risk of Persistent Acute Kidney Injury in Critically Ill Adult Patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ryo Matsuura ◽  
Masao Iwagami ◽  
Hidekazu Moriya ◽  
Takayasu Ohtake ◽  
Yoshifumi Hamasaki ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Low Risk ◽  
Adult Patients ◽  
Scoring Method

Predictive Value of Urine Interleukin-18 in the Evolution and Outcome of Acute Kidney Injury in Critically Ill Adult Patients

2015 ◽  
Vol 59 (6) ◽  
pp. 256-257 ◽  
Author(s):  
S. Nisula ◽  
R. Yang ◽  
M. Poukkanen ◽  
S. T. Vaara ◽  
K. M. Kakounen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Predictive Value ◽  
Kidney Injury ◽  
Adult Patients ◽  
Interleukin 18

scholarly journals Complement activation fragments are increased in critically ill pediatric patients with severe acute kidney injury

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0004542021
Author(s):  
Erin K Stenson ◽  
Zhiying You ◽  
Ron Reeder ◽  
Jesse Norris ◽  
Halden F. Scott ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Complement Activation ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
High Morbidity ◽  
Increased Risk ◽  
Severity Scores

Background:Critically ill children with acute kidney injury (AKI) suffer from high morbidity and mortality rates, and lack treatment options. Emerging evidence implicates the role of complement activation in AKI pathogenesis, which could potentially be treated with complement inhibitors. The purpose of this study is to evaluate the association between complement activation fragments and severity of AKI in critically ill children. Methods:A biorepository of critically ill children from a prior multi-site study was leveraged to identify children with stage 3 AKI and matched to patients without AKI based on PELOD-2 (illness severity) scores. Specimens were analyzed for plasma and urine complement activation fragments of factor B, C3a, C4a, and sC5b-9. The primary outcomes were MAKE30 and severe AKI rates. Results:14 patients with stage 3 AKI (5 requiring renal replacement therapy [RRT]) were matched to 14 patients without AKI. Urine factor Ba and plasma C4a levels increased stepwise as severity of AKI increased, from no AKI to stage 3 AKI, to stage 3 AKI with RRT need. Plasma C4a levels were independently associated with increased risk of MAKE30 outcomes (OR 3.2; IQR 1.1-8.9), and urine Ba and plasma Bb, C4a, and C3a were independently associated with risk of severe stage 2-3 AKI on day 3 of admission. Conclusions:Multiple complement fragments increase as magnitude of AKI severity increases. Very high levels of urine Ba or plasma C4a may identify patients at risk for severe AKI, hemodialysis, and MAKE30 outcomes. The fragments may be useful as a functional biomarker of complement activation and may identify those patients to study complement inhibition to treat or prevent AKI in critically ill children. These findings suggest the need for further specific investigations of the role of complement activation in critically ill children at risk of AKI.

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