scholarly journals Independent Predictive Ability of Procalcitonin of Acute Kidney Injury among Critically Ill Patients

2020 ◽  
Vol 9 (6) ◽  
pp. 1939 ◽  
Author(s):  
Ya-Ting Huang ◽  
Min-Yu Lai ◽  
Wei-Chih Kan ◽  
Chih-Chung Shiao
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Generalized Linear Model ◽  
Independent Predictor ◽  
Additive Model ◽  
Kidney Injury ◽  
Predictive Ability ◽  
Icu Admission ◽  
Logistic Regression Method

It is unclear whether serum procalcitonin (PCT) levels rise in patients with acute kidney injury (AKI), and it is also unclear whether the elevation of PCT levels in this setting is independent of the existence of infection and impaired renal clearance. We conducted a retrospective study in a regional teaching hospital in Taiwan to evaluate the AKI-predictive ability of serum PCT among critically ill patients. We enrolled 330 patients (mean age, 70.5 ± 16.4 years; 57.0% men) who were admitted to the intensive care unit (ICU) from 1 July 2016, to 31 December 2016, and who had serum PCT measurement performed within 24 h after ICU admission. We used the generalized additive model and generalized linear model to evaluate the association of serum PCT levels and renal function variables. In addition, we used the multivariate logistic regression method to demonstrate serum PCT level as an independent predictor of AKI in both the non-infected patients (odds ratio (OR) = 1.38, 95% confidence interval (CI) = 1.12–1.71, p = 0.003) and the infected patients (OR = 1.23, 95% CI = 1.03–1.46, p = 0.020). In conclusion, serum PCT level at ICU admission is an independent predictor of developing AKI irrespective of infection among critically ill patients.

Incidence Evaluation of Acute Kidney Injury and Pharmacoeconomic Analysis Among Critically Ill Patients With Use of Antipseudomonal β-Lactams and Vancomycin

2021 ◽  
Author(s):  
Yalin Dong ◽  
Ying Zhang ◽  
Yan Wang ◽  
Jiangping Lian ◽  
Ruixia Yang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Treatment Cost ◽  
Independent Predictor ◽  
Pharmacoeconomic Analysis ◽  
Kidney Injury ◽  
Decision Analytic Model ◽  
Combination Therapies ◽  
Matched Study

Abstract Background: Whether vancomycin (VAN) plus piperacillin-tazobactam (PTZ) could increase the risk of acute kidney injury (AKI) is still controversial in critically ill patients. The purpose of this study was to compare the risk of developing AKI and risk of developing AKI and treatment cost among this population receiving VAN/PTZ to a matched group receiving VAN/other antipseudomonal β-lactams. Methods: This multicenter, retrospective, matched study included 700 critically ill patients who received ≥48 hours of VAN/PTZ or VAN/other antipseudomonal β-lactams. The risk of developing AKI was compared between these two combination therapies using propensity-adjusted analysis. Furthermore, a pharmacoeconomic decision-analytic model was performed.Results: According to three AKI-defined criteria, VAN/PTZ was associated with significantly higher incidence of than VAN/other antipseudomonal β-lactams (all P < 0.001). In multivariate analysis, regardless of any VAN/other antipseudomonal β-lactams, VAN/PTZ was an independent predictor for stage 2 or 3 AKI. In the empiric treatment, the incremental cost-effectiveness ratios per additional nephrotoxic episode of 1147.35$, 1845.11$, and 3989.95$ were found for VAN/PTZ relative to, vancomycin plus imipenem-cilastatin, vancomycin plus meropenem, and vancomycin plus cefoperazone-sulbactam, respectively. Conclusion: In critically ill patients, VAN/PTZ was associated with both higher AKI risk and treatment cost when considering AKI occurence compared to VAN/other antipseudomonal β-lactams.Trial registration: retrospectively registered, ClinicalTrials.gov number: NCT03776409.

scholarly journals Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin-Tazobactam, Cefepime, or Meropenem

2019 ◽  
Vol 63 (5) ◽  
Author(s):  
Adam M. Blevins ◽  
Jennifer N. Lashinsky ◽  
Craig McCammon ◽  
Marin Kollef ◽  
Scott Micek ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Independent Predictor ◽  
Kidney Injury ◽  
University Hospital ◽  
Increased Risk ◽  
Kdigo Guidelines

ABSTRACT Critically ill patients are frequently treated with empirical antibiotic therapy, including vancomycin and β-lactams. Recent evidence suggests an increased risk of acute kidney injury (AKI) in patients who received a combination of vancomycin and piperacillin-tazobactam (VPT) compared with patients who received vancomycin alone or vancomycin in combination with cefepime (VC) or meropenem (VM), but most studies were conducted predominately in the non-critically ill population. A retrospective cohort study that included 2,492 patients was conducted in the intensive care units of a large university hospital with the primary outcome being the development of any AKI. The rates of any AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, were 39.3% for VPT patients, 24.2% for VC patients, and 23.5% for VM patients (P < 0.0001 for both comparisons). Similarly, the incidences of stage 2 and stage 3 AKI were also significantly higher for VPT patients than for the patients in the other groups. The rates of stage 2 and stage 3 AKI, respectively, were 15% and 6.6% for VPT patients, 5.8% and 1.8% for VC patients, and 6.6% and 1.3% for VM patients (P < 0.0001 for both comparisons). In multivariate analysis, the use of vancomycin in combination with piperacillin-tazobactam was found to be an independent predictor of AKI (odds ratio [OR], 2.161; 95% confidence interval [CI], 1.620 to 2.883). In conclusion, critically ill patients receiving the combination of VPT had the highest incidence of AKI compared to critically ill patients receiving either VC or VM.

scholarly journals Association between serum levels of interleukin-6 on ICU admission and subsequent outcomes in critically ill patients with acute kidney injury

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Takashi Shimazui ◽  
Taka-aki Nakada ◽  
Yoshihisa Tateishi ◽  
Taku Oshima ◽  
Tuerxun Aizimu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Interleukin 6 ◽  
Kidney Injury ◽  
Serum Levels ◽  
Icu Admission

scholarly journals Elevated serum galectin-1 concentrations are associated with increased risks of mortality and acute kidney injury in critically ill patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257558
Author(s):  
Ruey-Hsing Chou ◽  
Chuan-Tsai Tsai ◽  
Ya-Wen Lu ◽  
Jiun-Yu Guo ◽  
Chi-Ting Lu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Elevated Serum ◽  
Kidney Injury ◽  
The Body ◽  
Icu Admission ◽  
Increased Risk

Background Galectin-1 (Gal-1), a member of the β-galactoside binding protein family, is associated with inflammation and chronic kidney disease. However, the effect of Gal-1 on mortality and acute kidney injury (AKI) in critically-ill patients remain unclear. Methods From May 2018 to March 2020, 350 patients admitted to the medical intensive care unit (ICU) of Taipei Veterans General Hospital, a tertiary medical center, were enrolled in this study. Forty-one patients receiving long-term renal replacement therapy were excluded. Serum Gal-1 levels were determined within 24 h of ICU admission. The patients were divided into tertiles according to their serum Gal-1 levels (low, serum Gal-1 < 39 ng/ml; median, 39–70 ng/ml; high, ≥71 ng/ml). All patients were followed for 90 days or until death. Results Mortality in the ICU and at 90 days was greater among patients with elevated serum Gal-1 levels. In analyses adjusted for the body mass index, malignancy, sepsis, Sequential Organ Failure Assessment (SOFA) score, and serum lactate level, the serum Gal-1 level remained an independent predictor of 90-day mortality [median vs. low: adjusted hazard ratio (aHR) 2.11, 95% confidence interval (CI) 1.24–3.60, p = 0.006; high vs. low: aHR 3.21, 95% CI 1.90–5.42, p < 0.001]. Higher serum Gal-1 levels were also associated with a higher incidence of AKI within 48 h after ICU admission, independent of the SOFA score and renal function (median vs. low: aHR 2.77, 95% CI 1.21–6.34, p = 0.016; high vs. low: aHR 2.88, 95% CI 1.20–6.88, p = 0.017). The results were consistent among different subgroups with high and low Gal-1 levels. Conclusion Serum Gal-1 elevation at the time of ICU admission were associated with an increased risk of mortality at 90 days, and an increased incidence of AKI within 48 h after ICU admission.

scholarly journals Fluctuations in Serum Chloride and Acute Kidney Injury among Critically Ill Patients: A Retrospective Association Study

2019 ◽  
Vol 8 (4) ◽  
pp. 447 ◽  
Author(s):  
Tak Kyu Oh ◽  
In-Ae Song ◽  
Young-Tae Jeon ◽  
You Hwan Jo
Keyword(s):  
Acute Kidney Injury ◽  
Confidence Interval ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Kidney Injury ◽  
Icu Admission ◽  
Serum Chloride ◽  
Increased Risk ◽  
The Difference

Exposure to dyschloremia among critically ill patients is associated with an increased risk of acute kidney injury (AKI). We aimed to investigate how fluctuations in serum chloride (Cl−) are associated with the development of AKI in critically ill patients. We retrospectively analyzed medical records of adult patients admitted to the intensive care unit (ICU) between January 2012 and December 2017. Positive and negative fluctuations in Cl− were defined as the difference between the baseline Cl- and maximum Cl- levels and the difference between the baseline Cl− and minimum Cl− levels measured within 72 h after ICU admission, respectively. In total, 19,707 patients were included. The odds of developing AKI increased 1.06-fold for every 1 mmol L−1 increase in the positive fluctuations in Cl− (odds ratio: 1.06; 95% confidence interval: 1.04 to 1.08; p < 0.001) and 1.04-fold for every 1 mmol L−1 increase in the negative fluctuations in Cl− (odds ratio: 1.04; 95% confidence interval: 1.02 to 1.06; p < 0.001). Increases in both the positive and negative fluctuations in Cl- after ICU admission were associated with an increased risk of AKI. Furthermore, these associations differed based on the functional status of the kidneys at ICU admission or postoperative ICU admission.

scholarly journals Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) Could Provide Better Accuracy Than Creatinine in Predicting Acute Kidney Injury Development in Critically Ill Patients

2021 ◽  
Vol 10 (22) ◽  
pp. 5379
Author(s):  
Edison Jahaj ◽  
Alice G. Vassiliou ◽  
Maria Pratikaki ◽  
Parisis Gallos ◽  
Zafeiria Mastora ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Roc Curves ◽  
Serum Levels ◽  
Icu Admission ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Increased Risk ◽  
Neutrophil Gelatinase

Acute kidney injury (AKI) is one of the most common complications in critically ill patients. In recent years, studies have focused on exploring new biomarkers for the early diagnosis and prognosis of AKI. The aim of this study was to investigate serum prognostic biomarkers (neutrophil gelatinase-associated lipocalin, NGAL, and creatinine) of AKI in critically ill patients. The study included 266 critically ill, initially nonseptic, patients admitted to a multidisciplinary ICU. Serum levels of NGAL and creatinine were measured at ICU admission. ROC curves were generated to estimate the prognostic value of the biomarkers, while a logistic regression analysis was performed to assess their association with an increased AKI risk. Patients were divided in two groups based on the development (n = 98) or not (n = 168) of AKI during their ICU stay. Serum NGAL levels at ICU admission were significantly higher in those who subsequently developed AKI compared to those who did not (p < 0.0001). NGAL was shown to be more accurate in predicting AKI development than creatinine; furthermore, NGAL levels were associated with an increased risk of AKI development (1.005 (1.002–1.008), p < 0.0001). In the present study, we were able to demonstrate that increased serum NGAL levels at ICU admission might be predictive of AKI development during ICU hospitalization. Further studies are needed to support NGAL as a prognostic marker of acute kidney injury.

scholarly journals Ultrasound for Non-invasive Assessment and Monitoring of Quadriceps Muscle Thickness in Critically Ill Patients With Acute Kidney Injury

2021 ◽  
Vol 8 ◽  
Author(s):  
Alice Sabatino ◽  
Umberto Maggiore ◽  
Giuseppe Regolisti ◽  
Giovanni Maria Rossi ◽  
Francesca Di Mario ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Muscle Wasting ◽  
Kidney Injury ◽  
Muscle Thickness ◽  
Quadriceps Muscle ◽  
Apache Ii Score ◽  
Icu Admission ◽  
Icu Stay

Background and aims: Critically ill patients with acute kidney injury (AKI) undergo major muscle wasting in the first few days of ICU stay. An important concern in this clinical setting is the lack of adequate tools for routine bedside evaluation of the skeletal muscle mass, both for the determination of nutritional status at admission, and for monitoring. In this regard, the present study aims to ascertain if ultrasound (US) is able to detect changes in quadriceps muscle thickness of critically ill patients with acute kidney injury (AKI) over short periods of time.Methods: This is a prospective observational study with a follow-up at 5 days. All adult patients with AKI hospitalized at the Renal ICU of the Parma University Hospital over 12 months, with a hospital stay before ICU admission no longer than 72 h, and with a planned ICU stay of at least 5 days, were eligible for the study. An experienced investigator assessed quadriceps rectus femoris and vastus intermedius thickness (QRFT and QVIT) at baseline and after 5 days of ICU stay.Results: We enrolled 30 patients with 74 ± 11 years of age and APACHE II score of 22 ± 5. Muscle thickness decreased by 15 ± 13% within the first 5 days of ICU stay (P &lt; 0.001 for all sites as compared to ICU admission). Patients with more severe muscle loss had lower probability of being discharged home (OR: 0.04, 95%CI: 0.00–0.74; P = 0.031).Conclusions: In critically ill patients with AKI, bedside muscle US identifies patients with accelerated muscle wasting.

scholarly journals Preadmission Statin Therapy Is Associated with a Lower Incidence of Acute Kidney Injury in Critically Ill Patients: A Retrospective Observational Study

2018 ◽  
Vol 8 (1) ◽  
pp. 25 ◽  
Author(s):  
Tak Oh ◽  
In-Ae Song ◽  
Young-Jae Cho ◽  
Cheong Lim ◽  
Young-Tae Jeon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Statin Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Lower Incidence ◽  
Medical Records ◽  
Estimated Glomerular Filtration Rate ◽  
Kidney Injury ◽  
Icu Admission ◽  
Statin Use

This study aimed to investigate the association between preadmission statin use and acute kidney injury (AKI) incidence among critically ill patients who needed admission to the intensive care unit (ICU) for medical care. Medical records of patients admitted to the ICU were reviewed. Patients who continuously took statin for >1 month prior to ICU admission were defined as statin users. We investigated whether preadmission statin use was associated with AKI incidence within 72 h after ICU admission and whether the association differs according to preadmission estimated glomerular filtration rate (eGFR; in mL min−1 1.73 m−2). Among 21,236 patients examined, 5756 (27.1%) were preadmission statin users and 15,480 (72.9%) were non-statin users. Total AKI incidence within 72 h after ICU admission was 31% lower in preadmission statin users than in non-statin users [odds ratio (OR), 0.69; 95% confidence interval (CI), 0.61–0.79; p < 0.001]. This association was insignificant among individuals with eGFR <30 mL min−1 1.73 m−2 (p > 0.05). Our results suggested that preadmission statin therapy is associated with a lower incidence of AKI among critically ill patients; however, this effect might not be applicable for patients with eGFR <30 mL min−1 1.73 m−2.

scholarly journals Acute kidney injury prevalence, progression and long-term outcomes in critically ill patients with COVID-19: a cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nuttha Lumlertgul ◽  
Leah Pirondini ◽  
Enya Cooney ◽  
Waisun Kok ◽  
John Gregson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Steroid Therapy ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Renal Recovery ◽  
Long Term Outcomes ◽  
Icu Admission

Abstract Background There are limited data on acute kidney injury (AKI) progression and long-term outcomes in critically ill patients with coronavirus disease-19 (COVID-19). We aimed to describe the prevalence and risk factors for development of AKI, its subsequent clinical course and AKI progression, as well as renal recovery or dialysis dependence and survival in this group of patients. Methods This was a retrospective observational study in an expanded tertiary care intensive care unit in London, United Kingdom. Critically ill patients admitted to ICU between 1st March 2020 and 31st July 2020 with confirmed SARS-COV2 infection were included. Analysis of baseline characteristics, organ support, COVID-19 associated therapies and their association with mortality and outcomes at 90 days was performed. Results Of 313 patients (70% male, mean age 54.5 ± 13.9 years), 240 (76.7%) developed AKI within 14 days after ICU admission: 63 (20.1%) stage 1, 41 (13.1%) stage 2, 136 (43.5%) stage 3. 113 (36.1%) patients presented with AKI on ICU admission. Progression to AKI stage 2/3 occurred in 36%. Risk factors for AKI progression were mechanical ventilation [HR (hazard ratio) 4.11; 95% confidence interval (CI) 1.61–10.49] and positive fluid balance [HR 1.21 (95% CI 1.11–1.31)], while steroid therapy was associated with a reduction in AKI progression (HR 0.73 [95% CI 0.55–0.97]). Kidney replacement therapy (KRT) was initiated in 31.9%. AKI patients had a higher 90-day mortality than non-AKI patients (34% vs. 14%; p < 0.001). Dialysis dependence was 5% at hospital discharge and 4% at 90 days. Renal recovery was identified in 81.6% of survivors at discharge and in 90.9% at 90 days. At 3 months, 16% of all AKI survivors had chronic kidney disease (CKD); among those without renal recovery, the CKD incidence was 44%. Conclusions During the first COVID-19 wave, AKI was highly prevalent among severely ill COVID-19 patients with a third progressing to severe AKI requiring KRT. The risk of developing CKD was high. This study identifies factors modifying AKI progression, including a potentially protective effect of steroid therapy. Recognition of risk factors and monitoring of renal function post-discharge might help guide future practice and follow-up management strategies. Trial registration NCT04445259

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