scholarly journals Factors Determining Nephrotoxicity and Mortality in Critical Care Patients Receiving Colistin

2018 ◽  
Vol 11 (12) ◽  
pp. 912-917 ◽  
Author(s):  
Ali Ciftci ◽  
Seval Izdes ◽  
Neriman Defne Altintas
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Demographic Data ◽  
Kidney Injury ◽  
Apache Ii ◽  
Factors Affecting ◽  
Acute Kidney Injury Group ◽  
Injury Group ◽  
Independent Risk Factors ◽  
Critical Patients

Introduction: We aimed to determine risk factors for nephrotoxicity and factors affecting mortality in patients who received colistin. Methodology: Critical patients who received colistin were enrolled. Pregnancy, age < 18 years, basal creatinine level > 2 mg/dL, colistin use for < 48 hours, and previous renal replacement therapy were exclusion criteria. KDIGO stages were determined according to creatinine levels. Patients were grouped as those with no acute kidney injury (Group N0) and those with acute kidney injury (Group N). Their demographic data, APACHE II and SOFA scores, treatments, and laboratory results were recorded. Results: A total of 91 patients were included: 27 in Group N0 and 64 in Group N. Demographic data were similar between groups; however, higher admission APACHE-II scores (OR:1.179, 95% CI:1.033-1.346, p = 0.015) and need for vasopressors (OR:5.486, 95% CI:1.522–19.769, p = 0.009) were found to be independent risk factors for nephrotoxicity. Higher APACHE II scores (OR:1.253, %95 CI:1.093-1.437, p = 0.001), presence of coronary artery disease (OR:7.720, % 95 CI: 1.613-36.956, p = 0.011), need for vasopressors (OR: 4.587, % 95 CI: 1.224 – 17.241, p = 0.024), hypoalbuminemia (OR: 4.721, % 95 CI: 1.088 – 20.469, p = 0.038), and higher direct bilirubin levels (OR: 1.806, % 95 CI: 1.055 – 3.092, p = 0.031) were independent risk factors for mortality. Conclusion: When use of colistin is considered in ICU patients, presence of modifiable risk factors for nephrotoxicity such as hypoalbuminemia, nephrotoxic drug administration, and presence of shock should be determined and managed to prevent nephrotoxicity.

scholarly journals Acute Kidney Injury Following Rhabdomyolysis in Critically Ill Patients

2021 ◽  
Vol 7 (4) ◽  
pp. 267-271
Author(s):  
Alvin Saverymuthu ◽  
Rufinah Teo ◽  
Jaafar Md Zain ◽  
Saw Kian Cheah ◽  
Aliza Mohamad Yusof ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Creatinine Kinase ◽  
Injury Group ◽  
Independent Risk Factors ◽  
Prolonged Surgery

Abstract Introduction Rhabdomyolysis, which resulted from the rapid breakdown of damaged skeletal muscle, potentially leads to acute kidney injury. Aim To determine the incidence and associated risk of kidney injury following rhabdomyolysis in critically ill patients. Methods All critically ill patients admitted from January 2016 to December 2017 were screened. A creatinine kinase level of > 5 times the upper limit of normal (> 1000 U/L) was defined as rhabdomyolysis, and kidney injury was determined based on the Kidney Disease Improving Global Outcome (KDIGO) score. In addition, trauma, prolonged surgery, sepsis, antipsychotic drugs, hyperthermia were included as risk factors for kidney injury. Results Out of 1620 admissions, 149 (9.2%) were identified as having rhabdomyolysis and 54 (36.2%) developed kidney injury. Acute kidney injury, by and large, was related to rhabdomyolysis followed a prolonged surgery (18.7%), sepsis (50.0%) or trauma (31.5%). The reduction in the creatinine kinase levels following hydration treatment was statistically significant in the non- kidney injury group (Z= -3.948, p<0.05) compared to the kidney injury group (Z= -0.623, p=0.534). Significantly, odds of developing acute kidney injury were 1.040 (p<0.001) for mean BW >50kg, 1.372(p<0.001) for SOFA Score >2, 5.333 (p<0.001) for sepsis and the multivariate regression analysis showed that SOFA scores >2 (p<0.001), BW >50kg (p=0.016) and sepsis (p<0.05) were independent risk factors. The overall mortality due to rhabdomyolysis was 15.4% (23/149), with significantly higher incidences of mortality in the kidney injury group (35.2%) vs the non- kidney injury (3.5%) [ p<0.001]. Conclusions One-third of rhabdomyolysis patients developed acute kidney injury with a significantly high mortality rate. Sepsis was a prominent cause of acute kidney injury. Both sepsis and a SOFA score >2 were significant independent risk factors.

scholarly journals Defining heart disease risk for death in COVID-19 infection

QJM ◽  
2020 ◽  
Vol 113 (12) ◽  
pp. 876-882 ◽  
Author(s):  
J Li ◽  
T Guo ◽  
D Dong ◽  
X Zhang ◽  
X Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Disease Risk ◽  
Demographic Data ◽  
Kidney Injury ◽  
Laboratory Findings ◽  
Course Of Disease ◽  
Clinical Observations ◽  
Independent Risk Factors ◽  
Heart Disease Risk

Summary Background Cardiovascular disease (CVD) was in common in coronavirus disease 2019 (COVID-19) patients and associated with unfavorable outcomes. We aimed to compare the clinical observations and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients with or without CVD. Methods Patients with laboratory-confirmed SARS-CoV-2 infection were clinically evaluated at Wuhan Seventh People’s Hospital, Wuhan, China, from 23 January to 14 March 2020. Demographic data, laboratory findings, comorbidities, treatments and outcomes were collected and analyzed in COVID-19 patients with and without CVD. Results Among 596 patients with COVID-19, 215 (36.1%) of them with CVD. Compared with patients without CVD, these patients were significantly older (66 vs. 52 years) and had higher proportion of men (52.5% vs. 43.8%). Complications in the course of disease were more common in patients with CVD, included acute respiratory distress syndrome (22.8% vs. 8.1%), malignant arrhythmias (3.7% vs. 1.0%) including ventricular tachycardia/ventricular fibrillation, acute coagulopathy(7.9% vs. 1.8%) and acute kidney injury (11.6% vs. 3.4%). The rate of glucocorticoid therapy (36.7% vs. 25.5%), Vitamin C (23.3% vs. 11.8%), mechanical ventilation (21.9% vs. 7.6%), intensive care unit admission (12.6% vs. 3.7%) and mortality (16.7% vs. 4.7%) were higher in patients with CVD (both P &lt; 0.05). The multivariable Cox regression models showed that older age (≥65 years old) (HR 3.165, 95% CI 1.722–5.817) and patients with CVD (HR 2.166, 95% CI 1.189–3.948) were independent risk factors for death. Conclusions CVD are independent risk factors for COVID-19 patients. COVID-19 patients with CVD were more severe and had higher mortality rate, early intervention and vigilance should be taken.

scholarly journals Incidence, risk factors, and mortality of acute kidney injury within 1-month after lung transplantation

2021 ◽  
Author(s):  
Nam Eun Kim ◽  
Chi Young Kim ◽  
Song Yee Kim ◽  
Ha Eun Kim ◽  
Jin Gu Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Lung Transplantation ◽  
Kidney Injury ◽  
Operative Management ◽  
Rank Test ◽  
Severance Hospital ◽  
Incidence Risk ◽  
Independent Risk Factors ◽  
Grade 3

Abstract Background After lung transplantation (LT), some patients are at risk of acute kidney injury (AKI), which is associated with worse outcomes and increased mortality. Method Among 161 patients who underwent LT at Severance hospital in Seoul, Korea from October 2012 to September 2017, 148 patients were retrospectively enrolled. Results 59 (39.8%) developed AKI within 1-month after LT. Stage I or II, and stage III AKI were recorded in 26 (17.5%) and 33 (22.2%), respectively. AKI III usually occurred within 7 days after transplantation (early vs. late AKI III, 72.5% vs 21.1%). Pre-operative anemia, units of red blood cells transfused during surgery, colistin intravenous infusion for treating multi drug resistant pathogens were independent risk factors for AKI development. Post-operative bleeding, grade 3 PGD within 72 hrs, and sepsis were more common in the AKI group. Patients with AKI III ([24/33] 72.7%) had significantly higher 1-year mortality than the no-AKI ([18/89] 20.2%), and AKI I or II group ([9/26] 34.6%), log-rank test, P < 0.001). Conclusion AKI was associated with worse post-operative outcome, 3-month, and 1-year mortality after LT. Severity of AKI was usually determined in early post op period after LT, so optimal post-operative management as well as recipients selection should be considered.

scholarly journals Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China.

2020 ◽  
Author(s):  
Dawei Wang ◽  
Yimei Yin ◽  
Chang Hu ◽  
Xing Liu ◽  
Xingguo Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Clinical Course ◽  
Case Series ◽  
Kidney Injury ◽  
Retrospective Case ◽  
Illness Onset ◽  
Independent Risk Factors ◽  
Systemic Symptoms ◽  
Novel Coronavirus

Abstract Background In December 2019, Coronavirus Disease 2019 (COVID-19) outbreak was reported from Wuhan, China. Information on the clinical course and prognosis of COVID-19 was not thoroughly described. We described the clinical courses and prognosis in COVID-19 patients. Methods Retrospective case series of COVID-19 patients from Zhongnan Hospital of Wuhan University in Wuhan, and Xi-shui Hospital, Hubei Province, China, up to February 10, 2020. Epidemiological, demographic and clinical data were collected. Clinical course of survivors and non-survivors were compared. Risk factors for death were analyzed. Results A total of 107 discharged patients with COVID-19 were enrolled. The clinical course of COVID-19 presented as a tri-phasic pattern. Week 1 after illness onset was characterized by fever, cough, dyspnea, lymphopenia and radiological multilobar pulmonary infiltrates. In severe cases, thrombocytopenia, acute kidney injury, acute myocardial injury or adult respiratory distress syndrome were observed. During week 2, in mild cases, fever, cough and systemic symptoms began to resolve and platelet count rose to normal range, but lymphopenia persisted. In severe cases, leukocytosis, neutrophilia and deteriorating multi-organ dysfunction were dominant. By week 3, mild cases had clinically resolved except for lymphopenia. However, severe cases showed persistent lymphopenia, severe acute respiratory dyspnea syndrome , refractory shock, anuric acute kidney injury, coagulopathy, thrombocytopenia and death. Older age and male sex were independent risk factors for poor outcome of the illness. Conclusions A period of 7–13 days after illness onset is the critical stage in COVID-19 course. Age and male gender were independent risk factors for death of COVID-19.

scholarly journals Correlation between perioperative parecoxib and postoperative acute kidney injury in patients undergoing non-cardiac surgery: a retrospective cohort analysis

2020 ◽  
Author(s):  
Yongzhong Tang ◽  
Pingping Zeng ◽  
Yan Liao ◽  
Zheng Qin ◽  
Hao Zhang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Injury Risk ◽  
Cohort Analysis ◽  
Kidney Injury ◽  
Study Groups ◽  
Adult Patients ◽  
Group 4 ◽  
Acute Kidney Injury Group ◽  
Injury Group

Abstract Background: The association of nonsteroidal anti-inflammatory drugs with postoperative acute kidney injury is controversial. However, there are few studies focusing on the association between parecoxib and postoperative acute kidney injury. Methods: We retrospectively reviewed the electronic medical records and laboratory results of 9,246 adult patients (18–60 years) undergoing non-cardiac surgery at Third Xiangya Hospital of Central South University from January 1, 2012 to August 31, 2017. Study groups were either treated with or without parecoxib. Univariable analysis identified demographic, preoperative laboratory, and intraoperative factors associated with acute kidney injury. Logistic stepwise regression was used to calculate the adjusted odds ratio of parecoxib and acute kidney injury association. Results: The incidence of postoperative acute kidney injury was 6.06% and parecoxib was used in 0.105% of patients. The mortality was 4.64% in the acute kidney injury group. The incidence of acute kidney injury was lower in the parecoxib-administered group (4%) than in the without parecoxib-administered group (6.3%, p = 0.005). Postoperative acute kidney injury risk reduced by 33.40% in the parecoxib-administered group after adjusting for interference factors.Conclusions: Intraoperative single-dose parecoxib (40 mg or 80 mg) might reduce postoperative acute kidney injury risk in adult patients undergoing non-cardiac surgery.

scholarly journals Acute kidney injury at early stage as a negative prognostic indicator of patients with COVID-19: a hospital-based retrospective analysis

2020 ◽  
Author(s):  
Shen Xu ◽  
Lin Fu ◽  
Jun Fei ◽  
Hui-Xian Xiang ◽  
Ying Xiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Early Stage ◽  
Kidney Injury ◽  
Oxygenation Index ◽  
Prognostic Indicator ◽  
Critical Ill Patients ◽  
Patients With Diabetes ◽  
Independent Risk Factors ◽  
Critical Ill

AbstractCoronavirus disease 2019 (COVID-19) is a newly emerged infection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and has been pandemic all over the world. This study described acute kidney injury (AKI) at early stage of COVID-19 and its clinical significance. Three-hundred and fifty-five COVID-19 patients with were recruited and clinical data were collected from electronic medical records. Patient’s prognosis was tracked and risk factors of AKI was analyzed. Of 355 COVID-19 patients, common, severe and critical ill cases accounted for 63.1%, 16.9% and 20.0%, respectively. On admission, 56 (15.8%) patients were with AKI. Although AKI was more common in critical ill patients with COVID-19, there was no significant association between oxygenation index and renal functional indices among COVID-19 patients with AKI. By multivariate logistic regression, male, older age and comorbidity with diabetes were three important independent risk factors predicting AKI among COVID-19 patients. Among 56 COVID-19 patients with AKI, 33.9% were died on mean 10.9 day after hospitalization. Fatality rate was obviously higher among COVID-+19 patients with AKI than those without AKI (RR=7.08, P<0.001). In conclusion, male elderly COVID-19 patients with diabetes are more susceptible to AKI. AKI at early stage may be a negative prognostic indicator for COVID-19.

scholarly journals ACUTE KIDNEY INJURY ASSOCIATED WITH INTRAVENOUS FUROSEMIDE: INCIDENCE, INDEPENDENT RISK FACTORS, AND CLINICAL CONSEQUENCES

2012 ◽  
Vol 59 (13) ◽  
pp. E1036
Author(s):  
James Tisdale ◽  
Heather Wroblewski ◽  
Gilwan Kim ◽  
Brian R. Overholser ◽  
Joanna R. Kingery ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Clinical Consequences ◽  
Independent Risk Factors

Patient-Specific Risk Factors Associated With the Development of Hyperchloremia in a Neurocritical Care Intensive Care Unit

2021 ◽  
pp. 089719002110268
Author(s):  
Leslie A. Hamilton ◽  
Michael L. Behal ◽  
Ashley R. Carter ◽  
A. Shaun Rowe
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Neurocritical Care ◽  
Kidney Injury ◽  
Serum Osmolality ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Factors Associated

Background: Hypertonic sodium chloride (HTS) is used in intensive care unit (ICU) settings to manage cerebral edema, intracranial hypertension, and for the treatment of severe hyponatremia. It has been associated with an increased incidence of hyperchloremia; however, there is limited literature focusing on hyperchloremic risk in neurologically injured patients. Objective: The primary objective of this study was to determine risk factors associated with development of hyperchloremia in a neurocritical care (NCC) ICU population. Methods: This was a retrospective case-control study performed in an adult NCC ICU and included patients receiving HTS. The primary outcome was to evaluate patient characteristics and treatments associated with hyperchloremia. Secondary outcomes included acute kidney injury and mortality. Results: Overall, 133 patients were identified; patients who were hyperchloremic were considered cases (n = 100) and patients without hyperchloremia were considered controls (n = 33). Characteristics and treatments were evaluated with univariate analysis and a logistic regression model. In the multivariate model, APACHE II Score, initial serum osmolality, total 3% saline volume, and total 23.4% saline volume were significant predictors for hyperchloremia. In addition, patients with a serum chloride greater than 113.5 mEq/L were found to have a higher risk of acute kidney injury (AKI) (adjusted OR 3.15; 95% CI 1.10-9.04). Conclusions: This study demonstrated APACHE II Score, initial serum osmolality, and total 3% and 23.4% saline volumes were associated with developing hyperchloremia in the NCC ICU. In addition, hyperchloremia is associated with an increased risk of AKI.

scholarly journals Clinical course and outcome of novel coronavirus COVID-19 infection in 107 patients discharged from the Wuhan hospital

2020 ◽  
Author(s):  
Dawei Wang ◽  
Yimei Yin ◽  
Chang Hu ◽  
Xing Liu ◽  
Xingguo Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Case Series ◽  
Kidney Injury ◽  
Retrospective Case ◽  
Illness Onset ◽  
Acute Myocardial Injury ◽  
Independent Risk Factors ◽  
Systemic Symptoms ◽  
Novel Coronavirus

Abstract Background In December 2019, Coronavirus Disease 2019 (COVID-19) outbreak was reported from Wuhan, China. Information on the clinical progress and prognosis of COVID-19 was not thoroughly described. We described the clinical courses and prognosis in COVID-19 patients. Methods Retrospective case series of COVID-19 patients from Zhongnan Hospital of Wuhan University in Wuhan, and Xi-shui Hospital, Hubei Province, China, up to February 10, 2020. Epidemiological, demographic and clinical data were collected. Clinical progress of survivors and non-survivors were compared. Risk factors for death were analyzed. Results A total of 107 discharged patients with COVID-19 were enrolled. The clinical progression of COVID-19 presented as a tri-phasic pattern. Week 1 after illness onset was characterized by fever, cough, dyspnea, lymphopenia and radiological multilobar pulmonary infiltrates. In severe cases, thrombocytopenia, acute kidney injury, acute myocardial injury or adult respiratory distress syndrome were observed. During week 2, in mild cases, fever, cough and systemic symptoms began to resolve and platelet count rose to normal range, but lymphopenia persisted. In severe cases, leukocytosis, neutrophilia and deteriorating multi-organ dysfunction were dominant. By week 3, mild cases had clinically resolved except for lymphopenia. However, severe cases showed persistent lymphopenia, severe acute respiratory dyspnea syndrome , refractory shock, anuric acute kidney injury, coagulopathy, thrombocytopenia and death. Older age and male sex were independent risk factors for poor outcome of the illness. Conclusions A period of 7–13 days after illness onset is the critical stage in COVID-19 progression. Age and male gender were independent risk factors for death of COVID-19.

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