Prediction of Short-Term Mortality With Renal Replacement Therapy in Patients With Cardiac Surgery-Associated Acute Kidney Injury

Objective: We aimed to: (1) explore the risk factors that affect the prognosis of cardiac surgery-associated acute kidney injury (CS-AKI) in patients undergoing renal replacement therapy (RRT) and (2) investigate the predictive value of the Acute Physiology and Chronic Health Evaluation (APACHE) III score, Sequential Organ Failure Assessment (SOFA) score, and Vasoactive-Inotropic Score (VIS) for mortality risk in patients undergoing RRT.Methods: Data from patients who underwent cardiac surgery from January 2015 through February 2021 were retrospectively reviewed to calculate the APACHE III score, SOFA score, and VIS on the first postoperative day and at the start of RRT. Various risk factors influencing the prognosis of the patients during treatment were evaluated; the area under the receiver operating characteristics curve (AUCROC) was used to measure the predictive ability of the three scores. Independent risk factors influencing mortality were analyzed using multivariable binary logistic regression.Results: A total of 90 patients were included in the study, using 90-day survival as the end point. Of those patients, 36 patients survived, and 54 patients died; the mortality rate reached 60%. At the start of RRT, the AUCROC of the APACHE III score was 0.866 (95% CI: 0.795–0.937), the VIS was 0.796 (95% CI: 0.700–0.892), and the SOFA score was 0.732 (95% CI: 0.623–0.842). The AUCROC-value of the APACHE III score on the first postoperative day was 0.790 (95% CI: 0.694–0.885). After analyzing multiple factors, we obtained the final logistic regression model with five independent risk factors at the start of RRT: a high APACHE III score (OR: 1.228, 95% CI: 1.079–1.397), high VIS (OR: 1.147, 95% CI: 1.021–1.290), low mean arterial pressure (MAP) (OR: 1.170, 95% CI: 1.050–1.303), high lactate value (OR: 1.552, 95% CI: 1.032–2.333), and long time from AKI to initiation of RRT (OR: 1.014, 95% CI: 1.002–1.027).Conclusion: In this study, we showed that at the start of RRT, the APACHE III score and the VIS can accurately predict the risk of death in patients undergoing continuous RRT for CS-AKI. The APACHE III score on the first postoperative day allows early prediction of patient mortality risk. Predictors influencing patient mortality at the initiation of RRT were high APACHE III score, high VIS, low MAP, high lactate value, and long time from AKI to the start of RRT.

Risk factors for mortality in preterm infants with necrotizing enterocolitis: a retrospective multicenter analysis

It is difficult to predict the risk of mortality in necrotizing enterocolitis (NEC). This study aimed at identifying risk factors for severe NEC (Bell stage III) and mortality in preterm children with NEC. In this multicenter retrospective study, we analyzed multiple data from 157 premature children with confirmed NEC in the period from January 2007 to October 2018. We performed univariate, multivariate, stepwise logistic regression, and receiver operator characteristics (ROC) analyses. We were able to demonstrate that low Apgar scores (notably at 1′ and 5′), low hemoglobin concentration (Hgb), and high lactate level at disease onset and during disease correlated with NEC severity and mortality (P < 0.05, respectively). Severe NEC was related to congenital heart disease (CHD — OR 2.6, CI95% 1.2–5.8, P 0.015) and patent ductus arteriosus (PDA — OR 3.3, CI95% 1.6–6.9, P 0.0012), whereas death was related to the presence of PDA (OR 5.5, CI95% 2.3–14, P < 0.001).Conclusion: Low Apgar scores, low Hgb, high lactate levels, and the presence of CHD or PDA correlated with severe NEC or mortality in children with NEC. What is Known:• It remains difficult to predict which infant that suffers from necrotizing enterocolitis at risk of death.• Several clinical and laboratory parameters tools to predict fatal outcome in NEC. What is New:• The following laboratory parameters were associated with the risk of death from NEC: Hemoglobin concentration, base excess and lactate level.• The following clinical variables were associated with the risk of death from NEC: Apgar scores, as well as the presence of congenital heart disease and patent ductus arteriosus.

Safety and Tolerability of a 90-minute Infusion of Originator and Biosimilar Rituximab in Rituximab- Naïve Patients

This study aimed to investigate the safety and tolerability of 90-min rapid infusion of rituximab, originator or biosimilar (Truxima), for rituximab-naïve patients with hematologic malignancy. We undertook a retrospective review of records of 118 patients (81 originator rituximab and 37 Truxima) with hematologic malignancy who had received rituximab rapid infusion from the first cycle of chemotherapy with corticosteroid premedication administration. Most patients had high Ann Arbor stage (80.9%), high International Prognostic Index risk (69.1%), favorable performance status (98.3%), and high lactate dehydrogenase level (78.8%). The patients received a collective total of 717 rapid rituximab infusions, with an average of 6 infusions per patient (range, 1-8). The incidence of infusion-related reactions (IRRs) of any grade and grade 3/4 during first infusion was 21.2% and 0.8%, respectively. No episode of grade 3/4 IRR was observed during the second and subsequent rituximab infusions. Severity and type of IRRs in Truxima administration were comparable to those of originator rituximab. This study suggests that 90-minute rituximab infusion with the first dose of chemotherapy was well tolerated. In terms of IRR, safety profiles of Truxima were comparable to that of originator rituximab, suggesting that Truxima might replace originator rituximab in a rapid infusion setting.

Cardiac tamponade secondary to Dressler’s syndrome

A 56-year-old woman presented to hospital with chest pain. Following review and investigations in the medical assessment unit, she was diagnosed with costochondritis and discharged home. She represented 10 days later and was mottled and hypotensive with a high lactate, raised inflammatory markers, an acute kidney injury and bilateral loin pain. A CT of the thorax, abdomen and pelvis showed pleural effusions and a large pericardial effusion with features of cardiac tamponade on subsequent echocardiography. A pericardiocentesis was performed and she was admitted to intensive care for haemofiltration. Once the patient was stable, an inpatient cardiac MRI was requested to further investigate an enhancing pericardium and echo-bright areas in the inferior, inferoseptal and inferolateral walls of the left ventricle demonstrated on echocardiography. The cardiac MRI showed evidence of a recent infarction in the right coronary artery (RCA) territory with pericardial inflammation and a resolved pericardial effusion. Overall, the findings were in keeping with Dressler’s syndrome.

A Report of Two Cases: Unlearning Lactic Acidosis

Introduction: The term “lactic acidosis” reinforces the misconception that lactate contributes to acidemia. Although it is common to discover an anion gap acidosis with a concomitant elevated lactate concentration, the two are not mutually dependent. Case Report: Here we describe two patients exhibiting high lactate concentrations in the setting of metabolic alkalemia. Conclusion: Lactate is not necessarily the direct cause of acid-base disturbances, and there is no fixed relationship between lactate and the anion gap or between lactate and pH. The term “metabolic acidosis with hyperlactatemia” is more specific than “lactic acidosis” and thus more appropriate.