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Wang Y, Yu H. Association between lactate to albumin ratio and mortality among sepsis associated acute kidney injury patients. BMC Infect Dis 2025; 25:414. [PMID: 40140783 PMCID: PMC11948962 DOI: 10.1186/s12879-025-10838-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 03/20/2025] [Indexed: 03/28/2025] Open
Abstract
BACKGROUND Sepsis-Associated Acute Kidney Injury (SA-AKI) has high fatality rates, but clear outcome markers are lacking. The objective of this research was to ascertain the link between lactate-to-albumin ratio (LAR) and mortality in cases of SA-AKI. METHODS We performed a retrospective cohort analysis of 3589 critically ill patients with SA-AKI using the Intensive Care Medical Information Mart IV (MIMIC-IV) database. Patients were categorized into four groups based on the quartiles of LAR. The findings of this study provide baseline data and outcomes regarding in-hospital, 30-day, and 90-day mortality rates for SA-AKI patients in the intensive care unit. We utilized multivariate cox regression analysis to compute the adjusted hazard ratio (HR) and 95% confidence intervals (95% CI). Subgroup analysis and restricted cubic spline curves were employed to further investigate the relationship between LAR and mortality. RESULTS This study involved 3589 participants with a mean age of 62.5 years. Patients in the LAR group with a Q4 (LAR ≥ 0.95) were associated with an increased risk of in-hospital mortality, 30-day mortality, and 90-day mortality (hazards ratio (HR): 2.11, 95% CI:1.7-2.62; HR: 1.9, 95% CI: 1.55-2.34; HR: 1.91, 95% CI: 1.58-2.31, respectively). Notably, within the subgroup of patients with AKI stages 2 and no CHF patients, the association between LAR and mortality was more pronounced. CONCLUSION The research underscores that elevated LAR are linked to heightened mortality risks. Notably, subgroup analyses have demonstrated that the correlation between LAR and mortality is particularly robust in certain patient cohorts, most notably those with stage 2 AKI and those without congestive heart failure (CHF). CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Yaotang Wang
- Critical care medicine department of Inner Mongolia People's Hospital, Inner Mongolia People's Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China
| | - Haixia Yu
- The Geriatric Medicine Department of the People's Hospital of Inner Mongolia Autonomous Region, Hohhot, Inner Mongolia Autonomous Region, China.
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AlSahow A, Alkandari O, AlYousef A, AlHelal B, AlRajab H, AlQallaf A, Bahbahani Y, AlSharekh M, AlKandari A, Nessim G, Mashal B, Mazroue A, Abdelmoteleb A, Saad M, Abdelzaher A, Abdallah E, Abdellatif M, ElHusseini Z, Abdelrady A. Health Care Access, Socioeconomic Status, and Acute Kidney Injury Outcomes: A Prospective National Study. Kidney Med 2024; 6:100867. [PMID: 39257701 PMCID: PMC11385412 DOI: 10.1016/j.xkme.2024.100867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024] Open
Abstract
Rationale & Objectives Acute kidney injury (AKI) incidence and outcome in Kuwait are unknown. Moreover, non-Kuwaitis, who represent 66% of the population, have lower income, and their access to public health services is restricted compared with Kuwaitis who have free full access. Study Design Observational prospective multicenter cohort study. Setting & Participants Adult inpatients with AKI in 7 public hospitals from January 1 to December 31, 2021. Exposure AKI identified using Kidney Disease: Improving Global Outcomes serum creatinine-based criteria. Outcomes For hospitalized patients with AKI, the outcomes included 30-day outcomes of mortality, need for dialysis, kidney recovery rates, and differences in outcomes between Kuwaitis and non-Kuwaitis. Analytical Approach A backward stepwise multiple logistic regression analysis was performed to assess possible independent risk factors for the outcomes. Results We recruited 3,744 patients (mean age: 63 years; mean baseline estimated glomerular filtration rate [eGFR]: 66.7 mL/min; non-Kuwaitis: 42.3%), representing 3.2% of hospitalizations and 19.5% of intensive care unit (ICU) admissions. Non-Kuwaitis were significantly younger (57.6 vs 66.9 years), with higher baseline eGFR (73.1 vs. 62 mL/min), more frequent community acquired AKI (53.8% vs 46.7%), and AKI in summer (34.7% vs 26.9%). Dialysis was provided to 33.5% of patients, with a higher need for non-Kuwaitis (35.5% vs 32.1%). At 30 days, 34.4% of patients died, representing 24.8% of hospital mortality and 59.8% of ICU mortality. No differences in mortality or kidney recovery were noted between Kuwaitis and non-Kuwaitis. Low eGFR did not affect the mortality rate. Limitations Observational nature and short follow-up period of 30 days only. Conclusions AKI was associated with high dialysis need and mortality. Non-Kuwaitis accounted for less cases despite representing 66% of the population because they were younger with higher baseline eGFR and fewer comorbid conditions. Non-Kuwaitis had higher rates of community acquired AKI and AKI in summer and a higher need for dialysis but had similar mortality and complete kidney recovery rates.
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Affiliation(s)
- Ali AlSahow
- Division of Nephrology, Jahra Hospital, Al Jahra, Kuwait
| | - Omar Alkandari
- Division of Pediatric Nephrology, Mubarak Hospital, Jabriya, Kuwait
| | - Anas AlYousef
- Division of Nephrology, Amiri Hospital, Kuwait City, Kuwait
| | | | - Heba AlRajab
- Division of Nephrology, Farwaniya Hospital, Kuwait City, Kuwait
| | - Ahmed AlQallaf
- Division of Nephrology, Jaber Hospital, Kuwait City, Kuwait
| | | | - Monther AlSharekh
- Division of Nephrology, Chest Diseases Hospital, Kuwait City, Kuwait
| | | | - Gamal Nessim
- Division of Nephrology, Mubarak Hospital, Jabriya, Kuwait
| | - Bassem Mashal
- Division of Nephrology, Jahra Hospital, Al Jahra, Kuwait
| | - Ahmad Mazroue
- Division of Nephrology, Amiri Hospital, Kuwait City, Kuwait
| | | | - Mohamed Saad
- Division of Nephrology, Farwaniya Hospital, Kuwait City, Kuwait
| | - Ali Abdelzaher
- Division of Nephrology, Chest Diseases Hospital, Kuwait City, Kuwait
| | - Emad Abdallah
- Division of Nephrology, Adan Hospital, Hadiya, Kuwait
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Xu W, Huo J, Hu Q, Xu J, Chen G, Mo J, Zhou T, Jiang J. Association between lactate dehydrogenase to albumin ratio and acute kidney injury in patients with sepsis: a retrospective cohort study. Clin Exp Nephrol 2024; 28:882-893. [PMID: 38584195 DOI: 10.1007/s10157-024-02500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Serum lactate dehydrogenase to albumin ratio (LAR) is associated with poor outcomes in malignancy and pneumonia. However, there are few studies suggesting that LAR is associated with the occurrence of acute kidney injury (AKI) in patients with sepsis, which was investigated in this study. METHODS We conducted a retrospective cohort study based on the Medical Information Mart for Intensive Care (MIMIC)-IV database. The primary outcome was the occurrence of AKI within 2 days and 7 days. Multivariable logistic regression models were used to calculate odds ratios to validate the association between LAR and AKI, in-hospital mortality, RRT use, and recovery of renal function, respectively. RESULTS A total of 4010 participants were included in this study. The median age of the participants was 63.5 years and the median LAR was 10.5. After adjusting for confounding variables, patients in the highest LAR quartile had a higher risk of AKI than those in the lowest LAR quartile within 2 days and 7 days, with odds ratios of 1.37 (95% confidence interval [CI]: 1.23-1.52) and 1.95 (95% CI: 1.72-2.22), respectively. The adjusted odds of AKI within 2 and 7 days were 1.16 (95% CI: 1.12-1.20) and 1.29 (95% CI: 1.24-1.35) for each 1 unit increase in LAR(log2), respectively. CONCLUSION This study demonstrated that elevated LAR was associated with poor prognosis in patients with sepsis. The risk of AKI and in-hospital mortality increased, the need for RRT increased, and the chance of recovery of renal function decreased with the increase of LAR.
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Affiliation(s)
- Weigan Xu
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China.
| | - Jianyang Huo
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Qiaohua Hu
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Jingtao Xu
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Guojun Chen
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Jierong Mo
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Tianen Zhou
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Jun Jiang
- First People's Hospital of Foshan, Foshan, Guangdong Province, China
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Zhang L, Yang P, Yin F, Zhang J, Zhao B, Zhou J. Association between frailty and hypoproteinaemia in older patients: meta-analysis and systematic review. BMC Geriatr 2024; 24:689. [PMID: 39154175 PMCID: PMC11329991 DOI: 10.1186/s12877-024-05275-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/02/2024] [Indexed: 08/19/2024] Open
Abstract
OBJECTIVE Frailty and hypoproteinaemia are common in older individuals. Although there is evidence of a correlation between frailty and hypoproteinaemia, the relationship between frailty and hypoproteinaemia in hospitalized/critically ill and older community residents has not been clarified. Therefore, the aim of our meta-analysis was to evaluate the associations between frailty and hypoproteinaemia in different types of patients. METHODS A systematic retrieval of articles published in the PubMed, Embase, Medline, Web of Science, Cochrane, Wanfang, and CNKI databases from their establishment to April 2024 was performed to search for studies on the associations between severity of frailty or prefrailty and hypoproteinaemia in older adults. The Newcastle‒Ottawa Scale and the Agency for Healthcare Research and Quality Scale were used to assess study quality. RESULTS Twenty-two studies were included including 90,351 frail older people were included. Meta-analysis revealed an association between frailty or prefrailty and hypoproteinaemia (OR = 2.37, 95% CI: 1.47, 3.83; OR = 1.62, 95% CI: 1.23, 2.15), there was no significant difference in the risk of hypoproteinaemia between patients with severe frailty and those with low or moderate frailty (OR = 0.62, 95% CI:0.44, 0.87). The effect of frailty on the occurrence of hypoproteinaemia was more obvious in hospitalized patients/critically ill patients than in surgical patients (OR = 3.75, 95% CI: 2.36, 5.96), followed by older community residents (OR = 2.30, 95% CI: 1.18, 4.49). CONCLUSION Frailty is associated with hypoproteinaemia in surgical patients, hospitalized older patients and older community residents. Future studies should focus on the benefits of albumin supplementation in preventing or alleviating frailty and related outcomes in the future.
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Affiliation(s)
- Linxue Zhang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- Nursing College, Zunyi Medical University, Zunyi, 563000, China
| | - Pingping Yang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- Nursing College, Zunyi Medical University, Zunyi, 563000, China
| | - Furong Yin
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- Nursing College, Zunyi Medical University, Zunyi, 563000, China
| | - Jinbo Zhang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- Nursing College, Zunyi Medical University, Zunyi, 563000, China
| | - Benli Zhao
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
- Nursing College, Zunyi Medical University, Zunyi, 563000, China
| | - Jiamei Zhou
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China.
- Nursing College, Zunyi Medical University, Zunyi, 563000, China.
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Lai P, Gu X, Lin X, He Y, Dai Y, Duan C, Liu Y, He W. Association of random glucose to albumin ratio with post-contrast acute kidney injury and clinical outcomes in patients with ST-elevation myocardial infarction. Front Endocrinol (Lausanne) 2024; 15:1390868. [PMID: 38957440 PMCID: PMC11217170 DOI: 10.3389/fendo.2024.1390868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/03/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose Both glucose and albumin are associated with chronic inflammation, which plays a vital role in post-contrast acute kidney injury (PC-AKI). To explore the relationship between random glucose to albumin ratio (RAR) and the incidence of PC-AKI after percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). Patients and methods STEMI patients who underwent PCI were consecutively enrolled from January, 01, 2010 to February, 28, 2020. All patients were categorized into T1, T2, and T3 groups, respectively, based on RAR value (RAR < 3.377; 3.377 ≤ RAR ≤ 4.579; RAR > 4.579). The primary outcome was the incidence of PC-AKI, and the incidence of major adverse clinical events (MACE) was the second endpoint. The association between RAR and PC-AKI was assessed by multivariable logistic regression analysis. Results A total of 2,924 patients with STEMI undergoing PCI were finally included. The incidence of PC-AKI increased with the increasing tertile of RAR (3.2% vs 4.8% vs 10.6%, P<0.001). Multivariable regression analysis demonstrated that RAR (as a continuous variable) was associated with the incidence of PC-AKI (adjusted odds ratio (OR) =1.10, 95% confidence interval (CI) =1.04 - 1.16, P<0.001) and in-hospital MACE (OR=1.07, 95% CI=1.02 - 1.14, P=0.012); RAR, as a categorical variable, was significantly associated with PC-AKI (T3 vs. T1, OR=1.70, 95% CI=1.08 - 2.67, P=0.021) and in-hospital MACE (T3 vs. T1, OR=1.63, 95% CI=1.02 - 2.60, P=0.041) in multivariable regression analyses. Receiver operating characteristic curve analysis showed that RAR exhibited a predictive value for PC-AKI (area under the curve (AUC)=0.666, 95% CI=0.625 - 0.708), and in-hospital MACE (AUC= 0.662, 95% CI =0.619 - 0.706). Conclusions The high value of RAR was significantly associated with the increasing risk of PC-AKI and in-hospital MACE after PCI in STEMI patients, and RAR offers a good predictive value for those outcomes.
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Affiliation(s)
- Ping Lai
- Department of Cardiology, First Affiliated Hospital of Gannan Medical University, Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, China
| | - Xiaoyan Gu
- Department of Endocrinology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuhui Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yining Dai
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chongyang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenfei He
- Department of Cardiology, Guangdong Provincial People’s Hospital’s Nanhai Hospital, The Second People’s Hospital of Nanhai District, Foshan, China
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Almazmomi MA, Esmat A, Naeem A. Acute Kidney Injury: Definition, Management, and Promising Therapeutic Target. Cureus 2023; 15:e51228. [PMID: 38283512 PMCID: PMC10821757 DOI: 10.7759/cureus.51228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Acute kidney injury (AKI) is caused by a sudden loss of renal function, resulting in the build-up of waste products and a significant increase in mortality and morbidity. It is commonly diagnosed in critically ill patients, with its occurrence estimated at up to 50% in patients hospitalized in the intensive critical unit. Despite ongoing efforts, the death rate associated with AKI has remained high over the past half-century. Thus, it is critical to investigate novel therapy options for preventing the epidemic. Many studies have found that inflammation and Toll-like receptor-4 (TLR-4) activation have a significant role in the pathogenesis of AKI. Noteworthy, challenges in the search for efficient pharmacological therapy for AKI have arisen due to the multifaceted origin and complexity of the clinical history of people with the disease. This article focuses on kidney injury's epidemiology, risk factors, and pathophysiological processes. Specifically, it focuses on the role of TLRs especially type 4 in disease development.
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Affiliation(s)
- Meaad A Almazmomi
- Pharmaceutical Care Department, Ministry of National Guard - Health Affairs, Jeddah, SAU
- Pharmacology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Ahmed Esmat
- Pharmacology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Anjum Naeem
- Pharmaceutical Care Department, Ministry of National Guard - Health Affairs, Jeddah, SAU
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Yoon HJ, Kim TH, Ko DE, Song JW, Min N, Ham SY. Postoperative Hypoalbuminemia as a Predictor of Acute Kidney Injury After Open Repair of Ruptured Abdominal Aortic Aneurysm. World J Surg 2023; 47:3382-3393. [PMID: 37730902 DOI: 10.1007/s00268-023-07178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Perioperative hypoalbuminemia has a prognostic effect on mortality and morbidity in various cohorts. Patients undergoing open repair of ruptured abdominal aortic aneurysms (rAAA) are at a high risk of hypoalbuminemia due to bleeding and underlying diseases. Hence, this study aimed to investigate the predictive value of immediate postoperative hypoalbuminemia for the risk for acute kidney injury (AKI) in patients undergoing open rAAA repair. METHODS We retrospectively reviewed 143 patients who underwent open rAAA repair between January 2008 and May 2022. The patients were divided into two groups according to the presence of postoperative AKI. The perioperative serum albumin levels of the two groups were compared. The patients were further divided into two groups based on the median immediate postoperative albumin level (2.4 g/dL). The incidence of AKI was compared between the two groups. Multivariate logistic regression analysis was performed to assess the predictors of postoperative AKI. Kaplan-Meier survival curves were used to evaluate potential of AKI and albumin level as prognostic factors for mortality. RESULTS Immediate postoperative serum albumin was significantly lower in the AKI group than in the non-AKI group (2.11 ± 0.62 g/dL vs. 2.59 ± 0.62 g/dL, p < 0.001). The incidence of postoperative AKI was significantly higher in patients with albumin ≤ 2.4 g/dL than in patients with albumin > 2.4 g/dL (53.8% vs. 27.7%, p = 0.002). Immediate postoperative albumin level was an independent predictor of AKI (Odds ratio [OR], 0.310; 95% confidence interval [CI] 0.165-0.583, p < 0.001) and 1-year mortality (OR, 0.230; 95% CI 0.098-0.542, p = 0.001). CONCLUSIONS Immediate postoperative hypoalbuminemia was associated with postoperative AKI and mortality in patients with rAAA.
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Affiliation(s)
- Hei Jin Yoon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Hoon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Da Eun Ko
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Wook Song
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Narhyun Min
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Yeon Ham
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
- Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, South Korea.
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Yang K, Yang N, Sun W, Dai L, Jin J, Wu J, He Q. The association between albumin and mortality in patients with acute kidney injury: a retrospective observational study. BMC Nephrol 2023; 24:332. [PMID: 37946135 PMCID: PMC10636863 DOI: 10.1186/s12882-023-03323-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/05/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND While the association between decreased serum albumin (ALB) levels and increased risk of acute kidney injury (AKI) is well established, the risk of death among patients with AKI with low serum ALB levels is unclear. We aimed to evaluate the association between serum ALB levels in patients with AKI and mortality, and help guide their clinical management. METHODS The included patients were those diagnosed with AKI and admitted to Zhejiang Provincial People's Hospital between January 2018 and December 2020. The clinical endpoint was all-cause mortality rate at 90-days and 1-year. Patients were divided into four groups according to the quartiles (Qs) of ALB measurements at admission. Cumulative survival curves were calculated using Kaplan-Meier analysis, and Cox proportional risk models were used to assess the association between serum ALB levels and 90-day and 1-year all-cause mortality. RESULTS This study included 740 patients with AKI. Patients with measured ALB values were classified into quartiles: Q1 ≤ 26.0 g/L (n = 188); Q2 = 26.1-30.5 g/L (n = 186); Q3 = 30.6-34.7 g/L (n = 183); Q4 ≥ 34.8 g/L (n = 183). Univariate analysis using Cox regression showed that for every 10 g/L increase in ALB, the 90-day and 1-year mortality decreased by 29%. Among the four subgroups, patients with lower ALB levels had a higher risk of death. After adjusting for demographics, comorbid conditions, inflammatory index, and medicine, the lowest ALB quartile (ALB < 26 g/L) was associated with increased risk of 90-day mortality (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.30 to 2.38, P < 0.001) and 1-year all-cause mortality (HR, 1.79; 95% CI, 1.33 to 2.41, P < 0.001). CONCLUSIONS ALB levels in patients with AKI were significantly correlated with prognosis, and the higher the level, the better the prognosis. Compared to patients with ALB ≥ 34.8 g/L, patients with 26.1 g/L < ALB ≤ 30.5 g/L had an increased risk of 90-day and 1-year all-cause mortality of approximately 40%, and patients with ALB ≤ 26.0 g/L had an increased risk of 90-day and 1-year all-cause mortality of approximately 76% and 79%, respectively.
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Affiliation(s)
- Kaibi Yang
- Jinzhou Medical University, Jinzhou, Liaoning, 121001, China
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Nan Yang
- Jinzhou Medical University, Jinzhou, Liaoning, 121001, China
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Wenbo Sun
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Limiao Dai
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Juan Jin
- Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310000, Zhejiang, China
| | - Juan Wu
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
| | - Qiang He
- Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310000, Zhejiang, China.
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Xiang X, Zhu X, Zhang L. Association of Malnutrition with Risk of Acute Kidney Injury: A Systematic Review and Meta-Analysis. Int J Clin Pract 2023; 2023:9910718. [PMID: 37795077 PMCID: PMC10547578 DOI: 10.1155/2023/9910718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
Background Acute kidney injury (AKI) is a complex clinical syndrome of hospitalization that may be affected by undernutrition and metabolic changes. The aim of this meta-analysis was to systematically assess the association between malnutrition and the risk of prevalent AKI. Materials and Methods We searched PubMed, Embase, Ovid MEDLINE, Web of Science, and Chinese databases (WANFANG, VIP, and CKI) from database inception until May 1, 2023, for studies evaluating the association of malnutrition with the risk of AKI. Summary odds ratios (ORs) were estimated using a random-effects model. Results We identified 17 observational studies, which included 273,315 individuals. Compared with patients with normal nutritional status, those with malnutrition had a 125% increased risk of prevalent AKI (pooled ORs, 2.25; 95% confidence interval, 1.80-2.82). Malnutrition was also significantly associated with prevalent AKI across all subgroups when subgroup analyses were performed on covariates such as region, study design, age, sample size, malnutrition assessment method, patient characteristics, covariate adjustment degree, and risk of bias. Meta-regression models demonstrated no significant differences in AKI risk between patients with malnutrition and without malnutrition. Conclusions Our results suggest that malnutrition may be a potential target for AKI prevention. However, well-designed studies with ethnically or geographically diverse populations are needed to evaluate strategies and interventions to prevent or slow the development and progression of AKI in malnourished individuals.
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Affiliation(s)
- Xiang Xiang
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Critical Care Medicine, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu 611137, China
| | - Xinchen Zhu
- Department of Internal Medicine, Traditional Chinese Medicine Hospital of Wenjiang District, Chengdu 611130, China
| | - Lijuan Zhang
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Critical Care Medicine, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu 611137, China
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10
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Guo L, Chen D, Cheng B, Gong Y, Wang B. Prognostic Value of the Red Blood Cell Distribution Width-to-Albumin Ratio in Critically Ill Older Patients with Acute Kidney Injury: A Retrospective Database Study. Emerg Med Int 2023; 2023:3591243. [PMID: 37051465 PMCID: PMC10085652 DOI: 10.1155/2023/3591243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Abstract
Background. There is no evidence suggesting that red blood cell distribution width-to-albumin ratio (RA) predicts outcomes in severely ill older individuals with acute kidney injury (AKI). We hypothesized that RA is associated with all-cause mortality in critically ill older patients with AKI. Methods. We recorded demographics, laboratory tests, comorbidities, vital signs, and other clinical information from the MIMIC-III V1.4 dataset. The primary endpoint was 90-day all-cause mortality, and the secondary endpoints were 30-day mortality, one-year mortality, renal replacement treatment (RRT), duration of stay in the intensive care unit (ICU), sepsis, and septic shock. We generated Cox proportional hazards and logistic regression models to determine RA’s prognostic values and subgroup analyses to determine the subgroups’ mortality. We conducted a Pearson correlation analysis on RA and C-reactive protein (CRP) in the cohort of patients from the Second Affiliated Hospital of Wenzhou Medical University. Results. A total of 6,361 patients were extracted from MIMIC-III based on the inclusion and exclusion criteria. RA levels directly and linearly correlated with 90-day all-cause mortality. After controlling for ethnicity, gender, age, and other confounding variables in multivariate analysis, higher RA was significantly associated with an increased risk of 30-day, 90-day, and one-year all-cause mortality as opposed to the reduced levels of RA (tertile 3 vs. tertile 1: hazard ratios (HRs), 95% confidence intervals (CIs): 1.70, 1.43–2.01; 1.90, 1.64–2.19; and 1.95, 1.72–2.20, respectively). These results suggested that elevated levels of RA were linked to an elevated risk of 30-day, 90-day, and one-year all-cause death. There was a similar trend between RA and the use of RRT, length of stay in ICUs, sepsis, and septic shock. The subgroup analysis did not reveal any considerable interplay among strata. When areas under the curve were compared, RA was a weaker predictor than the SAPS II score but a stronger predictor than red blood cell distribution width (RDW) or albumin alone (
); RA combined with SAPS II has better predictive power than SAPS II alone (
). The Second Affiliated Hospital of Wenzhou Medical University cohort showed that CRP positively correlated with RA, with a coefficient of 0.2607 (
). Conclusions. RA was an independent prognostic predictor in critically ill older patients with AKI, and greater RA was linked to a higher probability of death. The risk of AKI is complicated when RRT occurs; sepsis and septic shock increase with RA levels.
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Affiliation(s)
- Lei Guo
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Dezhun Chen
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Bihuan Cheng
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Yuqiang Gong
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Benji Wang
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
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11
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Ibarra M, Combs R, Taylor ZL, Ramsey LB, Mikkelsen T, Buddington RK, Heldrup J, Barreto JN, Guscott M, Lowe J, Hurmiz C, Marada S, Howard SC, Schaiquevich P. Insights from a pharmacometric analysis of HDMTX in adults with cancer: Clinically relevant covariates for application in precision dosing. Br J Clin Pharmacol 2023; 89:660-671. [PMID: 35998099 DOI: 10.1111/bcp.15506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS High-dose methotrexate (HDMTX) is an essential part of the treatment of several adult and paediatric malignancies. Despite meticulous supportive care during HDMTX administration, severe toxicities, including acute kidney injury (AKI), may occur contributing to patient morbidity. Population pharmacokinetics provide a powerful tool to predict time to clear HDMTX and adjust subsequent doses. We sought to develop and validate pharmacokinetic models for HDMTX in adults with diverse malignancies and to relate systemic exposure with the occurrence of severe toxicity. METHODS Anonymized, de-identified data were provided from 101 US oncology practices that participate in the Guardian Research Network, a non-profit clinical research consortium. Modelled variables included clinical, laboratory, demographic and pharmacological data. Population pharmacokinetic analysis was performed by means of nonlinear mixed effects modelling using MonolixSuite. RESULTS A total of 693 HDMTX courses from 243 adults were analysed, of which 62 courses (8.8%) were associated with stage 2/3 acute kidney injury (43 stage 2, 19 stage 3). A three-compartment model adequately fitted the data. Time-dependent serum creatinine, baseline serum albumin and allometrically scaled bodyweight were clinically significant covariates related to methotrexate clearance. External evaluation confirmed a satisfactory predictive performance of the model in adults receiving HDMTX. Dose-normalized methotrexate concentration at 24 and 48 hours correlated with AKI incidence. CONCLUSION We developed a population pharmacometric model that considers weight, albumin and time-dependent creatinine that can be used to guide supportive care in adult patients with delayed HDMTX elimination.
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Affiliation(s)
- Manuel Ibarra
- Department of Pharmaceutical Sciences, Faculty of Chemistry. Universidad de la República, Montevideo, Uruguay
| | | | - Zachary L Taylor
- Division of Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Laura B Ramsey
- Division of Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Torben Mikkelsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Randal K Buddington
- Department of Molecular and Cellular Physiology, LSU Health Sciences, Shreveport, LA, USA
| | - Jesper Heldrup
- Childhood Cancer and Research Unit, University Children's Hospital, Lund, Sweden
| | | | | | | | | | | | - Scott C Howard
- Resonance, Inc., Arlington, TN, USA.,College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Paula Schaiquevich
- Unit of Innovative Treatments, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, Buenos Aires, Argentina
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12
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Influence of Nutritional Parameters on the Evolution, Severity and Prognosis of Critically Ill Patients with COVID-19. Nutrients 2022; 14:nu14245363. [PMID: 36558522 PMCID: PMC9783074 DOI: 10.3390/nu14245363] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
This study evaluated the clinical and nutritional status, the evolution over three days, and the relationship between nutritional, inflammatory, and clinical parameters of critically ill patients with COVID-19. A longitudinal study was conducted in the Intensive Care Unit of the Virgen de las Nieves University Hospital in Granada (Spain). The study population comprised patients with a positive polymerase chain reaction test for COVID-19 presenting critical clinical involvement. Clinical outcomes were collected, and inflammatory and nutritional parameters (albumin, prealbumin, transferrin, transferrin saturation index, cholesterol, triglycerides and Controlling Nutritional Status (CONUT) score) were determined. A total of 202 critical patients with COVID-19 were selected, presenting highly altered clinical-nutritional parameters. The evolution experienced by the patients on the third day of admission was a decrease in albumin (p < 0.001) and an increase in prealbumin (p < 0.001), transferrin (p < 0.002), transferrin saturation index (p < 0.018), and cholesterol (p < 0.001). Low levels of albumin, prealbumin (on the third day) and high CONUT score (on the third day) showed an association with higher mortality. Nutritional variables were inversely correlated with clinical and inflammatory parameters. Critically ill patients with COVID-19 have poor nutritional status related to a poor prognosis of disease severity and mortality.
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13
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Yang L, Li J, Wei W, Yi C, Pu Y, Zhang L, Cui T, Ma L, Zhang J, Koyner J, Zhao Y, Fu P. Kidney health in the COVID-19 pandemic: An umbrella review of meta-analyses and systematic reviews. Front Public Health 2022; 10:963667. [PMID: 36172213 PMCID: PMC9511113 DOI: 10.3389/fpubh.2022.963667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/16/2022] [Indexed: 01/24/2023] Open
Abstract
Background This umbrella review aims to consolidate evidence from systematic reviews and meta-analyses investigating the impact of the coronavirus disease-2019 (COVID-19) on kidney health, and the associations between kidney diseases and clinical outcomes in COVID-19 patients. Methods Five databases, namely, EMBASE, PubMed, Web of Science, the Cochrane Database of Systematic Reviews and Ovid Medline, were searched for meta-analyses and systematic reviews from January 1, 2020 to June 2, 2022. Two reviewers independently selected reviews, identified reviews for inclusion and extracted data. Disagreements were resolved by group discussions. Two reviewers independently assessed the methodological quality of all included reviews using ROBIS tool. A narrative synthesis was conducted. The characteristics and major findings of the included reviews are presented using tables and forest plots. The included meta-analyses were updated when necessary. The review protocol was prospectively registered in PROSPERO (CRD42021266300). Results A total of 103 reviews were identified. Using ROBIS, 30 reviews were rated as low risk of bias. Data from these 30 reviews were included in the narrative synthesis. Ten meta-analyses were updated by incorporating 119 newly available cohort studies. Hospitalized COVID-19 patients had a notable acute kidney injury (AKI) incidence of 27.17%. AKI was significantly associated with mortality (pooled OR: 5.24) and severe conditions in COVID-19 patients (OR: 14.94). The pooled prevalence of CKD in COVID-19 patients was 5.7%. Pre-existing CKD was associated with a higher risk of death (pooled OR: 2.21) and disease severity (pooled OR: 1.87). Kidney transplant recipients were susceptible to SARS-CoV-2 infection (incidence: 23 per 10,000 person-weeks) with a pooled mortality of 18%. Conclusion Kidney disease such as CKD or recipients of kidney transplants were at increased risk of contracting COVID-19. Persons with COVID-19 also had a notable AKI incidence. AKI, the need for RRT, pre-existing CKD and a history of kidney transplantation are associated with adverse outcomes in COVID-19. Systematic review registration www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021266300, identifier: CRD42021266300.
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Affiliation(s)
- Letian Yang
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Jian Li
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Wei Wei
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Cheng Yi
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yajun Pu
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Ling Zhang
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Tianlei Cui
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Liang Ma
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Juqian Zhang
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom
| | - Jay Koyner
- Division of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Yuliang Zhao
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Ping Fu
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
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14
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YEŞİLTAŞ S, GÜZEL C, SÜMER İ, UYSAL H, DAŞKAYA H, TÜRKAY M, KARAASLAN K. The Effect of Exogenous Human Albumin Administration on Acute Kidney Injury Development in Hypoalbuminemic Patients in the Intensive Care Unit. BEZMIALEM SCIENCE 2022. [DOI: 10.14235/bas.galenos.2021.6113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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15
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You T, Zhou YR, Liu XC, Li LQ. Risk Factors and Clinical Characteristics of Neonatal Acute Respiratory Distress Syndrome Caused by Early Onset Sepsis. Front Pediatr 2022; 10:847827. [PMID: 35419326 PMCID: PMC8995893 DOI: 10.3389/fped.2022.847827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To identify risk factors associated with the development of acute respiratory distress syndrome (ARDS) in infants with early onset sepsis (EOS) and to describe the clinical features. METHODS A retrospective study was conducted at the Children's Hospital of Chongqing Medical University between January 2000 and October 2020. The infants were divided into ARDS and non-ARDS groups. Clinical characteristics and risk factors were compared between the two groups. RESULTS Two hundred fifty infants (58 with ARDS) were included. Smaller gestational age, lower birth weight (LBW), lower serum albumin level, a higher rate of preterm birth, premature rupture of membranes, antenatal steroid exposure, and lower Apgar score were associated with an increased development of ARDS by univariate analysis (P < 0.05). LBW (β = -0.001, P = 0.000, OR: 0.999, 95% CI: 0.998-0.999) and low serum albumin levels (β = -0.063, P = 0.022, OR: 0.939, 95% CI: 0.889-0.991) were identified as independent risk factors for the development of ARDS by logistic regression analysis. A higher frequency of complications, including persistent pulmonary hypertension, intraventricular hemorrhage, pulmonary hemorrhage, septic shock, and bronchopulmonary dysplasia, was found in the ARDS group (P < 0.05). The rate of mortality was higher for those in the ARDS group than for those in the non-ARDS group (46.6% vs. 15.6%, χ2 = 24.205, P = 0.000). CONCLUSION Acute respiratory distress syndrome (ARDS) in EOS could lead to a higher frequency of complications and mortality. The risk factors for the development of ARDS were LBW and low serum albumin levels.
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Affiliation(s)
- Ting You
- Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yan-Rong Zhou
- Jiulongpo People's Hospital of Chongqing, Chongqing, China
| | - Xiao-Chen Liu
- Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Lu-Quan Li
- Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
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16
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Relationship between CRP Albumin Ratio and the Mortality in Critically Ill Patients with AKI: A Retrospective Observational Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9957563. [PMID: 34631892 PMCID: PMC8497108 DOI: 10.1155/2021/9957563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/11/2021] [Indexed: 11/22/2022]
Abstract
Background AKI is known to be associated with inflammation and nutritional status. The novel inflammatory prognostic score CAR (CRP/albumin ratio), which combines inflammation and nutritional status, was hypothesized to be associated with mortality in critically ill AKI patients in this study. Methods The included cases were patients admitted to the ICU of Shandong Provincial Hospital from January 2016 to November 2018 and diagnosed with AKI within 48 hours of ICU admission. From the electronic case database of Shandong Provincial Hospital, we extracted the baseline demographic information, vital signs, routine laboratory parameters, complications, and other data. The above records are measured within 48 hours of admission to ICU. The clinical endpoint was the total cause mortality rate in hospital and 2 years. We constructed two multivariate regression models to determine the statistically significant correlation between CAR and mortality and conducted subgroup analysis to determine the mortality among different subgroups. Results A total of 580 patients were included in this study. In multivariate regression analysis, higher CAR was associated with an increase in hospital and two-year all-cause mortality in critically ill patients with AKI after adjusting gender, age, respiratory frequency, temperature, and other confounding factors (tertile 3 versus tertile 1: OR, 95% CI: 2.97, 1.70-5.17; 3.03, 1.68-5.47, respectively; P < 0.001). Subgroup analysis showed that the CAR level in each subgroup increases with hospital mortality in critically ill patients with AKI. Conclusion The increase of CAR in critically ill patients with AKI was associated with an increased risk of all-cause death.
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17
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Association between Prognostic Nutritional Index and Contrast-Associated Acute Kidney Injury in Patients Complicated with Chronic Kidney Disease and Coronary Artery Disease. J Interv Cardiol 2021; 2021:2274430. [PMID: 34316292 PMCID: PMC8277523 DOI: 10.1155/2021/2274430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background Contrast-associated acute kidney injury (CA-AKI) is a major adverse effect of coronary angiography (CAG). Patients with chronic kidney disease (CKD) and coronary artery disease (CAD) are at high risk of CA-AKI. This study aimed to investigate the association between prognostic nutritional index (PNI) and CA-AKI in this high-risk population. Methods This study enrolled a total of 4,391 patients. CA-AKI was defined as a serum creatinine increase ≥0.3 mg/dL or 50% from baseline within the first 48 hours following CAG. The PNI was calculated upon hospital admission: serum albumin (g/L) + 5 × total lymphocyte count (109/L). PNI was analysed from the high level to low level as a continuous variable and categorical variable which was divided into four groups by quartile. Restricted cubic splines and logistic regression were applied. Results Overall, 13.09% (575/4391) of patients developed CA-AKI. PNI score was significantly lower in patients with CA-AKI than that in patients without CA-AKI (P < 0.01). The relationship between PNI score and CA-AKI was linear. A logistic regression model revealed that decreased PNI score was associated with increased risk of CA-AKI [per 1-point decrement; adjusted OR = 1.08, 95% CI, 1.05–1.09; compared with Quartile 1 (PNI ≥ 46.30), Quartile 4 (PNI < 37.90), adjusted OR = 1.88, 95% CI: 1.41–2.51; and Quartile 3 (37.90 ≤ PNI < 42.15), adjusted OR = 1.37, 95% CI: 1.02–1.84]. Conclusion Our study indicated a negative linear relationship between PNI score and CA-AKI in patients undergoing CAG complicated with CKD and CAD. It suggested that malnutrition is associated with increased risk of CA-AKI in this population.
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18
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The global incidence and mortality of contrast-associated acute kidney injury following coronary angiography: a meta-analysis of 1.2 million patients. J Nephrol 2021; 34:1479-1489. [PMID: 34076881 PMCID: PMC8494686 DOI: 10.1007/s40620-021-01021-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/05/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Contrast-associated acute kidney injury (CA-AKI) is a common complication after coronary angiography (CAG), which brings a poor prognosis. But up to now, there were fewer studies to discuss the incidence of CA-AKI comprehensively. We comprehensively explore the incidence of CA-AKI after coronary angiography. METHODS We searched Medline, Embase, and Cochrane Database of Systematic Reviews (to 30th June 2019). We evaluated the world's incidence of the CA-AKI, and associated mortality, and to described geographic variations according to countries, regions, and economies. CA-AKI was defined as an increase in serum creatinine ≥ 0.5 mg/dl or ≥ 25% within 72 h. Random effects model meta-analyses and meta-regressions was performed to derive the sources of heterogeneity. RESULTS A total of 134 articles (1,211,106 participants) were included in our meta-analysis. Most studies originated from China, Japan, Turkey and United States, from upper middle income and high income countries. The pooled incidence of CA-AKI after coronary angiography was 12.8% (95% CI 11.7-13.9%), and the CA-AKI associated mortality was 20.2% (95% CI 10.7-29.7%). The incidence of CA-AKI and the CA-AKI associated mortality were not declined over time (Incidence rate change: 0.23% 95% CI - 0.050 to 0.510 p = 0.617; Mortality rate change: - 1.05% 95% CI - 3.070 to 0.970 p = 0.308, respectively). CONCLUSION CA-AKI was a universal complication in many regions, and the burden of CA-AKI remains severe. In clinical practice, physicians should pay more attention to the occurrence and active prevention and treatment of CA-AKI.
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19
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Martins CA, Santos MCBD, Gonçalves-de-Albuquerque CF, Castro-Faria-Neto HC, Castro-Faria MV, Burth P, Younes-Ibrahim M. The relationship of oleic acid/albumin molar ratio and clinical outcomes in leptospirosis. Heliyon 2021; 7:e06420. [PMID: 33732938 PMCID: PMC7944043 DOI: 10.1016/j.heliyon.2021.e06420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 01/12/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Human leptospirosis is an acute infectious zoonosis presenting specific lipid disorders. Previous in vitro studies showed both leptospira glycolipoprotein endotoxin, and high oleic acid levels were associated with Na/K-ATPase inhibition that is amplified by the reduction of circulating albumin levels. In this study, we aimed to investigate the relationship of oleic acid/albumin (OA/A) molar ratio and clinical outcomes in Leptospirosis. Through a prospective observational cohort study employing high-performance liquid chromatography (HPLC) we sequentially determined serum concentrations of nonesterified fatty acids (NEFA) and albumin in twenty-eight patients with severe leptospirosis since their hospital admission. Twenty patients recovered, and eight died. Data was distributed in two groups according to clinical outcomes. Oleic acid/albumin molar ratios (OA/A), initial samples, were higher than those in healthy donors. The ratio OA/A, however, persisted high in dying patients, whereas patients who survived had a reduction matching to healthy donors. Biochemical alterations suggest that cure is correlated to the reestablishment of the OA/A molar ratio, while fatal outcomes related to persisting OA/A imbalances. Analysis by receiver operating characteristic (ROC) showed the area under the curve of 0.864 and the cutoff value of 0.715 being associated with a high odds ratio. Lipid analysis from patients with leptospirosis had an acute high serum OA/A molar ratio, and sustained imbalance has a high odds ratio and strong correlation with mortality.
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Affiliation(s)
- Caroline Azevedo Martins
- Laboratório Integrado de Nefrologia, Department of Internal Medicine, Medical Sciences School, State University of Rio de Janeiro, Brazil
| | - Maria Conceição B dos Santos
- Laboratório Integrado de Nefrologia, Department of Internal Medicine, Medical Sciences School, State University of Rio de Janeiro, Brazil
| | - Cassiano Felippe Gonçalves-de-Albuquerque
- Laboratório de Imunofarmacologia, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
- Laboratório de Imunofarmacologia, Departamento de Bioquímica, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mauro Velho Castro-Faria
- Laboratório Integrado de Nefrologia, Department of Internal Medicine, Medical Sciences School, State University of Rio de Janeiro, Brazil
| | - Patricia Burth
- Laboratório de Enzimologia e Sinalização Celular, Department of Cellular and Molecular Biology, Federal Fluminense University, Niteroi, Brazil
| | - Mauricio Younes-Ibrahim
- Laboratório Integrado de Nefrologia, Department of Internal Medicine, Medical Sciences School, State University of Rio de Janeiro, Brazil
- Departamento de Medicina, Pontifícia Universidade Católica, Rio de Janeiro, Brazil
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20
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Fielding CL, Mayer JR, Dechant JE, Epstein KL, Magdesian KG. Clinical and biochemical factors associated with survival in equids attacked by dogs: 28 cases (2008-2016). J Vet Intern Med 2020; 35:532-537. [PMID: 33274807 PMCID: PMC7848301 DOI: 10.1111/jvim.15979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 11/07/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022] Open
Abstract
Background Trauma from dog attacks has been associated with mortality rates as high as 23% in some species. However, the prognosis and clinical features of this type of injury have not been described in equids. Hypotheses/Objectives To describe survival rate, signalment, clinical features, and biochemical results in equids presented for emergency care after presumed dog attacks. We hypothesized there would be differences between survivors and nonsurvivors. Animals A total of 28 equids presented for presumed dog attacks from 3 referral centers. Methods A retrospective study was performed using data from 3 hospitals between 2008 and 2016. Survival was defined as survival at 14 days postdischarge. Variables were compared between survivors and nonsurvivors using a t test, Mann‐Whitney U test, or Fisher's exact test as appropriate. Results Overall mortality rate was 21%. Ponies and miniature horses represented 16/28 (57%) of the animals in the study. Full‐sized equids had a lower risk of nonsurvival as compared to smaller patients (odds ratio = 0.02; 95% confidence intervals = 0.00‐0.27; P < .005). Animals with lower body temperatures had increased risk for nonsurvival (P = .0004). Increased admission blood lactate concentrations (P = .003) and decreased serum total protein concentrations (P = .006) were associated with nonsurvival. Conclusions The mortality rate in equids attacked by dogs was similar to what is reported for other veterinary species. Smaller equids and those with increased admission blood lactate concentration, lower body temperature, and lower total serum protein concentrations were less likely to survive.
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Affiliation(s)
| | | | - Julie E Dechant
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Kira L Epstein
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - K Gary Magdesian
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
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Moramarco S, Morciano L, Morucci L, Messinese M, Gualtieri P, Carestia M, Ciccacci F, Orlando S, Buonomo E, Legramante JM, De Lorenzo A, Palombi L. Epidemiology of Hypoalbuminemia in Hospitalized Patients: A Clinical Matter or an Emerging Public Health Problem? Nutrients 2020; 12:nu12123656. [PMID: 33261019 PMCID: PMC7760225 DOI: 10.3390/nu12123656] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022] Open
Abstract
Serum albumin levels are strongly associated with the morbidity, prognosis, and mortality rates of patients with hypoalbuminemia, which is a frequent problem during hospitalization. An observational retrospective study was carried out to analyze changes in albumin levels in hospitalized patients at the “Fondazione Policlinico Tor Vergata—PTV” in 2018. The prevalence of preexisting hypoalbuminemia at the time of discharge from hospital was investigated using a sample of 9428 patients. Information was collected from the discharge files recorded in the central informatics system of the hospital. Analysis of albumin levels at admission and at discharge was conducted by classes of albuminemia and then stratified by age. At the time of admission, hypoalbuminemia was found to be present in more than half of the sample, with no sex differences. The serum albumin level tended to decrease with age, with pathologic levels appearing from 50 years and progressive worsening thereafter. The condition of marked and mild hypoalbuminemia was more prevalent in patients over 65 years of age. Our findings suggest that hypoalbuminemia should be considered a dangerous condition in itself and a serious public health problem. We aimed to emphasize the role of albumin as useful marker of the in-hospital malnutrition and frailty, to be integrated in the routinely assessment of patients for reconsidering ad hoc healthcare pathways after discharge from hospital, especially when dealing with fragile populations.
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Affiliation(s)
- Stefania Moramarco
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
- Correspondence:
| | - Laura Morciano
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
| | - Luca Morucci
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
| | - Mario Messinese
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
| | - Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (P.G.); (A.D.L.)
| | - Mariachiara Carestia
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
| | - Fausto Ciccacci
- Unicamillus, International Medical University in Rome, Via di Sant’Alessandro, 8-00131 Rome, Italy;
| | - Stefano Orlando
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
| | - Ersilia Buonomo
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
| | - Jacopo Maria Legramante
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy;
| | - Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (P.G.); (A.D.L.)
| | - Leonardo Palombi
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
- Unicamillus, International Medical University in Rome, Via di Sant’Alessandro, 8-00131 Rome, Italy;
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Tay HS, Wood AD, Carter B, Pearce L, McCarthy K, Stechman MJ, Myint PK, Hewitt J. Impact of Surgery on Older Patients Hospitalized With an Acute Abdomen: Findings From the Older Persons Surgical Outcome Collaborative. Front Surg 2020; 7:583653. [PMID: 33282905 PMCID: PMC7705344 DOI: 10.3389/fsurg.2020.583653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The impact of surgery compared to non-surgical management of older general surgical patients is not well researched. Methods: We examined the association between management and adverse outcomes in a cohort of emergency general surgery patients aged > 65 years. This multi-center study included 727 patients (mean+/-SD, 77.1 ± 8.2 years, 54% female) admitted to five UK hospitals. Data were analyzed using multi-level crude and multivariable logistic regression. Outcomes were: mortality at Day 30 and 90, length of stay, and readmission within 30 days of discharge. Covariates assessed were management approach, age, sex, frailty, polypharmacy, anemia, and hypoalbuminemia. Results: Approximately 25% of participants (n = 185) underwent emergency surgery. Frailty and albumin were associated with mortality at 30 (frailty OR = 3.52 [95% CI 1.66–7.49], albumin OR = 3.78 ([95% CI 1.53–9.31]), and 90 days post discharge (frailty OR = 3.20 [95% CI 1.86–5.51], albumin OR=3.25 [95% CI 1.70–6.19]) and readmission (frailty OR = 1.56 [95% CI (1.04–2.35)]). Surgically managed patients and frailty had increased odds of prolonged hospitalization (surgery OR = 5.69 [95% CI 3.67–8.80], frailty OR = 2.17 [95% CI 1.46–3.23]). Conclusion: We found the impact of surgery on length of hospitalization in older surgical patients is substantial. Whether early comprehensive geriatric assessment and post-op rehabilitation would improve this outcome require further evaluation.
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Affiliation(s)
- Hui Sian Tay
- Department of Geriatric Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Adrian D Wood
- Department of Geriatric Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.,Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Ben Carter
- Department of Biostatistics and Health Informatics, King's College, London, United Kingdom
| | - Lyndsay Pearce
- Department of General Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Kathryn McCarthy
- Department of General Surgery, North Bristol National Health Service (NHS) Trust, Bristol, United Kingdom
| | - Michael J Stechman
- Department of General Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Phyo K Myint
- Department of Geriatric Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.,Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Jonathan Hewitt
- Department of Geriatric Medicine, Cardiff University, Cardiff, United Kingdom
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23
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Liu L, Liu J, Lei L, Wang B, Sun G, Guo Z, He Y, Song F, Lun Z, Liu B, Chen G, Chen S, Yang Y, Liu Y, Chen J. A prediction model of contrast-associated acute kidney injury in patients with hypoalbuminemia undergoing coronary angiography. BMC Cardiovasc Disord 2020; 20:399. [PMID: 32867690 PMCID: PMC7460778 DOI: 10.1186/s12872-020-01689-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Risk stratification is recommended as the key step to prevent contrast-associated acute kidney injury (CA-AKI) among at-risk patients following coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). Patients with hypoalbuminemia are prone to CA-AKI and do not have their own risk stratification tool. Therefore, this study developed and validated a new model for predicting CA-AKI among hypoalbuminemia patients CAG/PCI. METHODS 1272 patients with hypoalbuminemia receiving CAG/PCI were enrolled and randomly allocated (2:1 ratio) into the development cohort (n = 848) and the validation cohort (n = 424). CA-AKI was defined as an increase of ≥0.3 mg/dL or 50% in serum creatinine (SCr) compared to baseline in the 48 to 72 h after CAG/PCI. A prediction model was established with independent predictors according to stepwise logistic regression, showing as a nomogram. The discrimination of the new model was evaluated by the area under the curve (AUC) and was compared to the classic Mehran CA-AKI model. The Hosmer-Lemeshow test was conducted to assess the calibration of our model. RESULTS Overall, 8.4% (71/848) patients of the development group and 11.2% (48/424) patients of the validation group experienced CA-AKI. A new nomogram included estimated glomerular filtration rate (eGFR), serum albumin (ALB), age and the use of intra-aortic balloon pump (IABP); showed better predictive ability than the Mehran score (C-index 0.756 vs. 0.693, p = 0.02); and had good calibration (Hosmer-Lemeshow test p = 0.187). CONCLUSIONS We developed a simple model for predicting CA-AKI among patients with hypoalbuminemia undergoing CAG/PCI, but our findings need validating externally. TRIAL REGISTRATION http://www.ClinicalTrials.gov NCT01400295 , retrospectively registered 21 July 2011.
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Affiliation(s)
- Liwei Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Li Lei
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Bo Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Guoli Sun
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Zhaodong Guo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yibo He
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Feier Song
- Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Zhubin Lun
- Department of Cardiology, Dongguan People's Hospital, Dongguan, 523059, China
| | - Bowen Liu
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510100, China
| | - Guanzhong Chen
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510100, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yongquan Yang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510100, China
| | - Yong Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China.
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510100, China.
| | - Jiyan Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China.
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510100, China.
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24
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Oh J, Liu A, Tran E, Berthelet E, Wu J, Olson RA, Chau N, Bowman A, Hamilton SN. Association between nutritional risk index and outcomes for head and neck cancer patients receiving concurrent chemo-radiotherapy. Head Neck 2020; 42:2560-2570. [PMID: 32562319 DOI: 10.1002/hed.26315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients receiving chemoradiotherapy for head and neck cancer (HNC) are often malnourished. We assessed the utility of nutritional risk index (NRI) in HNC patients undergoing chemoradiotherapy. METHODS A population-based retrospective review of HNC patients treated with curative chemoradiation was performed. Demographics, anthropometrics, overall survival (OS), and the composite treatment complication rate (G-tube dependence, radiation incompletion, 90-day mortality, and unplanned hospitalization) were collected. RESULTS Two hundred ninety-two patients were identified. Average pretreatment and posttreatment NRI were 110 (SD 3) and 99 (SD 12), respectively (P < .01). Pretreatment NRI risk category, age, ECOG status, and tumor subsites were associated with OS on multivariate analysis. Pretreatment NRI risk category was associated with risk of treatment related complications. CONCLUSIONS There was a significant decrease between pretreatment and posttreatment NRI in HNC patients receiving chemoradiation. Pretreatment NRI risk category may predict OS and composite treatment complications. Investigation of NRI as a prognostic factor is warranted.
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Affiliation(s)
- Justin Oh
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Oncology, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Alvin Liu
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Tran
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Oncology, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Eric Berthelet
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Oncology, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Jonn Wu
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Oncology, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Robert A Olson
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Oncology, British Columbia Cancer - Centre for the North, Prince George, British Columbia, Canada
| | - Nicole Chau
- Department of Medical Oncology, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Angie Bowman
- Oncology Nutrition, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - Sarah N Hamilton
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Oncology, British Columbia Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
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25
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Effects of Albumin Infusion on Serum Levels of Albumin, Proinflammatory Cytokines (TNF- α, IL-1, and IL-6), CRP, and MMP-8; Tissue Expression of EGRF, ERK1, ERK2, TGF- β, Collagen, and MMP-8; and Wound Healing in Sprague Dawley Rats. Int J Inflam 2020; 2020:3254017. [PMID: 32518615 PMCID: PMC7256723 DOI: 10.1155/2020/3254017] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 11/17/2022] Open
Abstract
In this study, we sought to determine the roles of albumin in wound healing, which is infused both pre- and postoperatively in malnourished patients presenting with hypoalbuminemia. For the purposes of the study, we used 25 male Sprague Dawley rats of predetermined weight and age, which were initially maintained in a standard environment and fed the same diet for 7 days prior to being segregated into one of the following five groups: A, control, normal protein feed (20% casein); B, hypoalbuminemia, 25% rat albumin infusion prior to surgery; C, hypoalbuminemia, normal protein feed (20% casein); D, hypoalbuminemia, 25% rat albumin infusion after surgery; and E, hypoalbuminemia, low-protein feed (casein 2%). The animals in all five groups were subjected to four deep incisions in their dorsal muscle fascia. On days 1, 3, 5, and 7 after surgery, ELISA was used to determine serum levels of TNF-α, IL-1, IL-6, CRP, and MMP-8, whereas immunohistochemistry was used to determine the tissue expression of EGFR, ERK1, ERK2, TGF-β, collagen, and MMP-8. Significant reductions in serum levels of TNF-α, IL-1, and CRP were detected in the groups receiving albumin infusion and the high-casein diet (P < 0.05). The administration of albumin and a high-casein diet also increased the tissue expression of EGFR, ERK1, ERK2, TGF-β, and collagen and decreased that of MMP-8 relative to the hypoalbuminemia control (P < 0.05). We propose that the administration of albumin promoted NF-κB signaling which, in turn, induced the transduction and transcription of factors involved in wound healing. Albumin infusion and dietary proteins play vital roles in accelerating the wound healing process, as they can contribute to correcting the hypoalbuminemic state. These findings provide insights that will contribute to our understanding of wound healing, particularly in malnourished patients.
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Thongprayoon C, Cheungpasitporn W, Chewcharat A, Mao MA, Thirunavukkarasu S, Kashani KB. Impacts of admission serum albumin levels on short-term and long-term mortality in hospitalized patients. QJM 2020; 113:393-398. [PMID: 31747010 DOI: 10.1093/qjmed/hcz305] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/19/2019] [Indexed: 12/14/2022] Open
Abstract
AIM The aim of this study is to assess the association between admission serum albumin and short- and long-term mortality in all hospitalized patients. DESIGN A single-center cohort study. METHODS A retrospective cohort of all adult hospitalized patients at a tertiary referral hospital between January 2009 and December 2013 were analysed. Admission serum albumin was stratified into six groups: ≤2.4, 2.5-2.9, 3.0-3.4, 3.5-3.9, 4.0-4.4 and ≥4.5 g/dl. The outcomes of interest were in-hospital mortality, length of hospital stay and 1-year mortality. Serum albumin of 4-4.4 g/dl was selected as a reference group for outcome comparison. RESULTS A total of 14 075 patients were studied. Admission serum albumin of ≥4.5 g/dl had the lowest in-hospital and 1-year mortality with progressively increased in-hospital mortality observed with decreased admission serum albumin. In adjusted analysis, compared with serum albumin of 4.0-4.4 g/dl, serum albumin of ≤2.4, 2.5-2.9, 3.0-3.4 and 3.5-3.9 were significantly associated with increased in-hospital and 1-year mortality. In contrast, serum albumin of ≥4.5 g/dl was significantly associated with lower 1-year mortality but not in-hospital mortality. Admission serum albumin <4.0 g/dl was significantly associated with a prolonged hospital stay, while admission serum albumin of ≥4.5 g/dl was significantly associated with shorter hospital stay, compared with serum albumin of 4.0-4.4 g/dl. CONCLUSION Low albumin level at admission was progressively associated with increased short- and long-term mortality in all hospitalized patients even when albumin level was considered in normal range.
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Affiliation(s)
- C Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905
| | - W Cheungpasitporn
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216
| | - A Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905
| | - M A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224
| | - S Thirunavukkarasu
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905
| | - K B Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Analysis of the short-term prognosis and risk factors of elderly acute kidney injury patients in different KDIGO diagnostic windows. Aging Clin Exp Res 2020; 32:851-860. [PMID: 31410742 PMCID: PMC7190600 DOI: 10.1007/s40520-019-01261-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/25/2019] [Indexed: 12/02/2022]
Abstract
Background and aims Follow-up observation was performed on elderly acute kidney injury (AKI) patients to analyze the short-term prognosis and risk factors of AKI patients in the 48-h diagnostic window and 7-day diagnostic window of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Methods Inpatients aged ≥ 75 years in the geriatric ward of the People’s Liberation Army General Hospital, China, between January 2007 and December 2015 were selected as the research subjects. According to two diagnostic criteria in the KDIGO guidelines, patients were divided into a 48-h diagnostic window group and a 7-day diagnostic window group. The medical data of the patients were divided into the death group and the survival group for analysis based on the survival condition of the patients after 90 days of AKI. Factors that affected the 90-day survival of patients in the 48-h diagnostic window and 7-day diagnostic window groups were analyzed using multivariate Cox regression. Results During the follow-up period, a total of 652 patients were enrolled in this study. Among them, 623 cases were men, accounting for 95.6% of the patients. The median age was 87 (84–91) years. According to the KDIGO staging criteria, there were 308 (47.2%) cases in AKI stage 1, 164 (25.2%) cases in stage 2, and 180 (27.6%) cases in stage 3. Among the 652 patients, 334 (51.2%) were diagnosed with AKI based on the 48-h diagnostic criteria window, and 318 (48.8%) were diagnosed with AKI based on the baseline 7-day diagnostic criteria. The 90-day mortality of AKI patients was 42.5% in the 48-h diagnostic window and 24.2% in the 7-day diagnostic window. The multivariate Cox analysis results showed that low mean arterial pressure (HR = 0.966; P < 0.001), low serum prealbumin level (HR = 0.932; P < 0.001), infection (HR = 1.448; P = 0.047), mechanical ventilation (HR = 1.485; P = 0.038), high blood urea nitrogen (BUN) level (HR = 1.026; P < 0.001), blood magnesium level (HR = 2.560; P = 0.024), and more severe AKI stage (stage 2: HR = 3.482; P < 0.001 and stage 3: HR = 6.267; P < 0.001) were independent risk factors affecting the 90-day mortality of elderly patients in the 48-h diagnostic window, whereas low body mass index (HR = 0.851; P < 0.001), low mean arterial pressure (HR = 0.980; P = 0.036), low serum prealbumin level (HR = 0.950; P = 0.048), low serum albumin level (HR = 0.936; P = 0.015), high BUN level (HR = 1.046; P < 0.001), and more severe AKI stage (stage 2: HR = 4.249; P = 0.001 and stage 3: HR = 9.230; P < 0.001) were independent risk factors affecting the 90-day mortality of elderly patients in the 7-day diagnostic window. Conclusions The clinical differences of AKI and risk factors for 90-day mortality in elderly AKI individuals vary depending on the definition used. An increment of Scr ≥ 26.5 μmol/L in 48 h (48-h KDIGO window) alone predicts adverse clinical outcomes.
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28
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Moon JJ, Kim Y, Kim DK, Joo KW, Kim YS, Han SS. Association of hypoalbuminemia with short-term and long-term mortality in patients undergoing continuous renal replacement therapy. Kidney Res Clin Pract 2020; 39:47-53. [PMID: 31995708 PMCID: PMC7105631 DOI: 10.23876/j.krcp.19.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/21/2019] [Accepted: 11/19/2019] [Indexed: 01/09/2023] Open
Abstract
Background Hypoalbuminemia reflects several pathological conditions, including nutritional deficiencies and chronic inflammation. However, its relationship with short-term and long-term mortality in patients undergoing continuous renal replacement therapy (CRRT) remains unclear. The present study aimed to assess the effect of hypoalbuminemia on mortality in a large cohort of patients undergoing CRRT. Methods The study retrospectively reviewed 1,581 patients who underwent CRRT for the treatment of acute kidney injury from 2010 to 2016. The patients were categorized by tertiles of serum albumin levels at CRRT initiation. The odds ratios and hazard ratios for the risk of all-cause mortality were calculated before and after adjustment for multiple covariates. Results The mean albumin level was 2.7 ± 0.6 g/dL at CRRT initiation. During a median follow-up period of 14 days (maximum, 4 years), 1,040 patients (65.8%) died. The risk of overall mortality was higher in the first tertile group than in the third tertile group (hazard ratio, 1.9 [1.63-2.21]). When the mortality rate was stratified by timeframe, the risk was steadily higher in the first tertile group than in the third tertile group (odds ratios: 3.0 [2.34-3.87] for 2-week mortality, 2.7 [2.12-3.52] for 1-month mortality, 2.7 [2.08-3.53] for 6-month mortality, and 2.8 [2.11-3.62] for 1-year mortality). Additionally, the rates of intensive care unit mortality and in-hospital mortality were higher in the first tertile group than in the third tertile group. Conclusion The initial hypoalbuminemia was independently associated with short-term and long-term mortality in patients undergoing CRRT. Thus, the serum albumin level should be monitored during CRRT.
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Affiliation(s)
- Jong Joo Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yaerim Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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The Neutrophil Percentage-to-Albumin Ratio Is Associated with All-Cause Mortality in Critically Ill Patients with Acute Kidney Injury. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5687672. [PMID: 32219136 PMCID: PMC7049452 DOI: 10.1155/2020/5687672] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 02/08/2023]
Abstract
Background There is no evidence to suggest the predictive power of neutrophil percentage-to-albumin ratio (NPAR) in patients with acute kidney injury (AKI). We hypothesized that NPAR would correlate with all-cause mortality in critically ill patients with AKI. Methods From the MIMIC-III V1.4 database, we extracted demographics, vital signs, comorbidities, laboratory tests, and other clinical data. The clinical endpoints were 30-, 90- and 365-day all-cause mortality in critically ill patients with AKI. Cox proportional hazards models were used to evaluate the prognostic values of NPAR, and subgroup analyses were performed to measure mortality across various subgroups. Results A total of 7,481 eligible subjects were enrolled. In multivariate analysis, after adjustments for age, ethnicity, gender, and other confounding factors, higher NPARs were associated with an increased risk of 30-, 90- and 365-day all-cause mortality in critically ill patients with AKI (tertile 3 versus tertile 1: adjusted HR, 95% CI: 1.48, 1.30–1.69; 1.47, 1.31–1.66; 1.46, 1.32–1.62, respectively; P trend <0.01). A similar trend was observed in the NPAR group division by quintiles. Subgroup analysis revealed no significant interactions in most strata. Conclusions Increased NPAR correlates with increased risk of all-cause mortality in critically ill patients with AKI.
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Thongprayoon C, Cheungpasitporn W, Chewcharat A, Mao MA, Thirunavukkarasu S, Kashani KB. Risk of acute respiratory failure among hospitalized patients with various admission serum albumin levels: A cohort study. Medicine (Baltimore) 2020; 99:e19352. [PMID: 32118775 PMCID: PMC7478795 DOI: 10.1097/md.0000000000019352] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Serum albumin is a marker of nutritional and frailty status. This study aimed to assess the association between serum albumin at the time of admission and the risk of acute respiratory failure (ARF) in hospitalized patientsThis cohort study, performed at a tertiary referral hospital, included all hospitalized adult patients from January 2009 to December 2013 who had serum albumin measurement and were not on mechanical ventilation within 24 hours of hospital admission. Serum albumin was stratified into 2.4, 2.5 to 2.9, 3.0 to 3.4, 3.5 to 3.9, 4.0 to 4.4, and ≥4.5 g/dL. Multivariate logistic regression analysis was performed to obtain adjusted odds ratio (OR) of risk of ARF requiring mechanical ventilation based on various admission serum albumin levels.Of 12,719 patients, ARF requiring mechanical ventilation occurred in 1128 (8.9%) during hospitalization. Hypoalbuminemia was associated with increased risk of ARF, in particular when serum albumin was ≤2.4 g/dL. Compared with serum albumin of 4.0-4.4 g/dL, serum albumin ≤2.4 g/dL at admission was associated with 2.38-time higher odds of ARF during hospitalization (OR 2.38, 95% confidence interval [CI] 1.84-3.07). In contrast, elevated serum albumin ≥4.5 g/dL was associated with lower odds of ARF (OR 0.68, 95% CI 0.48-0.97).Admission serum albumin level lower than 3.5 g/dL was associated with a higher risk of ARF requiring mechanical ventilation, whereas elevated serum albumin level at least 4.5 g/dL was associated with a lower risk of ARF. Therefore, admission albumin level at admission might be useful in the prediction of ARF during hospitalization.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, USA
| | | | - Kianoush B. Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
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Aksoy R, Adademir T, Yilmaz E, Cevirme D, Sengor M, Koksal C, Rabus MB. Is Hypoalbuminemia a Predictor for Acute Kidney Injury after Coronary Bypass Grafting in Diabetes Mellitus Patients? Braz J Cardiovasc Surg 2019; 34:565-571. [PMID: 31165612 PMCID: PMC6852450 DOI: 10.21470/1678-9741-2018-0291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective Acute kidney injury (AKI) is one of the most important complications after
coronary artery bypass grafting (CABG) procedure. Serum albumin, which is an
acute phase reactant, is suggested to be associated with AKI development
subsequent to various surgical procedures. In this study, we research the
relation between preoperative serum albumin levels and postoperative AKI
development in diabetes mellitus (DM) patients undergoing isolated CABG. Methods We included a total of 634 diabetic patients undergoing CABG (60.5±9.1
years, 65.1% male) into this study, which was performed between September
2009 and January 2014 in a single center. The relation between preoperative
serum albumin levels and postoperative AKI development was observed. AKI was
evaluated and diagnosed using the Kidney Disease: Improving Global Outcomes
(KDIGO) classification. Results AKI was diagnosed in 230 (36.3%) patients. Multiple logistic regression
analysis was performed to determine the independent predictors of AKI
development. Proteinuria (odds ratio [OR] and 95% confidence interval [CI],
1.066 [1.002-1.135]; P=0.043) and low preoperative serum
albumin levels (OR and 95% CI, 0.453 [0.216-0.947];
P=0.035) were found to be independent predictors of AKI.
According to the receiver operating characteristic curve analysis, albumin
level <3mg/dL (area under the curve: 0.621 [0.572-0.669],
P<0.001) had 83% sensitivity and 10% specificity on
predicting the development of AKI. Conclusion We observed that a preoperative low serum albumin level was associated with
postoperative AKI development in patients with DM who underwent isolated
CABG procedure. We emphasize that this adjustable albumin level should be
considered before the operation since it is an easy and clinically
implementable management for the prevention of AKI development.
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Affiliation(s)
- Rezan Aksoy
- University of Health Sciences Kartal Kosuyolu Heart Education and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Taylan Adademir
- University of Health Sciences Kartal Kosuyolu Heart Education and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ekrem Yilmaz
- University of Health Sciences Kartal Kosuyolu Heart Education and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Deniz Cevirme
- University of Health Sciences Kartal Kosuyolu Heart Education and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Sengor
- University of Health Sciences Kartal Kosuyolu Heart Education and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Cengiz Koksal
- Bezmialem Vakıf University Medical Faculty Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, Bezmialem Vakıf University, Medical Faculty, Istanbul, Turkey
| | - Murat Bulent Rabus
- University of Health Sciences Kartal Kosuyolu Heart Education and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
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Ihara K, Ishigami J, Inoshita S. Predictors of withdrawal from renal replacement therapy among patients with acute kidney injury requiring renal replacement therapy. Clin Exp Nephrol 2019; 23:814-824. [PMID: 30778780 DOI: 10.1007/s10157-019-01711-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 01/31/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although recovery of renal function after an episode of acute kidney injury (AKI) is an important clinical measure of morbidity, predictors of withdrawal from renal replacement therapy (RRT) among AKI patients remain unclear. METHODS In this single-center retrospective cohort study, we examined the clinical records of AKI patients requiring RRT who were hospitalized in the ICU or general wards at our hospital from January 2010 to December 2013. A priori-determined covariates of age, sex, cardiovascular disease, chronic kidney disease (CKD), mean arterial pressure (MAP), sepsis, nephrotoxic agents, and hypoalbuminemia were assessed in Cox hazard models to estimate hazard ratio (HR). RESULTS A total of 334 patients were enrolled (median age, 68 years; interquartile range [IQR], 57-77 years; male, 71.6%). During follow-up 157 (47.0%) patients achieved RRT withdrawal. Multivariable Cox regression analysis revealed that CKD, MAP between 95 and 105 mmHg and MAP ≥ 105 mmHg, compared with MAP between 65 and 75 mmHg, ventilator use and hypoalbuminemia, were significantly associated with RRT withdrawal. CONCLUSION Among patients with AKI requiring RRT, CKD, ventilator use, hypoalbuminemia, and high MAP were associated with RRT withdrawal. Furthermore, keeping a higher MAP at RRT initiation can potentially lead to dependence on RRT.
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Affiliation(s)
- Katsuhito Ihara
- Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, 21205, MD, USA
| | - Seiji Inoshita
- Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
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U-shape association of serum albumin level and acute kidney injury risk in hospitalized patients. PLoS One 2018; 13:e0199153. [PMID: 29927987 PMCID: PMC6013099 DOI: 10.1371/journal.pone.0199153] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 06/03/2018] [Indexed: 12/31/2022] Open
Abstract
Background While an association between hypoalbuminemia and increased risk of acute kidney injury (AKI) is well-established, the risk of AKI development and its severity among patients with elevated serum albumin is unclear. The aim of this study was to evaluate the risk of AKI in hospitalized patients stratified by various admission serum albumin levels. Methods This single-center retrospective study was conducted at a tertiary referral hospital. All adult hospitalized patients who had admission albumin levels available between January 2009 and December 2013 were enrolled. Admission albumin was categorized based on its distribution into six groups (≤2.4, 2.5–2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4, and ≥4.5 mg/dL). The primary outcome was the incidence of hospital-acquired AKI (HAKI). Logistic regression analysis was performed to obtain the odds ratio of AKI for various admission albumin strata using the albumin 3.5 to 3.9 mg/dL (lowest incidence of AKI) as the reference group. Results Of the total 9,552 studied patients, HAKI occurred in 1,556 (16.3%) patients. The incidence of HAKI among patients with admission albumin ≤2.4, 2.5–2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4, and ≥4.5 mg/dL was 18.3%, 14.3%, 15.5%, 14.2%, 16.7%, and 26.0%, respectively. After adjusting for potential confounders, admission serum albumin levels ≤2.4 and ≥4.5 mg/dL were associated with an increased risk of HAKI with odds ratios of 1.52 (95% CI 1.18–1.94) and 2.16 (95% CI 1.74–2.69), respectively. While stage 1 HAKI was significantly more frequent among patients with admission albumin ≥4.5 mg/dL (23.0% vs. 11.6%, P<0.001), incidence of stage 3 HAKI was higher in those with albumin ≤2.4 mg/dL (2.8% vs 0.3%, P<0.001). Conclusion Admission serum albumin levels ≤2.4 and ≥4.5 mg/dL were associated with an increased risk for HAKI. Patients with admission albumin ≥4.5 mg/dL had HAKI with a lower intensity when compared with those who had admission albumin levels ≤2.4 mg/dL.
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Schwartz N, Sakhnini A, Bisharat N. Predictive modeling of inpatient mortality in departments of internal medicine. Intern Emerg Med 2018; 13:205-211. [PMID: 29290047 DOI: 10.1007/s11739-017-1784-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/25/2017] [Indexed: 11/25/2022]
Abstract
Despite overwhelming data on predictors of inpatient mortality, it is unclear which variables are the most instructive in predicting mortality of patients in departments of internal medicine. This study aims to identify the most informative predictors of inpatient mortality, and builds a prediction model on an individual level, given a constellation of patient characteristics. We use a penalized method for developing the prediction model by applying the least-absolute-shrinkage and selection-operator regression. We utilize a cohort of adult patients admitted to any of 5 departments of internal medicine during 3.5 years. We integrated data from electronic health records that included clinical, epidemiological, administrative, and laboratory variables. The prediction model was evaluated using the validation sample. Of 10,788 patients hospitalized during the study period, 874 (8.1%) died during admission. We find that the strongest predictors of inpatient mortality are prior admission within 3 months, malignant morbidity, serum creatinine levels, and hypoalbuminemia at hospital admission, and an admitting diagnosis of sepsis, pneumonia, malignant neoplastic disease, or cerebrovascular disease. The C-statistic of the risk prediction model is 89.4% (95% CI 88.4-90.4%). The predictive performance of this model is better than a multivariate stepwise logistic regression model. By utilizing the prediction model, the AUC for the independent (validation) data set is 85.7% (95% CI 84.1-87.3%). Using penalized regression, this prediction model identifies the most informative predictors of inpatient mortality. The model illustrates the potential value and feasibility of a tool that can aid physicians in decision-making.
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Affiliation(s)
- Naama Schwartz
- Research Authority, Emek Medical Center, Clalit Health Services, Afula, Israel
| | - Ali Sakhnini
- Department of Medicine D, Emek Medical Center, Clalit Health Services, 21 Rabin Avenue, 18341, Afula, Israel
| | - Naiel Bisharat
- Department of Medicine D, Emek Medical Center, Clalit Health Services, 21 Rabin Avenue, 18341, Afula, Israel.
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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