Higher Rate Of Acute Kidney Injury Research Articles

Acyclovir treatment of varicella-zoster virus meningeal infections and acute kidney injury: a multicentre case series study

Background Systematic treatment with intravenous acyclovir is usually given when varicella zoster virus (VZV) DNA is isolated in cerebrospinal fluid (CSF), indicating central nervous system (CNS) involvement. Our study aimed to describe therapeutic management and acute kidney injury (AKI) occurrence during acyclovir treatment of VZV infection with CNS involvement. Methods Multicentre, retrospective study including all patients from 2010 to 2022 with VZV DNA in CSF. Patient management and outcomes were compared according to clinical presentation and indications for intravenous acyclovir: i) definite (encephalitis, myelitis or stroke, peripheral nervous system (PNS) with ≥ 2 roots, herpes zoster ≥ 3 dermatomes, immunosuppression), ii) questionable (1 or 2 dermatomes) or iii) no indication (other situations). Results 154 patients were included (median age 66 (interquartile range 43–77), 87 (56%) males); 60 (39%) had encephalitis, myelitis or stroke, 35 (23%) had PNS involvement, 37 (24%) had isolated meningitis, 14 (9%) had isolated cutaneous presentation, and 8 (5%) had other presentations. Overall, 128 (83%) received intravenous acyclovir for more than 72 h. AKI occurred in 57 (37%) patients. Finally, 42 (27%) and 25 (16%) patients had respectively no or a questionable indication for intravenous acyclovir, while 29 (69%) and 23 (92%) of them received it for more than 72 h, with AKI in 13 (35%) and 13 (52%) patients, respectively. In-hospital mortality was 12% (n = 18), and no deaths were reported in isolated meningitis. Conclusions Intravenous acyclovir is widely prescribed when VZV DNA is isolated in CSF, regardless of the clinical presentation, with a high rate of AKI. Further studies are needed to better define the value of intravenous acyclovir in isolated VZV meningitis.

Greater Disease Severity and Worse Clinical Outcomes in Patients Hospitalised with COVID-19 in Africa.

COVID-19 cardiovascular research from Africa is limited. This study describes cardiovascular risk factors, manifestations, and outcomes of patients hospitalised with COVID-19 in the African region, with an overarching goal to investigate whether important differences exist between African and other populations, which may inform health policies. A multinational prospective cohort study was conducted on adults hospitalised with confirmed COVID-19, consecutively admitted to 40 hospitals across 23 countries, 6 of which were African countries. Of the 5,313 participants enrolled globally, 948 were from African sites (n = 9). Data on demographics, pre-existing conditions, clinical outcomes in hospital (major adverse cardiovascular events (MACE), renal failure, neurological events, pulmonary outcomes, and death), 30-day vitality status and re-hospitalization were assessed, comparing African to non-African participants. Access to specialist care at African sites was significantly lower than the global average (71% vs. 95%), as were ICU admissions (19.4% vs. 34.0%) and COVID-19 vaccination rates (0.6% vs. 7.4%). The African cohort was slightly younger than the non-African cohort (55.0 vs. 57.5 years), with higher rates of hypertension (48.8% vs. 46.9%), HIV (5.9% vs. 0.3%), and Tuberculosis (3.6% vs. 0.3%). In African sites, a higher proportion of patients suffered cardiac arrest (7.5% vs. 5.1%) and acute kidney injury (12.7% vs. 7.2%), with acute kidney injury (AKI) appearing to be one of the strongest predictors of MACE and death in African populations compared to other populations. The overall mortality rate was significantly higher among African participants (18.2% vs. 14.2%). Overall, hospitalised African patients with COVID-19 had a higher mortality despite a lower mean age, contradicting literature that had previously reported a lower mortality attributed to COVID-19 in Africa. African sites had lower COVID-19 vaccination rates and higher AKI rates, which were positively associated with increased mortality. In conclusion, African patients were hospitalized with more severe COVID-19 cases and had poorer outcomes.

Characteristics of acute kidney injury and mortality in patients with sepsis and septic shock

Background and Objective: Acute kidney injury (AKI) is a life-threatening disease and a global health burden, with an increasing incidence in both developed and developing countries. 40 - 50% of AKI cases are caused by sepsis and septic shock. Mortality increases respectively with disease severity. Therefore, we conduct this research with the objective of determining the incidence of sepsis-associated and septic shock-associated AKI and mortality in these patients. Methods: This cross sectional study was conducted on 65 patients with sepsis or septic shock in the Department of ICU - Hue Central Hospital - Vietnam, from February 2022 to March 2023. Results: Of the 65 patients admitted with sepsis and septic shock, 38 (58.5%) developed AKI, the rates of KDIGO stage 1, 2, 3 were 44.7%, 38.8%, and 18.5%, respectively. The rate of patients receiving RRT was 39.5%. The rate of patients with positive blood cultures was 12.6%. The average SOFA score, APACHE II score at admission were respectively 7.63 ± 5.8; 19.18 ± 9.2. The average serum levels of lactate and PCT in patients with sepsis and septic shock were respectively 3.9 ± 3.23 mmol/l; 33.13 ± 38.49 ng/ml. The average ICU length of stay was 9.03 ± 5.23 days, the rate of requiring mechanical ventilation was 36.9%, in-28-day mortality was 32.3%. Mortality was statistically significantly higher in the AKI groups compared to non-AKI group (p < 0.05). Conclusion: Patients with sepsis and septic shock have high rates of AKI and mortality, increased length of hospital stay. Key words: acute kidney injury, sepsis, septic shock.

Acute kidney injury as a risk factor for atrial fibrillation after coronary artery bypass grafting — effects of sodium-glucose cotransporter-2 inhibitors

Aim. To identify predictors of paroxysmal atrial fibrillation (pAF) in patients with stable angina after coronary artery bypass grafting (CABG), as well as to evaluate the effect of sodium-glucose cotransporter 2 (SGLT-2) inhibitors.Material and methods. We examined 92 patients with stable angina who received CABG, aged 64±7 years (men, 78,3%). Among this cohort, 81,5% of patients had multivessel coronary artery disease, carbohydrate metabolism disorders — 35,6%, hypertension — 96,7%, chronic kidney disease (CKD) — 23,9%, preprocedural pAF — 10,9%, previous myocardial infarction (MI) — 54,3%. Off-pump CABG was performed in 31,5%, including bilateral inthernal thoracic artery grafting — in 50%. Cardiopulmonary bypass time was 68 (55-83) minutes. The number of grafts was 2,7±0,7. In addition, 18,5% of individuals received SGLT-2 inhibitors. Serum creatinine content was determined by the Jaffe method, and CKD was diagnosed with glomerular filtration rate <60 ml/min. Acute kidney injury (AKI) was assessed according to the KDIGO criteria (2012).Results. The number of patients who had pAF after CABG was 29,3%, AKI — 16,3%. There were following parameters associated with pAF after CABG: creatinine (100;82-142 in patients with pAF and 83;69-105 μmol/l — without pAF, p=0,032) and urea (7,8;5,8-9,7 in patients with pAF and 5,9;4,7-9,1 mmol/l — without pAF, p=0,025) one day after the intervention; postoperative AKI was revealed in 33,3% and 9,2% (p=0,004), while the number of patients taking SGLT-2 inhibitors was 3,7% and 24,6% (p=0,019) in those with and without pAF, respectively. The probability of pAF after CABG increased by an average of 5,5 times with AKI. Patients with pAF after CABG compared to patients without pAF have a higher rate of AKI, intraoperative MI, and cardiac death.Conclusion. The number of patients with pAF after CABG was 29,3%, AKI — 16,3%. Post-CABG pAF predictor was postoperative AKI. The use of SGLT-2 inhibitors was associated with a lower incidence of pAF after intervention. Patients with pAF after CABG have a poor inhospital prognosis.

Evaluation of the Closure of Patent Ductus Arteriosus With Ibuprofen Compared to Indomethacin.

Limited data exist comparing indomethacin and ibuprofen for the treatment of patent ductus arteriosus (PDA). The objective was to compare the safety and efficacy of indomethacin and ibuprofen for treatment of PDA closure. This single-center, pre-test/post-test quasi-experiment included preterm infants admitted to the neonatal intensive care unit who received indomethacin (July 1, 2013-September 30, 2015) or ibuprofen (December 1, 2015-July 31, 2019) for PDA. Patients were excluded if they were thrombocytopenic, had existing kidney injury, unresolved intraventricular hemorrhage (IVH) or necrotizing enterocolitis (NEC) at treatment initiation. Data were obtained from the electronic health record. Study outcomes were complete PDA closure, degree of PDA closure, resolution of symptoms, and new-onset acute kidney injury (AKI), IVH, or NEC. A total of 114 patients were included: 44 (39%) received indomethacin and 70 (61%) received -ibuprofen. Twenty-one (21%) patients experienced successful PDA closure within 1 week: 13 (32%) indomethacin patients and 8 (13%) ibuprofen patients (p = 0.023). PDA size reduction occurred in 43 (46%) patients with 29 (25%) experiencing complete symptom resolution. Significantly more indomethacin patients compared with ibuprofen patients experienced new-onset AKI (48% vs 17%; p < 0.001) and received concomitant nephrotoxins (68% vs 39%; p = 0.002). There were no significant differences in new-onset IVH or NEC. Indomethacin administration successfully closed the PDA in more neonates than ibuprofen but resulted in higher rates of AKI. However, this was confounded by more frequent administration of concomitant nephrotoxins. Larger trials are needed to help elucidate the optimal drug for closure of the PDA in neonates.

Pre-treatment risk factors to predict early cisplatin-related nephrotoxicity in locally advanced head and neck cancer patients treated with chemoradiation: A single Institution experience

ObjectivesCisplatin is essential in the curative treatment of locally advanced head and neck squamous cell carcinoma (LA-HNSCC) patients. The assessment of risk factors to predict an early cisplatin-induced nephrotoxicity could help in better managing one of the most relevant cisplatin-related dose-limiting factors. Material and methodsWe retrospectively collected data of LA-HNSCC patients treated at our Institution from 2008 to 2019. Patients received cisplatin in a curative setting concurrently with radiation. Acute Kidney Injury (AKI) was assessed as a dichotomous variable (CreaIncr) based on pre-treatment values, and values recorded at days 6–20 post-first cycle of cisplatin. Univariable logistic regression models were performed to investigate associations between CreaIncr and clinical characteristics. A multivariable logistic model on a priori selected putative covariates was performed. ResultsOf the 350 LA-HNSCC treated patients, 204 were analyzed. Ninety (44 %) suffered from any grade AKI (grade I 51.1 %): out of them, 84.4 % received high-dose cisplatin (100 mg/m2 q21). On the univariable logistic regression model, male sex, age, serum uric acid, creatinine, concomitant drugs, and cisplatin schedule were significantly associated with a higher rate of AKI. At multivariable model, age (p = 0.034), baseline creatinine (p = 0.027), concomitant drugs (p = 0.043), and cisplatin schedule (one-day bolus or fractionated high-dose vs. weekly; p = 0.001) maintained their significant association. ConclusionsIdentifying pre-treatment risk factors in LA-HNSCC patients may improve decision-making in a setting where cisplatin has a curative significance. A strict monitoring of AKI could avoid cisplatin dose adjustments, interruptions, and treatment delays, thus limiting a negative impact on outcomes.

Outcomes of minimal change disease without nephrotic range proteinuria.

Minimal change disease (MCD) is characterized by edema and nephrotic range proteinuria (NS). However, the fate of MCD without nephrotic proteinuria requires elucidation. We retrospectively reviewed 79 adults diagnosed with primary MCD at their initial renal biopsy at a tertiary hospital between May 2003 and June 2017. Clinicopathologic features were compared between patients with and without NS. The frequency of flaring to nephrotic proteinuria and renal outcomes were assessed during follow-up. There were 20 and 59 patients in the Non-NS and NS groups, respectively. The Non-NS group had a lower frequency of acute kidney injury (AKI) during the follow-up period [5.0% vs. 59.3%, p <0.001]. The response rate to steroid treatment was 100% in the Non-NS group and 92.3% in the NS group (p = 1.000). Except for one patient, the Non-NS group was treated with steroids when their proteinuria increased to a nephrotic level. There were no differences in the frequency of the first relapse or the number of relapses among patients with initial remission from nephrotic range proteinuria. At the final visit, the complete remission rate was 73.4%. The estimated glomerular filtration rate during follow-up was significantly better in the NS group than the Non-NS group, given the higher rates of AKI at renal biopsy. The rates of renal events, end-stage renal disease, and mortality did not differ between the groups. Adult MCD patients with nephrotic and non-nephrotic range proteinuria showed similar outcomes. Accordingly, this population must be carefully managed, regardless of the amount of proteinuria at renal biopsy.

Managing the kidney – The role of continuous renal replacement therapy in neonatal and pediatric ECMO

Extracorporeal membrane oxygenation (ECMO) represents a lifesaving therapy utilized in in the most critically ill neonates and children with reversible cardiopulmonary failure. As a result of the severity of their critical illness these patients are among the highest risk populations for developing acute kidney injury (AKI) and disorders of fluid balance including the pathologic state of fluid overload (FO). In multiple studies AKI has been shown to occur commonly in 60-80% children treated with ECMO and is associated with adverse outcomes. In early studies evaluating ECMO in neonatal respiratory populations, the importance of fluid balance and the development of FO was recognized as an important contributor to adverse outcomes. Multiple single center studies and multicenter work have confirmed that FO occurs commonly across ECMO populations and is consistently associated with adverse outcomes. As a result of the high rates of AKI and the high rates of FO, continuous renal replacement therapy (CRRT) is increasingly utilized in neonatal and pediatric ECMO. In this state-of-the-art review, we cover the definitions, pathophysiology, incidence, and impact of AKI and FO in neonates and children supported with ECMO and summarize and appraise the evidence regarding the use of CRRT concurrently with ECMO. This review will cover the appropriate timing of this initiation, the options for providing CRRT with ECMO, overview of CRRT prescription, and the long-term implications of kidney support therapy in this population.

Comparison of dosing strategies in obese patients prescribed intravenous acyclovir and evaluation of rate of acute kidney injury

IntroductionThere is limited guidance on the most appropriate dosing strategy for intravenous (IV) acyclovir in obese patients. The manufacturer's labelling suggests using ideal body weight (IBW); however, previous pharmacokinetic studies of obese patients have shown more rapid systemic clearance and lower area under the curve and peak concentrations compared with patients with a body mass index (BMI) < 30 kg/m2. Although pharmacokinetic data suggest that plasma concentrations of acyclovir are best predicted when using adjusted body weight (AdjBW) doses, there is concern about higher rates of acute kidney injury (AKI). MethodsThis was a retrospective cohort review of adult patients with a BMI ≥ 30 kg/m2 prescribed IV acyclovir ≥ 48 hours between 1 January 2014 and 31 August 2021 at a 511-bed academic medical centre. The primary objective was to compare AdjBW with IBW dosing in obese patients who had been prescribed IV acyclovir and to determine whether AdjBW dosing results in higher rates of AKI. ResultsNinety-four patients were included: 61 were in the IBW cohort and 33 were in the AdjBW cohort. The median BMI [IQR] for all patients was 34.7 kg/m2 [31.8–40.6]. Patients in the AdjBW cohort received a significantly higher median acyclovir dose of 800 mg/dose [IQR 700–850] compared with 600 mg/dose [IQR 500–700] for the IBW cohort (P ≤ 0.0001). No patients dosed using AdjBW developed AKI compared with eight (13.1%) in the IBW group. ConclusionIn this study, 8.5% of all obese patients receiving acyclovir developed AKI. Further studies are needed to confirm dosing recommendations.

Is gender an independent risk factor for AKI in STEMI patients?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients undergoing percutaneous coronary interventions (PCI) are prone to a wide range of complications, one complication that is constantly correlated with worse prognosis is acute kidney injury (AKI). Gender as an independent risk factor for said complications raised some interest yet studies showed conflicting results so far. Purpose We aimed to investigate the possible relation of gender on the occurrence of AKI among ST elevation myocardial infarction (STEMI) patients undergoing PCI. Methods This retrospective observational study cohort included 2967 consecutive patients admitted with STEMI between the years 2008-2019. Their renal outcomes ware assessed according to KDIGO criteria (AKI- serum creatinine ≥ 0.3 mg/dl from baseline within 48 hours from admission) and in-hospital complications and mortality were reviewed. Results Study population included 544 females and 2400 males. Female patients were older and with more co-morbidities. The occurrence of AKI was significantly higher among females (12.7% vs. 7.8%, p&amp;lt;0.001). Furthermore, among patients with AKI, severe AKI (defined as more than doubling on serum creatinine) was also more prevalent in females (26.1% vs. 14.5%, p=0.03). In general, AKI was associated with higher rates of in hospital complications and mortality in the entire cohort, while females demonstrated significantly higher rates of bleeding (8.9% vs. 3.7%, p&amp;lt;0.001), need for hemodynamic support (4.4% vs. 2.3%, p&amp;lt;0.001) and mortality (4.3% vs. 1.3 %, p&amp;lt;0.001) only in the "no AKI" group (figure 1). However, in multivariate analysis, after adjusting for the baseline characteristics, female gender was a nonsignificant predictor for AKI (adjusted OR 1.01, 95% CI 0.73-1.4, p=0.94) and for severe AKI (adjusted OR 1.65, 95% CI 0.80-1.65, p=0.18). Conclusions While females had higher rates of AKI and severe AKI, gender was non-significant as an independent risk factor after adjusting for other confounding variables. Other comorbidities that were more prevalent in females can account for the difference of AKI between the genders.

Risk factors, clinical characteristics and prognostic value of acute kidney injury in COVID-19 compared with influenza virus and respiratory syncytial virus.

Acute Kidney Injury (AKI) complicates a substantial part of patients withCOVID-19. Direct viral penetration of renal cells through the Angiotensin Converting Enzyme 2 receptor, and indirect damage by the aberrant inflammatory response characteristic of COVID-19 are likely mechanisms. Nevertheless, other common respiratory viruses such as Influenza and Respiratory Syncytial Virus (RSV) are also associated with AKI. We retrospectively compared the incidence, risk factors and outcomes of AKI among patients who were admitted to a tertiary hospital because of infection withCOVID-19, influenza (A + B) or RSV. We collected data of 2593 patients hospitalized withCOVID-19, 2041patients with influenza and 429 withRSV. Patients affected byRSV were older, had more comorbidities and presented with higher rates of AKI at admission and within 7 days (11.7% vs. 13.3% vs. 18% for COVID-19, influenza and RSV, respectively p = 0.001). Nevertheless, patients hospitalized withCOVID-19 had higher mortality (18% with COVID-19vs. 8.6% and 13.5% forinfluenza and RSV, respectively P < 0.001) and higher need ofmechanical ventilation (12.4% vs. 6.5% vs.8.2% for COVID-19, influenza and RSV, respectively, P = 0.002). High ferritin levels and low oxygen saturation were independent risk factors for severe AKI only in the COVID-19 group. AKI in the first 48h of admission and in the first 7 days of hospitalization were strong independent risk factors for adverse outcome in all groups. Despite many reports of direct kidney injury by SARS-COV-2, AKI was less in patients with COVID-19 compared to influenza and RSV patients. AKI was a prognostic marker for adverse outcome across all viruses.

Acute Kidney Injury Associated with Severe SARS-CoV-2 Infection: Risk Factors for Morbidity and Mortality and a Potential Benefit of Combined Therapy with Tocilizumab and Corticosteroids.

Acute kidney injury (AKI) is a common complication in patients with severe COVID-19. We retrospectively reviewed 249 patients admitted to an intensive care unit (ICU) during the first wave of the pandemic to determine risk factors for AKI. Demographics, comorbidities, and clinical and outcome variables were obtained from electronic medical records. Univariate analysis revealed older age, higher admission serum creatinine, elevated Sequential Organ Failure Assessment (SOFA) score, elevated admission D-Dimer, elevated CRP on day 2, mechanical ventilation, vasopressor requirement, and azithromycin usage as significant risk factors for AKI. Multivariate analysis demonstrated that higher admission creatinine (p = 0.0001, OR = 2.41, 95% CI = 1.56-3.70), vasopressor requirement (p = 0.0001, OR = 3.20, 95% CI = 1.69-5.98), elevated admission D-Dimer (p = 0.008, OR = 1.0001, 95% CI = 1.000-1.001), and elevated C-reactive protein (CRP) on day 2 (p = 0.033, OR = 1.0001, 95% CI = 1.004-1.009) were independent risk factors. Conversely, the combined use of Tocilizumab and corticosteroids was independently associated with reduced AKI risk (p = 0.0009, OR = 0.437, 95% CI = 0.23-0.81). This study confirms the high rate of AKI and associated mortality among COVID-19 patients admitted to ICUs and suggests a role for inflammation and/or coagulopathy in AKI development. One should consider the possibility that early administration of anti-inflammatory agents, as is now routinely conducted in the management of COVID-19-associated acute respiratory distress syndrome, may improve clinical outcomes in patients with AKI.

971. Antibiotic Prophylaxis for Grade III Open Fractures: A Retrospective Comparison of Ceftriaxone plus Vancomycin versus Cefazolin plus Gentamicin

Abstract Background Owing to the established path of bacterial entry and contamination-associated mechanisms, grade III open orthopedic fractures represent a substantial infection risk. Historically, the EAST Guidelines recommended covering Staphylococcus aureus and adding aminoglycoside gram negative coverage. Incorporating newer evidence, the Allegheny Health Network local guidelines rely on ceftriaxone to cover gram-negatives and add methicillin-resistant S. aureus coverage with vancomycin. Methods The electronic health records of adults admitted for a grade III open fracture between January 1, 2016, and October 31, 2021 were retrospectively reviewed. Patients who received cefazolin and gentamicin (CZ+GM) or ceftriaxone and vancomycin (CRO+VA) as their prophylaxis were included. We recorded rate of a composite treatment failure outcome of receipt of antibiotics for suspected infection, infection-related hospitalization, or subsequent debridement for injury site skin and soft tissue infection or osteomyelitis. Presence of acute kidney injury (AKI) within 7 days was also evaluated. Categorical variables were compared using the Chi-square or Fisher’s exact tests, and continuous variables by t-test or Wilcoxon Rank Sum. Results Patients in the CZ+GM group were younger, with a mean age of 42.6 years compared to 50.6 years in the CRO+VA group (p = 0.02). Otherwise, there were no significant differences between groups in demographics, mechanism and site of injury, timeline of care, or total number of surgical interventions. More patients in the CZ+GM arm met the composite primary treatment failure outcome, but it was not statistically significant (45% vs 32%, p = 0.2). There were similar rates of treatment failure at 30 days (21% vs 26%, p = 0.5) and for only osteomyelitis (8% vs 9%, p = 1). Patients receiving CZ+GM trended towards higher rates of AKI, but this was not statistically significant (26% vs 19%, p = 0.4). Conclusion The trend in numerically lower treatment failure rates in the CRO+VA group across all outcomes studied supports the current recommendations in the local institutional guidelines. Given our sample size, type II error may have occurred, and larger studies with greater power should analyze this question. Disclosures Derek N. Bremmer, PharmD, BCPS-AQ ID, Thermo Fisher Scientific: Honoraria.

A macrophage-endothelial immunoregulatory axis ameliorates septic acute kidney injury

The most common cause of acute kidney injury (AKI) in critically ill patients is sepsis. Kidney macrophages consist of both F4/80hi and CD11bhi cells. The role of macrophage subpopulations in septic AKI pathogenesis remains unclear. As F4/80hi macrophages are reported to contribute to immunomodulation following injury, we hypothesized that selective depletion of F4/80hi macrophages would worsen septic AKI. F4/80hi macrophages were depleted via diphtheria toxin injection in CD11cCre(+)/CX3CR1dtr/wt (F4/80 MKO mice) compared to CD11cCre(-)/CX3CR1dtr/wt (F4/80 MWT) mice. F4/80 MWT and F4/80 MKO mice were subjected to sham or cecal ligation and puncture to induce sepsis. Compared to F4/80 MWT mice, F4/80 MKO mice displayed worsened septic AKI at 24 hours as measured by serum creatinine and histologic injury scoring. Kidneys from F4/80 MKO mice elaborated higher kidney interleukin-6 levels. Mechanistically, single cell RNA sequencing identified a macrophage-endothelial cell immunoregulatory axis that underlies interleukin-6 expression. F4/80hi macrophages expressed interleukin-1 receptor antagonist and limited interleukin-6 expression in endothelial cells. In turn, anti-interleukin-6 therapy ameliorated septic AKI in F4/80 MKO mice. Thus, F4/80hi macrophages express interleukin-1 receptor antagonist and constrain interleukin-6 generation from endothelial cells to limit septic AKI, representing a targetable cellular crosstalk in septic AKI. These findings are particularly relevant owing to the efficacy of anti-interleukin-6 therapies during COVID-19 infection, a disease associated with high rates of AKI and endothelial dysfunction.

Relation of Gender to the Occurrence of AKI in STEMI Patients.

Patients undergoing percutaneous coronary interventions (PCIs) are prone to a wide range of complications; one complication that is constantly correlated with a worse prognosis is acute kidney injury (AKI). Gender as an independent risk factor for said complications has raised some interest; however, studies have shown conflicting results so far. We aimed to investigate the possible relation of gender to the occurrence of AKI in STEMI patients undergoing PCI. This retrospective observational study cohort included 2967 consecutive patients admitted with STEMI between the years 2008 and 2019. Their renal outcomes were assessed according to KDIGO criteria (AKI serum creatinine ≥ 0.3 mg/dL from baseline within 48 h from admission), and in-hospital complications and mortality were reviewed. Our main results show that female patients were older (69 vs. 60, p &lt; 0.001) and had higher rates of diabetes (29.2% vs. 23%, p &lt; 0.001), hypertension (62.9% vs. 41.3%, p &lt; 0.001), and chronic kidney disease (26.7% vs. 19.3%, p &lt; 0.001). Females also had a higher rate of AKI (12.7% vs. 7.8%, p &lt; 0.001), and among patients with AKI, severe AKI was also more prevalent in females (26.1% vs. 14.5%, p = 0.03). However, in multivariate analyses, after adjusting for the baseline characteristics above, the female gender was a non-significant predictor for AKI (adjusted OR 1.01, 95% CI 0.73-1.4, p = 0.94) or severe AKI (adjusted OR 1.65, 95% CI 0.80-1.65, p = 0.18). In conclusion, while females had higher rates of AKI and severe AKI, gender was not independently associated with AKI after adjusting for other confounding variables. Other comorbidities that are more prevalent in females can account for the difference in AKI between genders.

S894 Inpatient Outcomes and Healthcare Utilization in Obese vs Non-Obese Patients Hospitalized with an Acute Crohn’s Disease Flare—A Nationwide Cohort Study

Introduction: Crohn’s Disease (CD) remains a leading cause of patient morbidity and in severe cases, mortality. Given the rise in prevalence of obesity in the United States, the goal of this study is to illustrate the impact of obesity on hospitalized patients admitted for acute flares of Crohn’s Disease (CD). Our primary outcome was odds of inpatient mortality. Secondary outcomes included length of hospitalization (LOS), total hospital charge (THC), and complications including sepsis, upper and lower GI bleed (UGIB)(LGIB), and acute kidney injury (AKI). Methods: The National Inpatient Sample (NIS 2016-2018) was sourced for hospitalization data from adult patients admitted for a CD flare. The queried pool of patients was stratified into obese (BMI ≥ 30), and non-obese cohorts using International Classification of Diseases, Tenth Revision (ICD-10) codes. After performing descriptive analysis on the involved cohorts, linear and multivariate regression was used to evaluate study outcomes. STATA 14 was used for data analysis. Results: Of 232,650 admissions for CD flare, 20,100 (8.64%) had comorbid obesity. Compared to non-obese-CD patients, obese-CD patients were significantly older (45.8 vs 43.7 years, p < 0.0001), were more often female (65.9% vs 52.7%, p < 0.0001), and had greater African American representation (17.3% vs 15.4%, p < 0.0001) compared to non-obese patients. Obese-CD patients had more comorbid disease as measured by a Charlson Comorbidity Index score ≥3 (9.80% vs 5.16, p < 0.0001), and had more patients belonging to the poorest quartile of family income (29.0% vs 26.3%, p< 0.0001). No difference in adjusted odds of inpatient mortality was noted between the two groups. Obese-CD had higher rates of AKI (OR 1.17, p = 0.011), and had significantly increased LOS (5.04 vs 4.78 days, p = 0.006). There were no differences in total hospital cost, LGIB, or shock. Conclusion: Obesity did not significantly increase inpatient mortality. However Obese-CD patients had increased odds of AKI and increased LOS relative to CD patients without obesity. Additional studies are needed to further investigate the effects of obesity in CD, and to help reduce the economic burden obesity places on the healthcare system.

Renal Involvement in Hospitalized COVID-19 Patients: Epidemiology, Risk Factors, and Correlation with Outcomes

Background: While respiratory tract symptoms are the most frequent reasons for hospital admission in COVID-19 patients, renal involvement is common and is associated with worse outcomes. The aim of this study was to determine the incidence, risk factors and outcome of Acute Kidney Injury (AKI) in hospitalized COVID-19 patients in a referral center.&#x0D; Methods: In a retrospective review, patients hospitalized for COVID-&#x0D; 19 from February 2020 through April 2020 in a referral COVID center were studied. Demographic data, pre-existing comorbidities and drug history, along with laboratory data at presentation and during admission were recorded. AKI was diagnosed based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Data were analyzed to determine the incidence, risk factors and mortality of AKI.&#x0D; Results: Finally, 200 patients were included, with a mean age of 60.5 years. Of these, 126 (63%) developed AKI and this number was 73.5% among the ICU-admitted patients. Patients who developed AKI were 4.29 times more likely to die. Pre-existing CKD, treatment with immunosuppressant, ICU admission, and the need for hemodialysis, were significantly associated with mortality. Among the eleven renal transplant recipients in this study, we found that a prior renal transplant was not associated with a higher rate of AKI but was significantly associated with increased mortality after correcting for age and gender.&#x0D; Conclusion: Our findings showed a high incidence of AKI in patients admitted due to COVID-19, with a higher risk in ICU patients and it was a significant predictor of mortality. Further research is encouraged to understand the etiology of AKI, along with the long-term outcomes in the patients.

Postresuscitation care and prognostication after cardiac arrest-Does sex matter?

BackgroundThere are conflicting results concerning sex-specific differences in the post-cardiac arrest period. We investigated the sex distribution of patients after successful cardiopulmonary resuscitation (CPR), differences in treatment, complications, outcome and sex-specific performance of biomarkers for prognostication of neurological outcome.MethodsProspective observational study including cardiac-arrest (CA) patients treated with mild therapeutic hypothermia (MTH) at 33 °C for 24 h or normothermia. We investigated common complications including pneumonia and acute kidney injury (AKI) and neuron-specific enolase, secretoneurin and tau protein as biomarkers of neurological outcome, which was assessed with the cerebral performance categories score at hospital discharge.ResultsOut of 134 patients 26% were female. Women were significantly older (73 years, interquartile range (IQR) 56–79 years vs. 62 years, IQR 53–70 years; p = 0.038), whereas men showed a significantly higher rate of pneumonia (29% vs. 6%; p = 0.004) and a trend towards higher rates of AKI (62% vs. 45%; p = 0.091). Frequency of MTH treatment was not significantly different (48% vs. 31%; p = 0.081). Female sex was not associated with neurological outcome in multivariable analysis (p = 0.524). There was no significant interaction of sex with prognostication of neurological outcome at 24, 48 and 72 h after CPR. At the respective time intervals pinteraction for neuron-specific enolase was 0.524, 0.221 and 0.519, for secretoneurin 0.893, 0.573 and 0.545 and for tau protein 0.270, 0.635, and 0.110.ConclusionThe proportion of female patients was low. Women presented with higher age but had fewer complications during the post-CA period. Female sex was not associated with better neurological outcome. The performance of biomarkers is not affected by sex.Supplementary InformationThe online version of this article (10.1007/s00508-022-02026-x) contains supplementary material, which is available to authorized users.

The impact of hospital teaching status in atrial fibrillation hospital admission outcomes: a national inpatient analysis in the united states

Abstract Background Teaching hospitals are are usually larger and have a higher level of complexity. Admissions for atrial fibrillation are commonly encountered by residents and fellows and they carry a hight cost, morbidity and mortality. Purpose Our aim is to do a retrospective analysis of the National Impatient Sample (NIS) from 2016 to 2018 and determine the impact of the hospital teaching status and rural Vs urban location in the atrial fibrillation admission outcomes. Methods We combined the NIS from 2016–2018. A primary diagnosis of atrial fibrillation was identified identified. We stratified the admissions based on the hospital teaching status. We defined as primary outcomes the length of stay (LOS), in hospital mortality and total charges/cost per admission. The secondary outcomes were the rates acute kidney injury (AKI), acute blood loss anemia (ABLA) and embolic stroke (ES). We used the Charlson comorbidity index. We used univariate and multivariate linear regressions for the continuous outcomes and logistic regressions for the binary outcomes. Results We identified 981,739 admissions with a primary diagnosis of atrial fibrillation; 513,914 (47%) were female patients, the average age was 70.5 years. In the teaching hospitals, the LOS was 0.3 days longer [95% CI: 0.22–0.37]; p=0.000 and the total hospital charges were higher (8406.32 dollar more per admission [95% CI: 6510.89–10301.76]; p=0.000); there was no difference in mortality compared to the non-teaching institutions (OR 1.03 [95% CI: 0.87–1.21]; p=0.628). In teaching hospitals, the rates of AKI, ABLA and ES were higher (OR 1.2, 95% CI [1.12–1.27]; p=0.000), (OR 1.29, 95% CI [1.09–1.53]; p=0.003) and (OR 1.72, 95% CI [1.11–2.66]; p=0.014)respectively. In a subgroup analysis comparing urban teaching hospitals Vs urban non-teaching Vs rural non-teaching hospitals, we found that the primary outcomes were similar than the above but the results in the secondary outcomes were driven mainly by a marked difference between rural and urban institutions regardless of teaching status, which makes us think that there might be under diagnosis of atrial fibrillation related complications in lower complexity rural hospitals. The difference in costs per admission was not as high when comparing urban teaching with non-teaching hospitals (5103.96 dollar higher, 95% [CI: 3008.70–7199.23]; p=0.000). Conclusion Amongst admissions for atrial fibrillation, the total cost per admission was higher in teaching hospitals which was concordant with a longer LOS. Although our results show higher rates of AKI, ABLA and ES in teaching hospitals, this might be caused by underdiagnosis of such conditions in non-teaching rural institutions compared to large teaching hospital systems and these were not associated with an increase rate of mortality. There is need for more research to determine the factors impacting the higher costs of atrial fibrillation admissions amongst teaching institutions. Funding Acknowledgement Type of funding sources: None.

Minimally-invasive versus transcatheter aortic valve implantation: systematic review with meta-analysis of propensity-matched studies.

BackgroundMinimally invasive aortic valve replacement (MiAVR) and transcatheter aortic valve implantation (TAVI) provide aortic valve replacement (AVR) by less invasive methods than conventional surgical AVR, by avoiding complete sternotomy. This study directly compares and analyses the available evidence for early outcomes between these two AVR methods.MethodsElectronic databases were searched from inception until August 2019 for studies comparing MiAVR to TAVI, according to predefined search criteria. Propensity-matched studies with sufficient data were included in a meta-analysis.ResultsEight studies with 9,744 patients were included in the quantitative analysis. Analysis of risk-matched patients showed no difference in early mortality (RR 0.76, 95% CI, 0.37–1.54, P=0.44). MiAVR had a signal towards lower rate of postoperative stroke, although this did not reach statistical significance (OR 0.42, 95% CI, 0.13–1.29, P=0.13). MiAVR had significantly lower rates of new pacemaker (PPM) requirement (OR 0.29, 95% CI, 0.16–0.52, P<0.0001) and postoperative aortic insufficiency (AI) or paravalvular leak (PVL) (OR 0.05, 95% CI, 0.01–0.20, P<0.0001) compared to TAVI, (OR 0.42, 95% CI, 0.13–1.29, P=0.13), while acute kidney injury (AKI) was higher in MiAVR compared to TAVI (11.1% vs. 5.2%, OR 2.28, 95% CI, 1.25–4.16, P=0.007).ConclusionsIn patients of equivalent surgical risk scores, MiAVR may be performed with lower rates of postoperative PPM requirement and AI/PVL, higher rates of AKI and no statistical difference in postoperative stroke or short-term mortality, compared to TAVI. Further prospective trials are needed to validate these results.