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Lin Y, Yang Q, Zeng R. Crosstalk between macrophages and adjacent cells in AKI to CKD transition. Ren Fail 2025; 47:2478482. [PMID: 40110623 PMCID: PMC11926904 DOI: 10.1080/0886022x.2025.2478482] [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: 11/21/2024] [Revised: 02/17/2025] [Accepted: 03/07/2025] [Indexed: 03/22/2025] Open
Abstract
Acute kidney injury (AKI), triggered by ischemia, sepsis, toxicity, or obstruction, is marked by a rapid impairment of renal function and could lead to the initiation and advancement of chronic kidney disease (CKD). The concept of AKI to CKD transition has gained much interest. Despite a series of studies highlighting the diverse roles of renal macrophages in the immune response following AKI, the intricate mechanisms of macrophage-driven cell-cell communication in AKI to CKD transition remains incompletely understood. In this review, we introduce the dynamic phenotype change of macrophages under the different stages of kidney injury. Importantly, we present novel perspectives on the extensive interaction of renal macrophages with adjacent cells, including tubular epithelial cells, vascular endothelial cells, fibroblasts, and other immune cells via soluble factors, extracellular vesicles, and direct contact, to facilitate the transition from AKI to CKD. Additionally, we summarize the potential therapeutic strategies based on the adverse macrophage-neighboring cell crosstalk.
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Affiliation(s)
- Yanping Lin
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Yang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Zeng
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Fang Y, Dou A, Xie H, Zhang Y, Zhu W, Zhang Y, Li C, Su Y, Gao Y, Xie K. Association between renal mean perfusion pressure and prognosis in patients with sepsis-associated acute kidney injury: insights from the MIMIC IV database. Ren Fail 2025; 47:2449579. [PMID: 39780494 PMCID: PMC11722017 DOI: 10.1080/0886022x.2025.2449579] [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: 11/21/2024] [Revised: 12/21/2024] [Accepted: 12/31/2024] [Indexed: 01/11/2025] Open
Abstract
OBJECTIVE To investigate the association between renal mean perfusion pressure (MPP) and prognosis in sepsis-associated acute kidney injury (SA-AKI). METHODS Data were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Group-based trajectory modeling (GBTM) was applied to identify dynamic MPP patterns, while restricted cubic spline (RCS) curves were utilized to confirm the non-linear relationship between MPP and mortality. Cox regression analysis assessed the risk of mortality across different MPP levels, adjusting for potential confounders. Subgroup analyses and sensitivity analyses were conducted to ensure the robustness of the findings. RESULTS A total of 2318 patients with SA-AKI were stratified into five MPP trajectories by GBTM. Patients in Traj-1 and Traj-2, characterized by consistently low MPP (<60 mmHg), demonstrated markedly higher 90-d mortality (62.86% and 26.98%). RCS curves revealed a non-linear inverse relationship between MPP and 90-d mortality, identifying 60 mmHg as the optimal threshold. Patients with MPP ≤ 60 mmHg exhibited significantly elevated 90-d mortality compared to those with MPP > 60 mmHg (29.81% vs. 20.88%). Cox regression analysis established Traj-1 and Traj-2 as independent risk factors for increased mortality relative to Traj-3 (60-70 mmHg), with hazard ratios (HRs) of 4.67 (95%-CI 3.28-6.67) and 1.45 (95%-CI 1.20-1.76). MPP > 60 mmHg was significantly associated with reduced 90-d mortality (HR 0.65, 95%-CI 0.55-0.77). Subgroup and PSM analyses supported these findings. CONCLUSIONS Dynamic MPP trajectory serves as a valuable prognostic biomarker for SA-AKI. Early monitoring of MPP trends offers critical insights into renal perfusion management, potentially improving outcomes in SA-AKI.
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Affiliation(s)
- Yipeng Fang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Aizhen Dou
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Hui Xie
- Firth Clinical College, XinXiang Medical University, Xinxiang, Henan, China
| | - Yunfei Zhang
- Editorial Department of Journal, Tianjin Hospital, Tianjin, China
| | - Weiwei Zhu
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yingjin Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Caifeng Li
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanchao Su
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Gao
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Keliang Xie
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
- Department of Anesthesiology, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
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Fang Y, Zhang Y, Shen X, Dou A, Xie H, Zhang Y, Xie K. Utilization of lactate trajectory models for predicting acute kidney injury and mortality in patients with hyperlactatemia: insights across three independent cohorts. Ren Fail 2025; 47:2474205. [PMID: 40074720 PMCID: PMC11905305 DOI: 10.1080/0886022x.2025.2474205] [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: 10/28/2024] [Revised: 02/08/2025] [Accepted: 02/19/2025] [Indexed: 03/14/2025] Open
Abstract
This study aims to investigate the association between lactate trajectories and the risk of acute kidney injury (AKI) and hospital mortality in patients with hyperlactatemia. We conducted a multicenter retrospective study using data from three independent cohorts. By the lactate levels during the first 48 h of ICU admission, patients were classified into distinct lactate trajectories using group-based trajectory modeling (GBTM) method. The primary outcomes were AKI incidence and hospital mortality. Logistic regression analysis assessed the association between lactate trajectories and clinical outcomes, with adjusting potential confounders. Patients were divided into three trajectories: mild hyperlactatemia with rapid recovery (Traj-1), severe hyperlactatemia with gradual recovery (Traj-2), and severe hyperlactatemia with persistence (Traj-3). Traj-3 was an independent risk factor of both hospital mortality (all p < 0.001) and AKI development (all p < 0.001). Notably, Traj-2 was also associated with increased risk of mortality and AKI development (all p < 0.05) using Traj-1 as reference, except for the result in the Tianjin Medical University General Hospital (TMUGH) cohort for mortality in adjusted model (p = 0.123). Our finding was still robust in subgroup and sensitivity analysis. In the combination cohort, both Traj-2 and Traj-3 were considered as independent risk factor for hospital mortality and AKI development (all p < 0.001). When compared with the Traj-3, Traj-2 was only significantly associated with the decreased risk of hospital mortality (OR 0.17, 95% CI 0.14-0.20, p < 0.001), but no with the likelihood of AKI development (OR 0.90, 95% CI 0.77-1.05, p = 0.172). Lactate trajectories provide valuable information for predicting AKI and mortality in critically ill patients.
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Affiliation(s)
- Yipeng Fang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Zhang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Xuejun Shen
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Aizhen Dou
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Hui Xie
- Firth Clinical College, XinXiang Medical University, Xinxiang, Henan, China
| | - Yunfei Zhang
- Editorial Department of Journal, Tianjin Hospital, Tianjin, China
| | - Keliang Xie
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
- Department of Anesthesiology, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
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Li X, Qiao Y, Ruan L, Xu S, Fan Z, Liu S, Shen J, Tang C, Qin Y. Stress hyperglycemia ratio as an independent predictor of acute kidney injury in critically ill patients with acute myocardial infarction: a retrospective U.S. cohort study. Ren Fail 2025; 47:2471018. [PMID: 40012169 PMCID: PMC11869341 DOI: 10.1080/0886022x.2025.2471018] [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: 01/04/2025] [Revised: 02/09/2025] [Accepted: 02/12/2025] [Indexed: 02/28/2025] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent and severe complication in critically ill patients with acute myocardial infarction (AMI), significantly worsening prognosis. Identifying early risk markers for AKI in AMI patients is critical for timely intervention. The stress hyperglycemia ratio (SHR), a marker of acute glycemic response to physiological stress, has been proposed as a predictor of AKI, but its role remains unclear. OBJECTIVE This study investigates the association between SHR and AKI development in critically ill patients with AMI, using data from the MIMIC-III and MIMIC-IV databases. METHODS A total of 4,663 critically ill AMI patients were analyzed. SHR was evaluated for its association with AKI incidence using logistic regression, restricted cubic splines, and mediation analysis. Subgroup and sensitivity analyses were performed to confirm robustness. Additionally, Cox regression and Kaplan-Meier survival analysis were used to explore SHR's association with in-hospital mortality in the overall cohort and AKI subgroup. RESULTS Higher SHR levels were independently associated with an increased risk of AKI, demonstrating a J-shaped relationship. Mediation analysis revealed that neutrophil count and albumin partially mediated this effect. Kaplan-Meier survival curves showed significant differences in in-hospital mortality among SHR quartiles (log-rank p < 0.001). However, Cox regression analysis indicated that SHR was not an independent predictor of in-hospital mortality in either the full cohort or the AKI subgroup. CONCLUSIONS SHR serves as an early and independent marker for AKI risk in critically ill AMI patients, offering potential utility in clinical risk stratification. However, its role in predicting in-hospital mortality appears limited. These findings underscore the importance of glycemic monitoring and management in AMI patients at risk of AKI.
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Affiliation(s)
- Xudong Li
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
| | - Yong Qiao
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Liang Ruan
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
| | - Shuailei Xu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
| | - Zhongguo Fan
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Shiqi Liu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
| | - Junxian Shen
- Department of Cardiology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Chengchun Tang
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yuhan Qin
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
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Sivadasan PC, Carr CS, Pattath ARA, Hanoura S, Sudarsanan S, Ragab HO, Sarhan H, Karmakar A, Singh R, Omar AS. Incidence and outcome of rhabdomyolysis after type A aortic dissection surgery: A retrospective analysis. World J Crit Care Med 2025; 14:98004. [DOI: 10.5492/wjccm.v14.i2.98004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 10/27/2024] [Accepted: 12/10/2024] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND Rhabdomyolysis (RML) as an etiological factor causing acute kidney injury (AKI) is sparsely reported in the literature.
AIM To study the incidence of RML after surgical repair of an ascending aortic dissection (AAD) and to correlate with the outcome, especially regarding renal function. To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.
METHODS Retrospective single-center cohort study conducted in a tertiary cardiac center. We included all patients who underwent AAD repair from 2011-2017. Post-operative RML workup is part of the institutional protocol; studied patients were divided into two groups: Group 1 with RML (creatine kinase above cut-off levels 2500 U/L) and Group 2 without RML. The potential determinants of RML and impact on patient outcome, especially postoperative renal function, were studied. Other outcome parameters studied were markers of cardiac injury, length of ventilation, length of stay in the intensive care unit), and length of hospitalization.
RESULTS Out of 33 patients studied, 21 patients (64%) developed RML (Group RML), and 12 did not (Group non-RML). Demographic and intraoperative factors, notably body mass index, duration of surgery, and cardiopulmonary bypass, had no significant impact on the incidence of RML. Preoperative visceral/peripheral malperfusion, though not statistically significant, was higher in the RML group. A significantly higher incidence of renal complications, including de novo postoperative dialysis, was noticed in the RML group. Other morbidity parameters were also higher in the RML group. There was a significantly higher incidence of AKI in the RML group (90%) than in the non-RML group (25%). All four patients who required de novo dialysis belonged to the RML group. The peak troponin levels were significantly higher in the RML group.
CONCLUSION In this study, we noticed a high incidence of RML after aortic dissection surgery, coupled with an adverse renal outcome and the need for post-operative dialysis. Prompt recognition and management of RML might improve the renal outcome. Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.
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Affiliation(s)
- Praveen C Sivadasan
- Cardiac Anesthesia and ICU Section, Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Cornelia S Carr
- Department of Clinical Surgery, College of Medicine, Qatar University, Doha 3050, Qatar
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Abdul Rasheed A Pattath
- Cardiac Anesthesia and ICU Section, Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Samy Hanoura
- Cardiac Anesthesia and ICU Section, Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- Department of Anesthesia and Intensive Care, Al-Azhar University, Cairo 11651, Egypt
| | - Suraj Sudarsanan
- Cardiac Anesthesia and ICU Section, Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Hany O Ragab
- Cardiac Anesthesia and ICU Section, Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- Department of Anesthesia and Intensive Care, Al-Azhar University, Cairo 11651, Egypt
| | - Hatem Sarhan
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44106, United States
| | - Arunabha Karmakar
- Department of Medical Education, Hamad Medical Corporation, Doha 3050, Qatar
| | - Rajvir Singh
- Department of Medical Research, Hamad Medical Corporation, Doha 3050, Qatar
| | - Amr S Omar
- Cardiac Anesthesia and ICU Section, Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- Department of Critical Care Medicine, Beni Suef University, Beni Suef 2722165, Egypt
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Bachmann D, Monard C, Kelevina T, Ahmad Y, Pruijm M, Chiche JD, Schneider AG. Generalization of regional citrate anticoagulation for continuous renal replacement therapy is not associated with an increased rate of severe complications. J Crit Care 2025; 87:155032. [PMID: 39954302 DOI: 10.1016/j.jcrc.2025.155032] [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: 11/19/2024] [Revised: 12/20/2024] [Accepted: 01/27/2025] [Indexed: 02/17/2025]
Abstract
BACKGROUND Contraindications to regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) have recently been challenged. We aimed to assess the safety of the generalization of RCA to all CRRT sessions. METHODS We reviewed all CRRT sessions performed in our ICU during two periods (P1:2018-2019 and P2:2020-2022). RCA was considered as contraindicated in situations at risk of citrate accumulation (lactate >4 mmol/L and/or prothrombin time < 40 %) during P1 but not P2. We reviewed CRRT modality, filter lifespan, and therapy-associated complications including citrate accumulation, electrolyte and acid/base disturbances, and blood transfusion requirements. CRRT efficacy was assessed by serum creatinine and urea kinetics across circuits' lifespan. RESULTS We studied 1877 circuits in 467 (P1:245, P2:222) patients. The proportion of patients with risk factors for citrate accumulation was similar between both periods (P1:35 %, P2:32 % p = 0.61). During P2, RCA was used in more circuits (93 vs 66 %, p < 0.001) and filter lifespan was longer (44 vs 32 h, p < 0.001). CRRT efficacy was similar between the two periods. Although risk factors for citrate accumulation were present at first circuit initiation in more RCA circuits during P2 (25 vs 11 %, p = 0.002), the rate of citrate accumulation remained similar (0.3 vs 0.4 %, p = 0.72). There was no increase in the rates of electrolyte disturbances or significant bleeding. There was, however, a higher rate of metabolic acidoses during P2 (13 vs. 9 %, p = 0.01). CONCLUSION In an experienced team, generalization of RCA to nearly all patients requiring CRRT extended median filter lifespan without increasing the rate of significant complications.
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Affiliation(s)
- Doreen Bachmann
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland; Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Céline Monard
- Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Tatiana Kelevina
- Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Yannis Ahmad
- Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Menno Pruijm
- Nephrology and Hypertension Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Daniel Chiche
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland; Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Antoine Guillaume Schneider
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland; Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland.
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Lescroart M, Kemp H, Imauven O, Raphalen JH, Bagate F, Schmidt J, Issa N, Decavele M, Moreau AS, Tamion F, Mourvillier B, Calvet L, Canet E, Lebert C, Pons S, Lacave G, Wallet F, Winiszewski H, Merdji H, De Chambrun MP, Argaud L, Kimmoun A, Dumas G, Zafrani L. Cardiogenic shock in patients with active onco-hematological malignancies: A multicenter retrospective study. J Crit Care 2025; 87:155028. [PMID: 39848115 DOI: 10.1016/j.jcrc.2025.155028] [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: 10/28/2024] [Revised: 12/28/2024] [Accepted: 01/16/2025] [Indexed: 01/25/2025]
Abstract
PURPOSE Onco-hematological (OH) patients face significant cardiovascular risks due to malignancy and drug toxicity. Data are limited on the characteristics and outcomes of OH patients with cardiogenic shock (CS) in intensive care units (ICUs). METHODS This multicenter retrospective study included 214 OH patients with CS across 22 ICUs (2010-2021). The objectives were to (i) identify risk factors for 30-day mortality, (ii) describe early and long-term outcomes, and (iii) assess the prognostic impact of malignancy by comparing OH patients to a control group of CS patients. RESULTS The 30-day survival rate was 44.8 %. Multivariate analysis identified previous cardiomyopathy (OR = 1.61), acute kidney injury (OR = 1.62), lactate levels (OR = 1.08 per 1 mmol/L), pulmonary embolism (OR = 3.04), invasive mechanical ventilation (OR = 3.48), and epinephrine use (OR = 2.09) as factors associated with 30-day mortality. Among ICU survivors, 54 % were alive at 1 year with a median left ventricular ejection fraction of 52 %. OH malignancy was significantly associated with 30-day mortality (HR 2.54). CONCLUSION The prognosis for OH patients with CS in the ICU is poor, with epinephrine use associated with worse outcomes. Further research is needed to refine risk stratification and improve treatments for this population.
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Affiliation(s)
- Mickael Lescroart
- Hospital Saint-Louis et Université Paris Cité, Assistance Publique-Hôpitaux de Paris, France; CHRU de Nancy, Médecine Intensive et Réanimation Brabois, Université de Lorraine, Vandœuvre-Lès-Nancy, France
| | - Hélène Kemp
- Hospital Saint-Louis et Université Paris Cité, Assistance Publique-Hôpitaux de Paris, France
| | - Olivier Imauven
- Groupe hospitalier Diaconesses - Croix Saint-Simon, institut d'anesthésie de l'Est Parisien, Paris, France
| | - Jean Herlé Raphalen
- Intensive Care Unit, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France
| | - François Bagate
- Service de Médecine Intensive Réanimation, AP-HP, CHU Henri Mondor, DHU A-TVB, 51, avenue du Mal de Lattre de Tassigny, 94010 Créteil Cedex, France
| | - Julien Schmidt
- Unité de médecine intensive et réanimation, Assistance Publique-Hôpitaux de Paris, Avicenne Hospital, Groupe Hospitalier Paris Seine Saint-Denis, Bobigny, France
| | - Nahema Issa
- Réanimation médicale, groupe hospitalier Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France; Médecine interne et maladies infectieuses, groupe hospitalier Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France
| | - Maxens Decavele
- APHP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service Médecine Intensive et Réanimation (Département R3S), 75013, Paris, France
| | - Anne-Sophie Moreau
- CHU de Lille, Hôpital Salengro, Service de Médecine Intensive Réanimation, rue Emile-Laine, 59037 Lille, France
| | - Fabienne Tamion
- Service de Réanimation Médicale, Normandie Univ, UNIROUEN, U1096, CHU de Rouen, F 76000 Rouen, France
| | - Bruno Mourvillier
- Centre Hospitalo-Universitaire de Reims (CHU), Hôpital Robert-Debré, Service de Réanimation médicale, Reims, France
| | - Laure Calvet
- Service de Reanimation Medicale, Hopital Gabriel Monpied, CHU, Clermont-Ferrand, France
| | - Emmanuel Canet
- Medecine Intensive Reanimation, University Hospital Center, Nantes, France
| | - Christine Lebert
- Service Medico-Chirurgical, Unité de soins Intensifs, Centre Hospitalier de La Roche-sur-Yon, France
| | - Stephanie Pons
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France; Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Guillaume Lacave
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Florent Wallet
- Médecine Intensive et Réanimation, Hôpital Lyon Sud, Pierre-Bénite 69495, France
| | - Hadrien Winiszewski
- Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Besançon, Université de Franche-Comté, France
| | - Hamid Merdji
- Service de Médecine Intensive et Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, INSERM UMR 1260, Regenerative NanoMedicine, FMTS, Strasbourg, France
| | - Marc Pineton De Chambrun
- Sorbonne Université, UPMC Univ Paris 06, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651 Paris Cedex 13, France; Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651 Paris Cedex 13, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 5, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Antoine Kimmoun
- CHRU de Nancy, Médecine Intensive et Réanimation Brabois, Université de Lorraine, Vandœuvre-Lès-Nancy, France; INSERM U942, MASCOT, Paris, France
| | - Guillaume Dumas
- Medical Intensive Care Unit, Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes, Université Grenoble-Alpes, INSERM, U1042-HP2, Grenoble, France
| | - Lara Zafrani
- Hospital Saint-Louis et Université Paris Cité, Assistance Publique-Hôpitaux de Paris, France.
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Yang Y, Pan JJ, Chen XQ, Shi J, Wang MZ, Liu TY, Zhou XG. CircPICALM promotes neonatal acute kidney injury triggered by hypoxia/reoxygenation via sponging microRNA-204-5p. Biochim Biophys Acta Mol Basis Dis 2025; 1871:167795. [PMID: 40086516 DOI: 10.1016/j.bbadis.2025.167795] [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: 10/18/2024] [Revised: 02/01/2025] [Accepted: 03/06/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND Circular RNAs (circRNAs) have been documented to regulate neonatal acute kidney injury (AKI). Based on previous RNA-sequence findings, circPICALM exhibited significantly disparate expression between AKI newborns and Controls. This study aimed to provide further insights into the regulatory mechanism of circPICALM in neonatal AKI. METHODS C57BL/6 mice born 7 days were divided into Control group and hypoxia groups (11%O2 and 8%O2 groups). Human tubule epithelial cells (HK-2) were stimulated with hypoxia/reoxygenation (H/R) to establish an AKI cell model. Through overexpression and knockdown techniques, the regulatory role of circPICALM in H/R-induced kidney injury was explored. Inflammatory cytokines, cell apoptosis, and oxidative stress were also detected to confirm the regulatory function of circPICALM in neonatal AKI. RESULTS RT-qPCR confirmed that circPICALM was highly expressed in the serum of AKI newborns, neonatal I/R mice and H/R-treated HK-2 cells. Functionally, circPICALM exacerbated H/R-induced HK-2 cell injury by aggravating apoptosis and mitochondrial oxidative stress, increasing the expression of inflammatory factors, including IL-6, IL-1β, and TNF-α. Conversely, inhibition of circPICALM alleviated H/R injury in the HK-2 cell line. The interaction between circPICALM and miR-204-5p was validated through RNA immunoprecipitation and luciferase assay. Finally, circPICALM functioned as a molecular sponge of miR-204-5p and promoted the upregulation of downstream IL-1β expression. CONCLUSION CircPICALM plays a critical role in H/R-induced neonatal AKI by sponging miR-204-5p and then activating the downstream IL-1β signaling axis. The inhibition of circPICALM and subsequent suppression of pro-inflammatory factors could serve as a promising biomarker and therapeutic target for early intervention in neonatal AKI.
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Affiliation(s)
- Yang Yang
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, PR China
| | - Jing-Jing Pan
- Department of Neonatology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, PR China.
| | - Xiao-Qing Chen
- Department of Neonatology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, PR China
| | - Jia Shi
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, PR China
| | - Mu-Zi Wang
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, PR China
| | - Tian-Yu Liu
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, PR China
| | - Xiao-Guang Zhou
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, PR China
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9
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White KC, Bellomo R, Laupland KB, Gatton ML, Ostermann M, McIlroy P, Luke S, Garrett P, Tabah A, Whebell S, Marella P, McCullough J, Shekar K, Attokaran AG, Kumar A, Meyer J, Sanderson B, Serpa-Neto A. Predicting a strongly positive fluid balance in critically ill patients with acute kidney injury: A multicentre, international study. J Crit Care 2025; 87:155016. [PMID: 39855144 DOI: 10.1016/j.jcrc.2025.155016] [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: 09/01/2024] [Revised: 12/30/2024] [Accepted: 01/06/2025] [Indexed: 01/27/2025]
Abstract
BACKGROUND In critically ill patients with acute kidney injury (AKI), a fluid balance (FB) > 2 L at 72 h after AKI diagnosis is associated with adverse outcomes. Identification of patients at high-risk for such fluid accumulation may help prevent it. METHODS We used Australian electronic medical record (EMR)-based clinical data to develop the "AKI-FB risk score", validated it in a British cohort and used it to predict a positive FB >2 L at 72 h after AKI diagnosis. RESULTS We developed the AKI-FB score in 32,030 patients with a median age of 63 years and a median APACHE 2 score of 16. We validated it in 4465 patients, with significant differences in admission diagnoses and interventions. The key score variables were admission after trauma, sepsis or septic shock, and, on the day of AKI diagnosis, highest creatinine, daily cumulative FB, mechanical ventilation, noradrenaline use, noradrenaline equivalent dose >0.07 μg/kg/min, lactate ≥2 mmol/L, transfusion, and nutritional support. A score threshold of 32 had a sensitivity of 75 % and a specificity of 72 % for predicting a > 2 L positive FB with an AUC-ROC of 0.805; 95 % CI 0.799 to 0.810. External validation demonstrated an AUC of 0.761 (95 % CI 0.746 to 0.775). CONCLUSION We developed and validated the "AKI-FB risk score" to predict patients who developed a positive FB >2 L within 72 h of AKI diagnosis. This prediction score was robust and facilitated the identification of high-risk AKI patients who could be the tarted for preventive measures and be included in future clinical trials of FB management.
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Affiliation(s)
- Kyle C White
- Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; Intensive Care Unit, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia; School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia; Mayne Academy of Critical Care, Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia.
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Kevin B Laupland
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia; Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Michelle L Gatton
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, United Kingdom
| | - Philipa McIlroy
- Intensive Care Unit, Cairns Hospital, Cairns, QLD, Australia
| | - Stephen Luke
- Intensive Care Services, Mackay Base Hospital, Mackay, QLD, Australia; College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Peter Garrett
- Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, QLD, Australia; School of Medicine and Dentistry, Griffith University, Mount Gravatt, QLD, Australia
| | - Alexis Tabah
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia; Mayne Academy of Critical Care, Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia; Intensive Care Unit, Redcliffe Hospital, Redcliffe, QLD, Australia
| | - Stephen Whebell
- Intensive Care Unit, Townsville Hospital, Townsville, QLD, Australia
| | - Prashanti Marella
- Mayne Academy of Critical Care, Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia; Intensive Care Unit, Caboolture Hospital, Caboolture, QLD, Australia
| | - James McCullough
- School of Medicine and Dentistry, Griffith University, Mount Gravatt, QLD, Australia; Intensive Care Unit, Gold Coast University Hospital, Southport, QLD, Australia
| | - Kiran Shekar
- Mayne Academy of Critical Care, Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia; Adult Intensive Care Services, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Antony G Attokaran
- Mayne Academy of Critical Care, Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia; Intensive Care Unit, Rockhampton Hospital, The Range, QLD, Australia
| | - Aashish Kumar
- Intensive Care Unit, Logan Hospital, Logan, QLD, Australia
| | - Jason Meyer
- Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Barnaby Sanderson
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, United Kingdom
| | - Ary Serpa-Neto
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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10
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de Moura Pedro RA, Cunha GB, Pietrobom I, Scharanch BC, Cubos DC, Franco RA, Zampieri F, Romano TG. Should diuresis remain a diagnostic criterion for surgery associated acute kidney injury? Revisiting the role of perioperative oliguria. J Crit Care 2025; 87:155047. [PMID: 40043600 DOI: 10.1016/j.jcrc.2025.155047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 02/13/2025] [Accepted: 02/19/2025] [Indexed: 03/15/2025]
Affiliation(s)
- Rodolpho Augusto de Moura Pedro
- General ICU, Hospital Vila Nova Star, Rede D'OR São Luiz, Brazil; Oncological ICU, Hospital São Luiz Itaim, Rede D'OR São Luiz, Brazil; Liver and Gastroenterology Intensive Care Unit, Hospital das Clínicas da Faculdade de Medicina de São Paulo, Brazil.
| | - Guilherme Bittar Cunha
- General ICU, Hospital Vila Nova Star, Rede D'OR São Luiz, Brazil; Oncological ICU, Hospital São Luiz Itaim, Rede D'OR São Luiz, Brazil
| | - Igor Pietrobom
- General ICU, Hospital Vila Nova Star, Rede D'OR São Luiz, Brazil; Oncological ICU, Hospital São Luiz Itaim, Rede D'OR São Luiz, Brazil
| | - Bruna Carla Scharanch
- General ICU, Hospital Vila Nova Star, Rede D'OR São Luiz, Brazil; Oncological ICU, Hospital São Luiz Itaim, Rede D'OR São Luiz, Brazil; Liver and Gastroenterology Intensive Care Unit, Hospital das Clínicas da Faculdade de Medicina de São Paulo, Brazil.
| | - Daniel Caraca Cubos
- General ICU, Hospital Vila Nova Star, Rede D'OR São Luiz, Brazil; Oncological ICU, Hospital São Luiz Itaim, Rede D'OR São Luiz, Brazil
| | - Rafael Alves Franco
- General ICU, Hospital Vila Nova Star, Rede D'OR São Luiz, Brazil; Oncological ICU, Hospital São Luiz Itaim, Rede D'OR São Luiz, Brazil.
| | - Fernando Zampieri
- General ICU, Hospital Vila Nova Star, Rede D'OR São Luiz, Brazil; Oncological ICU, Hospital São Luiz Itaim, Rede D'OR São Luiz, Brazil; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | - Thiago Gomes Romano
- General ICU, Hospital Vila Nova Star, Rede D'OR São Luiz, Brazil; Oncological ICU, Hospital São Luiz Itaim, Rede D'OR São Luiz, Brazil; Nephrology Department, ABC Medical School, Brazil; D'Or Institute for Research and Education (IDOR), Av. Brigadeiro Luís Antônio, 5001 - Jardim Paulista, São Paulo - SP 01401-002, Brazil.
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11
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Gilhooley S, Power D, Roumeliotis A, Tanner R, Camaj A, Sartori S, Smith K, Nicolas J, Makhija RR, Leone PP, Yasumura K, Vinayak M, Hooda A, Krishnamoorthy PM, Farhan S, Sweeny JM, Dangas GD, Mehran R, Kini AS, Sharma SK. Treatment of Additional Vessels During Percutaneous Coronary Intervention for Unprotected Left Main Disease: Insights From a Large Prospective Registry. Am J Cardiol 2025; 243:65-72. [PMID: 39978565 DOI: 10.1016/j.amjcard.2025.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 02/14/2025] [Accepted: 02/16/2025] [Indexed: 02/22/2025]
Abstract
Percutaneous coronary intervention (PCI) is an established alternative to coronary artery bypass grafting for the treatment of select patients with unprotected left main (LM) coronary artery disease (CAD). This study evaluates the safety and clinical impact of treating additional coronary arteries during LM-PCI. Consecutive patients undergoing PCI with drug-eluting stents for unprotected LM-CAD between 2010 and 2021 at The Mount Sinai Hospital, New York, USA were eligible for inclusion. Patients were stratified based on whether they underwent treatment of the LM complex alone or had concomitant PCI to an additional vessel outside the LM complex. The primary outcome was major adverse cardiovascular events (MACE), a composite of death, myocardial infarction, or stroke, at 1 year following PCI. Among 869 consecutive patients (mean age 70.9, 33.0% female, 27.9 mean SYNTAX score) undergoing LM-PCI, 479 (55.1%) underwent treatment of the LM complex alone, and 390 (44.9%) had concomitant PCI of an additional non-LM vessel. Compared with LM complex PCI only, there were no significant differences in the rate of MACE at 1 year [HR 12.0% vs 13.3%; HR: 0.95; 95% CI (0.62-1.44), p = 0.797], even after adjustment for potential confounders [HR 12.0% vs 13.3%; HR: 0.87; 95% CI (0.56-1.36), p = 0.550]. In conclusion, in a large, real-world cohort of patients undergoing unprotected LM-PCI, treatment of an additional non-LM vessel did not increase the risk of MACE at 1 year compared to LM complex PCI alone.
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Affiliation(s)
- Sean Gilhooley
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David Power
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anastasios Roumeliotis
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard Tanner
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anton Camaj
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenneth Smith
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johny Nicolas
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rakhee R Makhija
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pier Pasquale Leone
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Keisuke Yasumura
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Manish Vinayak
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amit Hooda
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Serdar Farhan
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph Michael Sweeny
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - George D Dangas
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna S Kini
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York.
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12
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Pruna A, Monaco F, Asiller ÖÖ, Delrio S, Yavorovskiy A, Bellomo R, Landoni G. How Would We Prevent Our Own Acute Kidney Injury After Cardiac Surgery? J Cardiothorac Vasc Anesth 2025; 39:1123-1134. [PMID: 39922732 DOI: 10.1053/j.jvca.2025.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 12/28/2024] [Accepted: 01/12/2025] [Indexed: 02/10/2025]
Abstract
Acute Kidney Injury (AKI) is a common complication after cardiac surgery affecting up to 40% leading to increased morbidity and mortality. To date, there is no specific treatment for AKI, thus, clinical research efforts are focused on preventive measures. The only pharmacological preventive intervention that has demonstrated a beneficial effect on AKI in a high-quality, double-blind, randomized controlled trial is a short perioperative infusion of a balanced mixture of amino acid solution. Amino acid infusion reduced the incidence of AKI by recruiting renal functional reserve and, therefore, increasing the glomerular filtration rate. The beneficial effect of amino acids was further confirmed for severe AKI and applied to patients with chronic kidney disease. Among non-pharmacological interventions, international guidelines on AKI suggest the implementation of a bundle of good clinical practice measures to reduce the incidence of perioperative AKI or to improve renal function whenever AKI occurs. The Kidney Disease Improving Global Outcomes (KDIGO) bundle includes the discontinuation of nephrotoxic agents, volume status and perfusion pressure assessment, renal functional hemodynamic monitoring, serum creatine, and urine output monitoring, and the avoidance of hyperglycemia and radiocontrast procedures. However, pooled data from a meta-analysis did not find a significant reduction in AKI. The aim of this review is to delineate the most appropriate evidence-based approach to prevent AKI in cardiac surgery patients.
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Affiliation(s)
- Alessandro Pruna
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Özgün Ömer Asiller
- Department of Anesthesia and Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Silvia Delrio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrey Yavorovskiy
- I.M. Sechenov First Moscow State Medical University of the Russian Ministry of Health, Moscow, Russia
| | - Rinaldo Bellomo
- Department of Critical Care, The University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
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13
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Zhou S, Luo X, Cheng S, ShuLai X, Zhou H, Ge W. Predictive factors for 30-day mortality after polymyxin B treatment of carbapenem-resistant Gram-negative bacilli infections. Int J Infect Dis 2025; 154:107844. [PMID: 39961452 DOI: 10.1016/j.ijid.2025.107844] [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: 10/21/2024] [Revised: 12/27/2024] [Accepted: 02/12/2025] [Indexed: 03/12/2025] Open
Abstract
OBJECTIVES This study aimed to investigate the associated factors predicting 30-day mortality of carbapenem-resistant Gram-negative bacilli (CR-GNB) infections, with focus on polymyxin B AUCss,24h/MIC. METHODS This prospective cohort study included patients with CR-GNB infections from January 2022 to January 2024. The primary outcome was 30-day mortality. Classification and regression tree (CART) analysis was used to calculate the AUCss,24h/MIC threshold for 30-day mortality. Multivariate analysis was conducted to assess risk factors affecting this outcome. RESULTS We enrolled 107 patients, among which 30-day mortality occurred in 31 (29.0%) cases. The CART-derived AUCss,24h/MIC breakpoint was 51.3, and patients in the below-breakpoint group had 3.4-fold higher 30-day mortality than those in the above-breakpoint group (58.1% vs 17.1%, P < 0.001). On multivariate analysis, polymyxin B AUCss,24h/MIC of ≥51.3 (aOR 0.08, P = 0.001) predicted a lower risk for 30-day mortality. In subgroup analysis, the survival benefit of AUCss,24h/MIC target attainment remained in patients with high risk of mortality or carbapenem-resistant Acinetobacter baumannii infections. CONCLUSIONS Polymyxin B AUCss,24h/MIC of ≥51.3 independently predicted lower 30-day mortality in treating CR-GNB infections. Further studies should verify the AUCss,24h/MIC target associated with survival outcomes in larger randomized controlled trials.
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Affiliation(s)
- Simin Zhou
- Department of Pharmacy, China Pharmaceutical University, Nanjing Drum Tower Hospital, Nanjing 210008, China
| | - Xuemei Luo
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Shuo Cheng
- Department of Pharmacy, China Pharmaceutical University, Nanjing Drum Tower Hospital, Nanjing 210008, China
| | - Xinyue ShuLai
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Huimin Zhou
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Weihong Ge
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
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14
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Roccaforte V, Sabbatini G, Panella R, Daves M, Formenti P, Gotti M, Galimberti A, Spreafico M, Piccin A, Lippi G, Pezzi A, Pastori S. The potential role of leukocytes cell population data (CPD) for diagnosing sepsis in adult patients admitted to the intensive care unit. Clin Chem Lab Med 2025; 63:1031-1042. [PMID: 39851139 DOI: 10.1515/cclm-2024-1202] [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: 10/15/2024] [Accepted: 12/11/2024] [Indexed: 01/26/2025]
Abstract
OBJECTIVES The aim of the study was to evaluate the predictive value of cell population data (CPD) parameters in comparison with procalcitonin (PCT) and C-reactive protein (CRP) for an early diagnosis of sepsis in intensive care unit (ICU). The effect of renal function on CPD, PCT and CRP, in septic and non-septic patients was also investigated. METHODS This is a retrospective, observational and single-center study, performed with data collected from patients consecutively admitted to the ICU of the Edoardo Bassini Hospital in Milan. Patients were divided in septic and non-septic according to Sepsis-III criteria. The control group was formed by critically ill patients without sepsis. Patients with sepsis were further divided in patients with sepsis and patients with septic shock. RESULTS A significant difference between septic and non-septic patients was found for neutrophils complexity (NE-SSC), neutrophils fluorescence intensity (NE-SFL), width of dispersion of neutrophils fluorescence (NE-WY), monocytes complexity (MO-X), monocytes fluorescence intensity (MO-Y), PCT and CRP parameters. PCT, neutrophils sixe (NE-FSC), NE-WY, width of dispersion of neutrophils size (NE-WZ) and MO-X discriminated sepsis and septic-shock patients. CPD parameters were not influenced by renal function. CPD, PCT and CRP had a heterogeneous diagnostic performance efficiency in the prediction of sepsis. Overall, NE-SSC, NE-SFL, width of dispersion of neutrophils complexity (NE-WX), MO-X, MO-Y, PCT and CRP displayed the best diagnostic performance for sepsis. CONCLUSIONS This study suggested that some CPD parameters (i.e., NE-SFL and MO-X) might provide useful information for diagnosis and management of sepsis.
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Affiliation(s)
- Vincenzo Roccaforte
- S.C. Analisi Chimico Cliniche e Microbiologiche, 159114 ASST Nord Milano , Ospedale Bassini, Cinisello Balsamo, Italy
| | - Giovanni Sabbatini
- S.C. Anestesia, Rianimazione e Terapia Intensiva, 159114 ASST Nord Milano , Ospedale Bassini, Cinisello Balsamo, Italy
| | - Rossella Panella
- S.C. Analisi Chimico Cliniche e Microbiologiche, 159114 ASST Nord Milano , Ospedale Bassini, Cinisello Balsamo, Italy
| | - Massimo Daves
- Laboratory of Clinical Biochemistry (SABES-ASDAA), Hospital of Bolzano, Bolzano, Italy
| | - Paolo Formenti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, 159114 ASST Nord Milano , Ospedale Bassini, Cinisello Balsamo, Italy
| | - Miriam Gotti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, 159114 ASST Nord Milano , Ospedale Bassini, Cinisello Balsamo, Italy
| | - Andrea Galimberti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, 159114 ASST Nord Milano , Ospedale Bassini, Cinisello Balsamo, Italy
| | - Marta Spreafico
- Department of Transfusion Medicine and Hematology, ASST-Lecco, Lecco, Italy
| | - Andrea Piccin
- Northern Ireland Blood Transfusion Service, Belfast, UK
- University of Medicine Innsbruck, Innsbruck, Austria
- Department of Industrial Engineering, University of Trento, Trento, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Angelo Pezzi
- S.C. Anestesia, Rianimazione e Terapia Intensiva, 159114 ASST Nord Milano , Ospedale Bassini, Cinisello Balsamo, Italy
| | - Stefano Pastori
- S.C. Analisi Chimico Cliniche e Microbiologiche, 159114 ASST Nord Milano , Ospedale Bassini, Cinisello Balsamo, Italy
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15
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Fisher MC, Hanna DB, Fazzari M, Felsen UR, Wyatt CM, Abramowitz MK, Ross MJ. Brief Report: Preadmission VACS Index as a Predictor of Hospital Acute Kidney Injury in People With HIV. J Acquir Immune Defic Syndr 2025; 98:501-505. [PMID: 39729640 DOI: 10.1097/qai.0000000000003589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 11/21/2024] [Indexed: 12/29/2024]
Abstract
BACKGROUND The Veterans Aging Cohort Study (VACS) Index is a summary measure of routinely obtained clinical variables that predicts numerous health outcomes. Because there are currently no tools to predict acute kidney injury (AKI) in people with HIV (PWH), we investigated the association of preadmission VACS Index with hospital AKI in PWH. METHODS We conducted an observational study of PWH hospitalized in a New York City health system between 2010 and 2019. The VACS Index, calculated using outpatient laboratory values within 8-365 days of admission, was examined continuously and in quartiles. Multivariable Cox proportional hazards models, adjusting for sociodemographic factors, comorbidities, and ICU admission, determined the association of the VACS Index with AKI. RESULTS Among 1186 PWH, median age was 53 years, 43.5% were women, 86.2% were Hispanic or Black, 23.1% were coinfected with hepatitis C, and 65% were virally suppressed (<200 copies/mL). Overall AKI incidence was 20.9%. The proportion with AKI was higher by increasing VACS Index quartile: 10.7%, 18.6%, 28.1%, and 60.7% in quartiles 1-4, respectively. There was a graded, independent association of VACS Index quartile with AKI. Compared with those in the lowest quartile, the adjusted relative hazard of AKI was 1.55, 1.92, and 3.07 times higher in quartiles 2-4, respectively ( P for trend <0.001). CONCLUSIONS Preadmission VACS Index is associated with hospital AKI. Use of the VACS Index may allow for early identification of PWH at risk for AKI and initiation of preventative strategies. These findings should be externally validated in other health systems, including its predictive performance in specific hospital settings.
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Affiliation(s)
- Molly C Fisher
- Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
| | - Melissa Fazzari
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
| | - Uriel R Felsen
- Division of Infectious Diseases, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
| | - Christina M Wyatt
- Division of Nephrology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC; and
| | - Matthew K Abramowitz
- Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
| | - Michael J Ross
- Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, NY
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16
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Peng D, Cai Z, He J, Duan W, Zhang X. Comparison of regional citrate anticoagulation and nafamostat mesylate anticoagulation during plasma exchange for children at high bleeding risk: a retrospective study. Ital J Pediatr 2025; 51:114. [PMID: 40221768 PMCID: PMC11994001 DOI: 10.1186/s13052-025-01954-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 03/27/2025] [Indexed: 04/14/2025] Open
Abstract
BACKGROUND There is currently no established optimal anticoagulation protocol for plasma exchange (PE) in pediatric patients at a high risk of bleeding. Therefore, we aimed to evaluate the efficacy and safety of regional citrate anticoagulation (RCA) and nafamostat mesylate (NM) for PE anticoagulation in this patient group. METHODS This retrospective study analyzed data from 66 children with high bleeding risk who underwent PE in the Pediatric Intensive Care Unit of Hunan Children's Hospital between June 2018 and January 2023. Patients were divided into two groups: RCA-PE (n = 45) and NM-PE (n = 21), and filter performance and adverse reaction rates were compared. Statistical analysis utilized SPSS 25.0, comprising two-sample t-tests, chi-square or Fisher's exact tests, and Mann-Whitney U tests, as appropriate. Data visualization was performed using ggplot2 in R-studio. P < 0.05 was considered statistically significant. RESULTS No statistically significant differences were found between the two groups in initial transmembrane pressure (TMP) [17.0 (14.0, 21.5) mmHg vs. 16.0 (14.0, 19.5) mmHg, P = 0.614], maximum TMP [46.0 (42.0, 49.5) mmHg vs. 43.0 (41.5, 49.5) mmHg, P = 0.689], and final TMP [40.0 (35.5, 45.0) mmHg vs. 38.0 (35.0, 42.0) mmHg, P = 0.298]. Filter grade distribution and bleeding events also showed no statistically significant difference between the groups. However, the NM-PE group had significantly lower overall adverse reaction and metabolic alkalosis rates (both P < 0.05) compared to the RCA-PE group. CONCLUSIONS NM demonstrates similar efficacy but superior safety compared with RCA, making it a more suitable anticoagulation strategy for children with high bleeding risk. Study limitations include single-center design, selection bias, and uncertain NM dosage.
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Affiliation(s)
- Dan Peng
- Department of Critical Care Medicine, Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, Hunan Children's Hospital, Changsha, 410007, Hunan, China
| | - Zili Cai
- Health Management Center, Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, Hunan Children's Hospital, Changsha, 410007, Hunan, China
| | - Jie He
- Department of Critical Care Medicine, Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, Hunan Children's Hospital, Changsha, 410007, Hunan, China
| | - Wei Duan
- Complex Disease Ward, Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, Hunan Children's Hospital, Changsha, 410007, Hunan, China
| | - Xinping Zhang
- Department of Critical Care Medicine, Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, Hunan Children's Hospital, Changsha, 410007, Hunan, China.
- Pediatric Intensive Care Unit, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University/Hunan Children's Hospital, No. 86 Ziyuan Rd, Yuhua District, Changsha, 410007, China.
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17
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Zhou Z, Liu C, Li P, Yang Y, Wang F, Xu Q, Jin L, Zhang L, Fu P. A randomized controlled trial of catheters with different tips and lengths for patients requiring continuous renal replacement therapy in intensive care unit. Crit Care 2025; 29:148. [PMID: 40217330 PMCID: PMC11987356 DOI: 10.1186/s13054-025-05389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Accepted: 03/27/2025] [Indexed: 04/14/2025] Open
Abstract
BACKGROUND The tip design and length of catheter impact catheter function. Two types of catheters with different tips, side-hole catheters and step-tip catheters, are commonly used during continuous renal replacement therapy (CRRT). However, there is insufficient evidence comparing their efficacy and safety in CRRT. In addition, whether the insertion of a longer catheter could enhance catheter function remains poorly studied and controversial. METHODS In this open-label, three-arm, randomized trial, critically ill patients receiving CRRT were randomized to three groups. Group A received 20 cm side-hole catheters (GDHK-1120), group B received 20 cm step-tip catheters (GDHK-1320) and group C received 25 cm step-tip catheters (GDHK-1325). The primary outcomes were the incidence of catheter dysfunction and catheter survival time. RESULTS A total of 351 patients were enrolled, with 116 in group A, 117 in group B, and 118 in group C. The incidence of catheter dysfunction in group A (35.7%, 51/143) was significantly higher than that in group B (17.7%, 22/124) (P = 0.001). However, there was no difference between group B and group C (15.6%, 23/147) (P = 0.744). The catheter survival time was comparable between group A (5.5 days, IQR 2.5-9.3) and group B (5.0 days, IQR 3.0-10.0) (P = 0.626). In contrast, group C (6.4 days, IQR 3.9-12.0) demonstrated a significantly longer catheter survival time compared to group B (P = 0.019). Cox regression analysis identified BMI (HR 1.052, 95% CI 1.003-1.103, P = 0.036) as an independent risk factor for catheter dysfunction. Results were not consistent across BMI tertiles, with similar results observed only in patients with a lower BMI (BMI < 24.2) (chi-square 13.65, P = 0.001). There was also a trend that patients in group C have a longer filter lifespan (36.5 h, IQR 16.9-68.1, P = 0.001) and a lower incidence of catheter-related thrombosis (10.40 per 1000 catheter-days, 95% CI 5.93, 17.83, P = 0.019). Other secondary outcomes were not significantly different among groups. CONCLUSIONS Step-tip catheters may be preferable for CRRT, particularly for patients in the lower BMI tercile. Longer femoral vein catheterization demonstrated enhanced benefits in CRRT, especially among obese patients. Further high-quality, multicenter RCTs are essential to strengthen the evidence guiding catheter selection during CRRT. TRIAL REGISTRATION ChiCTR2300075107. Registered 25 August 2023.
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Affiliation(s)
- Zhifeng Zhou
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Chen Liu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Peiyun Li
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yingying Yang
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Fang Wang
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Qing Xu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Lu Jin
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Ling Zhang
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China.
| | - Ping Fu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
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18
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Seres T, Wilkey B, Weitzel N, Clendenen N. Year in Review 2024: Noteworthy Literature in Cardiac Anesthesiology. Semin Cardiothorac Vasc Anesth 2025:10892532251332468. [PMID: 40209162 DOI: 10.1177/10892532251332468] [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: 04/12/2025]
Abstract
The research findings relevant for Cardiac Anesthesiology studies published in 2024 involved key innovations in devices and gene therapy in addition to the expansion of transcatheter techniques for valve repair or replacement. We reviewed 447 relevant articles and selected 21 as the most noteworthy studies published in 2024. Themes that emerged from our review include the etiology and prevention of delirium or outcomes after mechanical circulatory support. Robust clinical outcome data now supports the use of microaxial flow devices for mechanical circulatory support for cardiogenic shock due to acute myocardial infarction. Pharmacology development presents colchicine as anti-inflammatory medication to prevent atrial fibrillation or intravenous amino acids for kidney protection after cardiopulmonary bypass. Technological advances include implantable wireless pacing-defibrillator devices, pulmonary artery pressure monitoring in heart failure patients, extracorporeal blood purification for preventing acute kidney injury and hypothermic oxygenated perfusion of the donor heart in heart transplantation. Transcatheter interventions on mitral or aortic valve were gaining advances over surgical procedures. Novel paradigms included treatments with gene therapy for cardiac amyloidosis or refractory angina and the emerging risk of microplastic exposure in cardiovascular events.
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Affiliation(s)
- Tamas Seres
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
| | - Barbara Wilkey
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
| | - Nathaen Weitzel
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Nathan Clendenen
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
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Huette P, Beyls C, Diouf M, Ibrahima A, Haye G, Guilbart M, Lefebvre T, Bayart G, Lhotellier F, Radji M, Walczak KA, Caboche M, De Dominicis F, Georges O, Berna P, Merlusca G, Hermida A, Traullé S, Dupont H, Mahjoub Y, Abou-Arab O. Study protocol: diagnosis of atrial fibrillation in postoperative thoracic surgery using a smartwatch, an open-label randomised controlled study (THOFAWATCH trial). BMJ Open 2025; 15:e097765. [PMID: 40204329 PMCID: PMC11987144 DOI: 10.1136/bmjopen-2024-097765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Accepted: 03/27/2025] [Indexed: 04/11/2025] Open
Abstract
INTRODUCTION Postoperative atrial fibrillation (POAF) affects approximately 20% of patients undergoing thoracic surgery and is associated with severe complications such as stroke, myocardial infarction, heart failure, and increased mortality. Early diagnosis is critical to mitigate these risks, but conventional monitoring is limited in detecting asymptomatic episodes. Smartwatches equipped with single-lead ECG and atrial fibrillation (AF) detection algorithms offer a novel approach for early POAF detection. This study aims to evaluate the effectiveness of smartwatch-based monitoring compared with standard care in identifying POAF following thoracic surgery. METHODS AND ANALYSIS The THOFAWATCH trial is a randomised, bicentric open-label study enrolling 302 adult patients undergoing major thoracic surgery (pneumonectomy or lobectomy) with one-lung ventilation. Eligible patients will be randomised into two groups: (1) the 'Smartwatch Monitoring' group, where participants will undergo rhythm monitoring using a smartwatch and (2) the 'Conventional Monitoring' group, receiving standard care without smartwatch monitoring. In the intervention group, any smartwatch-detected POAF episodes will be confirmed by 12-lead ECG. The primary outcome is the incidence of POAF within 7-day postsurgery. Secondary outcomes include the rate of asymptomatic POAF, cardiovascular prognosis evaluated at 2 and 6 months (composite major adverse cardiovascular events outcome), feasibility of smartwatch usage (device usage time and success rate of single-lead ECGs) and recurrence or management of AF at follow-up. Inclusion criteria include adults (>18 years) undergoing scheduled thoracic surgery and able to use the smartwatch device. Exclusion criteria encompass patients with prior AF, those requiring telemetry, or undergoing reoperations. Statistical analysis will assess the primary outcome using χ2 or Fisher's exact test (α=5%), while secondary outcomes will include descriptive and inferential statistics, with analysis conducted using SAS V.9.4. ETHICS AND DISSEMINATION Ethical approval for this bicentric study has been granted by the institutional review board (IRB) of the University Hospital of Amiens (Comité de Protection des Personnes sud-ouest et outre-mer 1, 21050 Toulouse, France, registration number ID RDB: 2022-A02028-27 in November 2024). The trial is registered under ClinicalTrials.gov (ID: (NCT06724718)). Results will be disseminated through peer-reviewed publications and scientific conferences to inform clinical practice regarding POAF detection and management following thoracic surgery. TRIAL REGISTRATION NUMBER NCT06724718; clinical trial.
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Affiliation(s)
- Pierre Huette
- Anesthesiology and critical care, Pauchet santé, Victor Pauchet Clinic, Amiens, France
- Anesthesiology and critical care, Amiens University Hospital, Amiens, Hauts-de-France, France
| | - Christophe Beyls
- Anesthesiology and critical care, Amiens University Hospital, Amiens, Hauts-de-France, France
| | - Momar Diouf
- Department of Statistics, Amiens Hospital University, Amiens, France
| | - Azrat Ibrahima
- Anesthesiology and critical care, Amiens University Hospital, Amiens, Hauts-de-France, France
| | - Guillaume Haye
- Anesthesiology and critical care, Amiens University Hospital, Amiens, Hauts-de-France, France
| | - Mathieu Guilbart
- Anesthesiology and critical care, Amiens University Hospital, Amiens, Hauts-de-France, France
| | - Thomas Lefebvre
- Anesthesiology and critical care, Amiens University Hospital, Amiens, Hauts-de-France, France
| | - Guillaume Bayart
- Anesthesiology and critical care, Amiens University Hospital, Amiens, Hauts-de-France, France
| | - Franck Lhotellier
- Anesthesiology and critical care, Pauchet santé, Victor Pauchet Clinic, Amiens, France
| | - Michael Radji
- Anesthesiology and critical care, Pauchet santé, Victor Pauchet Clinic, Amiens, France
| | - Katy-Anne Walczak
- Anesthesiology and critical care, Pauchet santé, Victor Pauchet Clinic, Amiens, France
| | - Matthieu Caboche
- Anesthesiology and critical care, Pauchet santé, Victor Pauchet Clinic, Amiens, France
| | | | - Olivier Georges
- Department of Thoracic surgery, Amiens Hospital University, Amiens, France
| | - Pascal Berna
- Department of Thoracic Surgery, Pauchet santé, Victor Pauchet Clinic, Amiens, France
| | - Geonie Merlusca
- Department of Thoracic surgery, Amiens Hospital University, Amiens, France
- Department of Thoracic Surgery, Pauchet santé, Victor Pauchet Clinic, Amiens, France
| | - Alexis Hermida
- Department of Cardiology, Amiens University hospital, Amiens, France
| | - Sarah Traullé
- Department of Cardiology, Victor Pauchet Clinic, Amiens, France
| | - Herve Dupont
- Anesthesiology and critical care, Amiens University Hospital, Amiens, Hauts-de-France, France
| | - Yazine Mahjoub
- Anesthesiology and critical care, Amiens University Hospital, Amiens, Hauts-de-France, France
| | - Osama Abou-Arab
- Anesthesiology and critical care, Amiens University Hospital, Amiens, Hauts-de-France, France
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20
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Montes D, Weerasiri SD, Suarez MG. 60-Year-Old Man With Low Hemoglobin and Elevated Creatinine Levels. Mayo Clin Proc 2025:S0025-6196(24)00364-1. [PMID: 40202474 DOI: 10.1016/j.mayocp.2024.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 04/10/2025]
Affiliation(s)
- Daniel Montes
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Samiddhi D Weerasiri
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Maria Gonzalez Suarez
- Advisor to residents and Consultant in Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
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21
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Hu ZQ, Ye ZL, Zou H, Liu SX, Mei CQ. Development and validation of a prediction model for the risk of citrate accumulation in critically ill patients with citrate anticoagulation for continuous renal replacement therapy: a retrospective cohort study based on MIMIC-IV database. BMC Nephrol 2025; 26:183. [PMID: 40205353 PMCID: PMC11983910 DOI: 10.1186/s12882-025-04106-2] [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: 07/17/2024] [Accepted: 04/02/2025] [Indexed: 04/11/2025] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common clinical syndrome, especially in the intensive care unit (ICU), with an incidence of more than 50% and in-hospital mortality of 30%. Continuous renal replacement therapy (CRRT) is an important supportive treatment for patients with AKI (Patel in Trauma Surg Acute Care Open e001381, 2024). Citrate is the preferred anticoagulant for critically ill patients requiring CRRT. Unfortunately, such patients may be confronted with citrate accumulation during citrate anticoagulation. METHODS The MIMIC-IV2.2 database was used to extract data of patients undergoing CRRT who opted for citrate anticoagulation during ICU admission, including 883 critically ill patients. These 883 patients were randomized into training (n = 618) and Internal validation (n = 265) groups at a ratio of 7:3. Least Absolute Shrinkage and Selection Operator(LASSO)-logistic regression was utilized to screen the variables and construct the prediction model, followed by the plotting of the nomogram. Then, Utilizing the retrospective data from the ICU at Jiangbei Hospital in Nanjing, China, from 2014 to 2024 (n = 200) for external model validation, the model was evaluated with discriminant analysis, calibration curves, decision curve analysis, and rationality analysis. RESULTS A total of 883 critically ill patients undergoing CRRT were included, consisting of 542 males and 341 females, with a mean age of 65 ± 14 years. Additionally, there were 618 patients in the training set and 265 in the validation set. A total of 47 independent variables were obtained, among which 15 independent variables were screened with LASSO regression and included in the multivariate logistic analysis. The five risk factors ultimately included in the prediction model were height, hepatic insufficiency, mechanical ventilation, prefilter replacement rate, and albumin. The area under the receiver operating characteristic curve (ROC) of the model was 0.758 (0.701-0.816), 0.747 (0.678-0.817), and 0.714 (0.632-0.810) for the training set, internal validation set, and external validation set, respectively. The calibration curves in the training set and internal/external validation sets showed a high degree of consistency between predicted values and observed values (according to the Hosmer-Lemeshow test, the P-values were 0.7673, 0.2401, and 0.4512 for the training set, internal validation set, and external validation set, respectively). In addition, the Decision-Curve(DCA) revealed that the model had good clinical applicability. Nomo-score comparisons exhibited the rationality of the model. CONCLUSION The model developed based on LASSO-logistic regression can reliably predict the risk of citrate accumulation in critically ill patients with citrate anticoagulation for CRRT, providing valuable guidance for the application of early measures to prevent the occurrence of citrate accumulation and to improve the prognosis of patients.
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Affiliation(s)
- Zhi-Qing Hu
- Department of Critical Care Medicine, Nanjing Jiangbei Hospital, 552GeGuan Road, Dachang Street, Jiangbei New District, Nanjing, Jiangsu Province, 210048, China
| | - Zheng-Long Ye
- Department of Critical Care Medicine, Nanjing Jiangbei Hospital, 552GeGuan Road, Dachang Street, Jiangbei New District, Nanjing, Jiangsu Province, 210048, China.
| | - Hui Zou
- Department of Critical Care Medicine, Nanjing Jiangbei Hospital, 552GeGuan Road, Dachang Street, Jiangbei New District, Nanjing, Jiangsu Province, 210048, China
| | - Shang-Xiang Liu
- Department of Critical Care Medicine, Nanjing Jiangbei Hospital, 552GeGuan Road, Dachang Street, Jiangbei New District, Nanjing, Jiangsu Province, 210048, China
| | - Cheng-Qing Mei
- Department of Critical Care Medicine, Nanjing Jiangbei Hospital, 552GeGuan Road, Dachang Street, Jiangbei New District, Nanjing, Jiangsu Province, 210048, China
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22
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Gu Y, Zhang W, Zhou J, Niu X, Wang Y, Wang L, Yan L, Xu Y, Shao F. Lack of Association Between Intraoperative Hypotension and Postoperative Acute Kidney Injury in Patients Undergoing Pancreaticoduodenectomy: A Retrospective Cohort Study. Int J Nephrol 2025; 2025:5568151. [PMID: 40236610 PMCID: PMC11999749 DOI: 10.1155/ijne/5568151] [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] [Received: 02/09/2024] [Revised: 02/10/2025] [Accepted: 02/25/2025] [Indexed: 04/17/2025] Open
Abstract
Background: Acute kidney injury (AKI) is a common postoperative event. Previous research suggests that intraoperative hypotension (IOH) is associated with postoperative AKI. This connection, however, has not been studied in patients undergoing pancreaticoduodenectomy. Methods: Based on a retrospective cohort study, we analyzed 844 adult patients who had pancreaticoduodenectomy between December 2016 and June 2020 in Henan Provincial People's Hospital. We graphically modeled the associations between the lowest intraoperative systolic and diastolic pressure and AKI using a restricted cubic spline with all covariates adjusted. The association between time under the above-specified systolic blood pressure (SPB) and diastolic blood pressure (DBP) thresholds and AKI, respectively, was investigated using logistic regression models. We further tested the robustness of our findings with a sensitivity analysis. Results: AKI occurred in 98 (11.6%) of the 844 patients in this cohort. Blood pressure components below the thresholds of 100 mmHg for systolic and 60 mmHg for diastolic were visual change points associated with increasing odds of AKI. The median (IQR) time under SBP < 100 mmHg was 15.0 (0, 40) min and 65.0 (18.8, 105.4) min for DBP < 60 mmHg. Time spent under the threshold of SBP less than 100 mmHg and DBP less than 60 mmHg was not significantly associated with AKI. Conclusions: We found no relationship between IOH and postoperative AKI after pancreaticoduodenectomy. More research is needed to investigate the complex aspects influencing intraoperative blood management in order to lessen the occurrence of AKI.
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Affiliation(s)
- Yue Gu
- Department of Nephrology, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Wenwen Zhang
- Department of Nephrology, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Jing Zhou
- Department of Nephrology, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Xiaoge Niu
- Department of Nephrology, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Yanliang Wang
- Department of Nephrology, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Limeng Wang
- Department of Nephrology, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Lei Yan
- Department of Nephrology, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Yang Xu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Fengmin Shao
- Department of Nephrology, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
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23
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Ishigo T, Suzuki A, Ibe Y, Fujii S, Fukudo M, Yoshida H, Tanaka H, Fujihara H, Yamaguchi F, Ebihara F, Maruyama T, Yagi Y, Hamada Y, Samura M, Nagumo F, Komatsu T, Tomizawa A, Takuma A, Chiba H, Nishi Y, Igarashi Y, Enoki Y, Matsumoto K. External validation of a flowchart related to achieving the target area under the concentration-time curve for vancomycin: A retrospective multicenter study. J Infect Chemother 2025; 31:102701. [PMID: 40209931 DOI: 10.1016/j.jiac.2025.102701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2025] [Revised: 03/24/2025] [Accepted: 04/07/2025] [Indexed: 04/12/2025]
Abstract
During therapeutic drug monitoring (TDM) for vancomycin (VCM), the area under the concentration-time curve (AUC) is important for balancing efficacy versus toxicity. In a previous study, we developed a decision tree (DT) model to achieve the target AUC during TDM over the follow-up period (AUCfollow-up). This study aimed to validate the DT model for achieving the target AUCfollow-up. Patients who received VCM for at least 72 h and had an initial TDM within four doses between January 2023 and December 2023 were analyzed. The AUC of the initial TDM was calculated over 2-point (peak/trough) concentrations via Bayesian estimation. The target AUCfollow-up was defined as 400-600 μg h/mL. Among 188 patients (median age [interquartile range], 66 [56, 79] years; 50 % female), the target AUCfollow-up was achieved in 70 % (132/188). When the predicted AUC was 400-600 μg h/mL, 84 % (102/121) achieved the target AUCfollow-up. In a 12 h dosing interval subgroup, 86 % (88/102) achieved the target AUCfollow-up. Conversely, when the predicted AUC was <400 or >600 μg h/mL, the proportion who achieved the target AUCfollow-up dropped to 44 % (30/67). Only 30 % (3/10) of those with creatinine clearance rates of >130 mL/min/1.73 m2 achieved the target. The area under the receiver operating characteristics curve was 0.74, and the R2 value was 0.15. Our findings confirmed the external validity of the DT model and supported its use for optimizing VCM dosing. Overall, the DT model offers a reliable framework for achieving target AUC values during follow-up for TDM, aiding safe and effective treatment.
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Affiliation(s)
- Tomoyuki Ishigo
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Ayako Suzuki
- Laboratory of Clinical Pharmacokinetics, School of Pharmacy, Kitasato University, Sagamihara, Japan; Department of Pharmacy, Kitasato University Hospital, Sagamihara, Japan; Department of Pharmacy, Showa University Hospital, Tokyo, Japan
| | - Yuta Ibe
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Satoshi Fujii
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Masahide Fukudo
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, Japan
| | - Hiroaki Yoshida
- Department of Pharmacy, Kyorin University Hospital, Mitaka, Japan
| | - Hiroaki Tanaka
- Department of Pharmacy, Kyorin University Hospital, Mitaka, Japan
| | - Hisato Fujihara
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Fumihiro Yamaguchi
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Fumiya Ebihara
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Takumi Maruyama
- Department of Pharmacy, Kochi Medical School Hospital, Kochi, Japan
| | - Yusuke Yagi
- Department of Pharmacy, Kochi Medical School Hospital, Kochi, Japan
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan; Department of Pharmacy, Kochi Medical School Hospital, Kochi, Japan
| | - Masaru Samura
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Japan; Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan; Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Fumio Nagumo
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Japan
| | - Toshiaki Komatsu
- Department of Pharmacy, Kitasato University Hospital, Sagamihara, Japan
| | - Atsushi Tomizawa
- Department of Pharmacy, Kitasato University Hospital, Sagamihara, Japan
| | - Akitoshi Takuma
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan; Department of Pharmacy, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hiroaki Chiba
- Department of Pharmacy, Tohoku Kosai Hospital, Sendai, Japan
| | - Yoshifumi Nishi
- Center for Pharmacist Education, School of Pharmacy, Nihon University, Funabashi, Japan
| | - Yuki Igarashi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Yuki Enoki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan.
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Serre J, Mulier G, Boud'hors C, Lemerle M, Abdel-Nabey M, Orvain C, Chaba A, Biard L, Demiselle J, Zafrani L. Impact of early versus conventional kidney replacement therapy initiation in tumor lysis syndrome: a target trial emulation. Ann Intensive Care 2025; 15:49. [PMID: 40180676 PMCID: PMC11968619 DOI: 10.1186/s13613-025-01439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 01/16/2025] [Indexed: 04/05/2025] Open
Abstract
BACKGROUND In the context of tumor lysis syndrome (TLS), the optimal timing and criteria for initiating kidney replacement therapy (KRT) remain unclear. This study aims to assess the effect of initiating KRT at various phosphatemia thresholds on Major Adverse Kidney Events at day 30 (MAKE30). METHODS AND RESULTS We retrospectively emulated a pragmatic clinical trial comparing the effect of KRT initiation at various phosphatemia thresholds versus a conventional approach during TLS on MAKE30. All consecutive patients admitted to the ICU at Saint-Louis University hospital in Paris and Angers University hospital between January 2007 and June 2020, presenting with laboratory TLS were included. The design criteria of a clinical trial were mimicked by using the cloning, censoring and weighting method. The primary outcome was the MAKE30 composite outcome, considering only KRT requirement between day 7 and day 30 for the dialysis criteria. We evaluated multiple phosphatemia thresholds to guide KRT initiation, ranging from 6.20 mg.dL-1 to 9.30 mg.dL-1. Among the initial population of 220 patients, 192 were included in the emulated trial (median age 60 years old, with non-Hodgkin Lymphoma and Acute Leukemia being the most frequent hematological malignancies). TLS-related AKI occurred in 140 patients, and 75 patients met the criteria for MAKE30. Regardless of the phosphate threshold considered, KRT initiation based on phosphate level was not associated with a significant difference in the MAKE30 rate. KRT requirement during the first 7 days (Odd Ratio [OR] 4.01 [1.65-4.86], p = 0.003) and non-renal SOFA (OR 1.39 per 1 point increment [1.25-1.57], p < 0.001) were identified as factors associated with MAKE30 (multivariable analysis). CONCLUSION Our results do not support the strategy of KRT initiation based on a sole critical phosphatemia level in TLS patients.
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Affiliation(s)
- Justine Serre
- Department of Medical Intensive Care, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Guillaume Mulier
- Department of Biostatistics and Medical Information, AP-HP, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Charlotte Boud'hors
- Department of Nephrology, Dialysis, Transplantation, CHU Angers, Angers, France
| | - Marie Lemerle
- Department of Medical Intensive Care, CHU Angers, Angers, France
| | | | - Corentin Orvain
- Department of Hematology, CHU Angers, Angers, France
- Federation hospitalo-universitaire « Grand Ouest against Leukemia », Nantes, France
- Inserm UMR 1307, CNRS UMR 6075, Nantes Université, Université d'Angers, Angers, CRCI2NA, France
| | - Anis Chaba
- Department of Medical Intensive Care, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Lucie Biard
- Department of Biostatistics and Medical Information, AP-HP, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Julien Demiselle
- Department of Medical Intensive Care, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- CRBS (Centre de Recherche en Biomédecine de Strasbourg), FMTS (Fédération de Médecine Translationnelle de Strasbourg), INSERM UMR 1260, Regenerative Nanomedicin, University of Strasbourg, Strasbourg, France
| | - Lara Zafrani
- Department of Medical Intensive Care, Hôpital Saint-Louis, AP-HP, Paris, France.
- INSERM UMR 944, Université Paris Cité, Paris, France.
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25
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Oktan MA, Sarioglu O, Heybeli C, Ozdemir E, Atay I, Korucu B, Bildaci YD, Deger SM, Cavdar C, Celik A, Gulcu A. Predictors of kidney disease progression after renal artery stenting. BMC Nephrol 2025; 26:175. [PMID: 40181262 PMCID: PMC11969715 DOI: 10.1186/s12882-025-04097-0] [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: 01/11/2025] [Accepted: 03/27/2025] [Indexed: 04/05/2025] Open
Abstract
BACKGROUND Atherosclerotic renovascular disease (ARVD) is the most common cause of renal artery stenosis (RAS). ARVD is associated with an increased risk of progression of kidney disease and high mortality. In this regard, the aim was to evaluate the effects of the factors on kidney functions in short- and long-term follow-ups. METHOD Patients with RAS treated with renal artery stenting since January 2015 were evaluated retrospectively in a single center. The primary endpoint was a decline in the estimated glomerular filtration rate (eGFR) of ≥ 20 ml/min and/or evolution to end stage kidney disease. Predictors of the primary endpoint were determined using the Cox regression model. RESULTS Of the 95 patients included, 57 (56.4%) were male, and the mean age was 68.7 ± 10.4. Median serum creatinine (mg/dl) and eGFR (ml/min/1.73 m2) at presentation were 1.57 (IQR, 1.11-2.12) and 40 (27-58). The median follow-up was 31 months. Indications for renal artery revascularization included high blood pressure (34 patients, 35.8%), kidney failure (29 patients, 30.5%), or a mixture of these (32 patients, 33.7%). RAS was unilateral in 67 (70%) patients. In the multivariate Cox regression analysis, serum creatinine (HR 2.03, 95% CI 1.3-3.2, p = 0.002), peak systolic velocity (HR 1.005 per 10 ms, 95% CI 1.001-1.010, p = 0.007), and acute kidney injury after revascularization (HR 10.18, 95% CI 2.3-45.4, p < 0.001) were independent predictors of progression of chronic kidney disease. CONCLUSION Serum creatinine level, peak systolic velocity of the renal artery before revascularization, and acute kidney injury after angiographic intervention are independent predictors of the progression of chronic kidney disease in patients who underwent renal artery stenting.
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Affiliation(s)
- Mehmet Ası Oktan
- Division of Nephrology, Dokuz Eylül University School of Medicine, İzmir, Türkiye.
| | - Orkun Sarioglu
- Division of Interventional Radiology, Dokuz Eylül University School of Medicine, İzmir, Türkiye
| | - Cihan Heybeli
- Division of Nephrology, Dokuz Eylül University School of Medicine, İzmir, Türkiye
| | - Esra Ozdemir
- Department of Internal Medicine, Dokuz Eylül University School of Medicine, İzmir, Türkiye
| | - Ilker Atay
- Division of Nephrology, Dokuz Eylül University School of Medicine, İzmir, Türkiye
| | - Berfu Korucu
- Division of Nephrology, Dokuz Eylül University School of Medicine, İzmir, Türkiye
| | | | - Serpil Muge Deger
- Division of Nephrology, Dokuz Eylül University School of Medicine, İzmir, Türkiye
| | - Caner Cavdar
- Division of Nephrology, Dokuz Eylül University School of Medicine, İzmir, Türkiye
| | - Ali Celik
- Division of Nephrology, Başkent University, İzmir, Türkiye
| | - Aytaç Gulcu
- Division of Interventional Radiology, Dokuz Eylül University School of Medicine, İzmir, Türkiye
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Li H, Wang L, Shi C, Zhou B, Yao L. Impact of Dexmedetomidine Dosing and Timing on Acute Kidney Injury and Renal Outcomes After Cardiac Surgery: A Meta-Analytic Approach. Ann Pharmacother 2025; 59:319-329. [PMID: 39164825 DOI: 10.1177/10600280241271098] [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] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common and serious complication following cardiac surgery. Dexmedetomidine, a highly selective α2-adrenergic agonist, has shown potential renoprotective effects, but previous studies have yielded conflicting results. OBJECTIVE This meta-analysis aimed to evaluate the efficacy and safety of dexmedetomidine in preventing AKI and reducing postoperative serum creatinine levels in adult patients undergoing cardiac surgery. METHODS We comprehensively searched 5 databases for randomized controlled trials comparing dexmedetomidine with control groups in adult cardiac surgery patients. The main outcomes were the incidence of AKI and change in postoperative serum creatinine levels. Meta-analyses were conducted using RevMan 5.4 models, and subgroup analyses were performed based on dexmedetomidine dosing and timing of administration. Continuous outcomes were combined and analyzed using either mean difference (M.D.), while dichotomous outcomes were analyzed using risk ratio (RR) with 95% confidence intervals (CI). RESULTS Our study included a total of 14 trials involving 2744 patients. Dexmedetomidine administration significantly reduced the incidence of AKI compared to control groups (RR = 0.54, 95% CI: 0.41-0.70, P < 0.00001). Postoperative serum creatinine levels were also lower with dexmedetomidine (MD = -0.14 mg/dL, 95% CI: -0.28 to -0.001, P =0.04). Subgroup analyses revealed that higher initial doses (>0.5 μg/kg) and administration during intraoperative and postoperative periods were associated with more pronounced renoprotective effects. Dexmedetomidine did not significantly affect mortality but reduced the duration of the length of hospital stay and mechanical ventilation. CONCLUSIONS AND RELEVANCE This meta-analysis demonstrates that dexmedetomidine administration, particularly at higher doses and during both intraoperative and postoperative periods, reduces the risk of AKI in adults undergoing cardiac surgery. These findings support the use of dexmedetomidine as a preventive strategy to enhance renal outcomes in this population.
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Affiliation(s)
- Hongpei Li
- Department of Anesthesiology, Peking University International Hospital, Beijing, China
| | - Lei Wang
- Department of Anesthesiology, Peking University International Hospital, Beijing, China
| | - Chunxia Shi
- Department of Anesthesiology, Peking University International Hospital, Beijing, China
| | - Baolong Zhou
- Department of Anesthesiology, Peking University International Hospital, Beijing, China
| | - Lan Yao
- Department of Anesthesiology, Peking University International Hospital, Beijing, China
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Yoshida K, Nakae H, Satoh K, Suzuki Y, Hirasawa N, Kameyama K, Okuyama M. Relationship between septic acute kidney injury and adiponectin: A retrospective study in patients undergoing continuous plasma exchange with dialysis. Ther Apher Dial 2025; 29:285-290. [PMID: 39377249 DOI: 10.1111/1744-9987.14216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 08/29/2024] [Accepted: 09/25/2024] [Indexed: 10/09/2024]
Abstract
INTRODUCTION Adiponectin (APN) is a multimeric protein with anti-inflammatory properties that is specifically secreted by adipocytes. Continuous plasma exchange with dialysis (cPED) is a blood purification therapy in which plasma exchange is performed using a selective membrane plasma separator while the dialysate flows outside the hollow fibers. METHODS Patients with sepsis were divided into two groups based on the presence or absence of acute kidney injury (AKI) complications: AKI and non-AKI group. RESULTS Plasma APN levels significantly increased after cPED in both groups. The creatinine levels in the AKI group before cPED were significantly higher than those in the non- AKI group. The plasma APN levels in the AKI group before cPED were significantly higher than those in the non-AKI group. CONCLUSION cPED increased APN levels in both patients with and without AKI. Therefore, cPED therapy may be a promising intervention for increasing APN levels in patients with sepsis.
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Affiliation(s)
- Kenji Yoshida
- Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Hajime Nakae
- Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Kasumi Satoh
- Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuya Suzuki
- Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Nobufumi Hirasawa
- Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Komei Kameyama
- Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Manabu Okuyama
- Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
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28
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Yoon SH, Kang SH, Kim H, Choi ES, Im HJ, Koh KN. Incidence, risk factors, and outcomes of transplant-associated thrombotic microangiopathy in pediatric patients after allogeneic hematopoietic cell transplantation: a single-institution prospective study. Bone Marrow Transplant 2025; 60:447-457. [PMID: 39815034 DOI: 10.1038/s41409-024-02506-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 12/12/2024] [Accepted: 12/27/2024] [Indexed: 01/18/2025]
Abstract
Transplant-associated thrombotic microangiopathy (TA-TMA) is an increasingly recognized complication in hematopoietic cell transplantation (HCT). Given the rarity of prospective pediatric studies on TA-TMA, this study aimed to evaluate the incidence, survival outcomes, and risk factors for predicting early the development of TA-TMA in a pediatric population following allogeneic HCT. We conducted a prospective analysis of 173 pediatric patients to evaluate the incidence, survival outcome, and risk factors of TA-TMA. The cumulative incidence of TA-TMA at one-year post-HCT was 4.7% (95% CI, 2.2-8.6%). Patients with TA-TMA showed significantly poorer 1-year overall survival (OS) rate, 50.0% ± 17.7% compared to 85.4% ± 2.8% in those without TA-TMA (p = 0.008). Additionally, the non-relapse mortality (NRM) rate was higher in the TA-TMA group at 12.5% (95% CI, 3.7-55.8%) versus 7.0% (95% CI, 2.8-10.1%) (p = 0.598). A urine protein/creatinine ratio ≥ 1 mg/mg on day 30 post-HCT was significantly associated with TA-TMA occurrence (adjusted HR, 9.5; [95% CI], 1.28-70.39; p = 0.028). This study showed the significantly unfavorable clinical outcomes associated with TA-TMA in pediatric patients and emphasized the importance of early identification of patients at risk. Further research is needed to explore additional strategies for early detection and intervention to improve outcomes.
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Affiliation(s)
- Su Hyun Yoon
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Han Kang
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyery Kim
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Seok Choi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Joon Im
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung-Nam Koh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Addario G, Moroni L, Mota C. Kidney Fibrosis In Vitro and In Vivo Models: Path Toward Physiologically Relevant Humanized Models. Adv Healthc Mater 2025; 14:e2403230. [PMID: 39906010 PMCID: PMC11973949 DOI: 10.1002/adhm.202403230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 01/14/2025] [Indexed: 02/06/2025]
Abstract
Chronic kidney disease (CKD) affects over 10% of the global population and is a leading cause of mortality. Kidney fibrosis, a key endpoint of CKD, disrupts nephron tubule anatomy and filtration function, and disease pathomechanisms are not fully understood. Kidney fibrosis is currently investigated with in vivo models, that gradually support the identification of possible mechanisms of fibrosis, but with limited translational research, as they do not fully recapitulate human kidney physiology, metabolism, and molecular pathways. In vitro 2D cell culture models are currently used, as a starting point in disease modeling and pharmacology, however, they lack the 3D kidney architecture complexity and functions. The failure of several therapies and drugs in clinical trials highlights the urgent need for advanced 3D in vitro models. This review discusses the urinary system's anatomy, associated diseases, and diagnostic methods, including biomarker analysis and tissue biopsy. It evaluates 2D and in vivo models, highlighting their limitations. The review explores the state-of-the-art 3D-humanized in vitro models, such as 3D cell aggregates, on-chip models, biofabrication techniques, and hybrid models, which aim to mimic kidney morphogenesis and functions. These advanced models hold promise for translating new therapies and drugs for kidney fibrosis into clinics.
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Affiliation(s)
- Gabriele Addario
- Department of Complex Tissue RegenerationMERLN Institute for Technology‐Inspired Regenerative MedicineMaastricht UniversityER Maastricht6229The Netherlands
| | - Lorenzo Moroni
- Department of Complex Tissue RegenerationMERLN Institute for Technology‐Inspired Regenerative MedicineMaastricht UniversityER Maastricht6229The Netherlands
| | - Carlos Mota
- Department of Complex Tissue RegenerationMERLN Institute for Technology‐Inspired Regenerative MedicineMaastricht UniversityER Maastricht6229The Netherlands
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30
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Ghazi L, Chen X, Harhay MO, Hu L, Biswas A, Peixoto AJ, Li F, Wilson FP. Treatment Effect Heterogeneity in Acute Kidney Injury Incidence Following Intravenous Antihypertensive Administration for Severe Blood Pressure Elevation During Hospitalization. Am J Kidney Dis 2025; 85:442-453. [PMID: 39580068 DOI: 10.1053/j.ajkd.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 09/11/2024] [Accepted: 09/11/2024] [Indexed: 11/25/2024]
Abstract
RATIONALE & OBJECTIVE Severe hypertension (HTN) that develops after hospital admission is prevalent in 10% of patients admitted for reasons other than HTN. Severe HTN is commonly treated with intravenous (IV) antihypertensives and is associated with a greater risk of acute kidney injury (AKI). We explored whether there is heterogeneity in IV antihypertensives' effect on AKI incidence among patients who develop severe HTN during hospitalization. STUDY DESIGN Heterogeneity of treatment effect analysis. SETTINGS & PARTICIPANTS Patients who developed severe HTN, defined as systolic blood pressure (BP)>180 or diastolic BP>110mm Hg, during hospitalization and did not have kidney failure. EXPOSURE Treatment with IV antihypertensives within 3 hours of BP elevation. OUTCOME Time to developing AKI. ANALYTICAL APPROACH An accelerated failure time Bayesian additive regression trees (BART) model to capture the association between the time to develop AKI and predictors. Individual treatment effects were estimated for each participant using a counterfactual outcome framework, and these estimates were used to identify patient characteristics associated with treatment effect heterogeneity in response to IV antihypertensives. RESULTS We included 11,951 patients who developed severe HTN, 741 were treated with IV antihypertensives, and 11,210 were not, of whom 18% and 13% developed AKI, respectively. Most patients would have been harmed from IV antihypertensive treatment except for a small subset of 317 patients who were White, had a systolic BP on admission≥156mm Hg, an estimated glomerular filtration rate of≥70.7mL/min/1.73m2, and a serum bicarbonate of<21.7mmol/L. LIMITATIONS Data-driven, hypothesis-generating approach. Findings were not validated with external data sources. CONCLUSIONS These exploratory findings suggest that most patients who develop severe HTN will not benefit from IV antihypertensive treatment. Future studies should assess for heterogeneity when identifying treatment options, if any are needed, for severe HTN. PLAIN-LANGUAGE SUMMARY Patients who develop severe blood pressure elevation during hospitalization are commonly treated with intravenous antihypertensives; however, this could lead to acute kidney injury (AKI). We wanted to assess whether this is consistent across all patients, using a new statistical approach that predicts what would happen if patients who were treated had not been treated and those who were not treated had been. We found that most patients will develop AKI, and only a small subset of patients might not. This exploratory study can help inform future studies on the treatment of hypertension that develops during hospitalization.
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Affiliation(s)
- Lama Ghazi
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Xinyuan Chen
- Department of Mathematics and Statistics, Mississippi State University, Mississippi State, Mississippi.
| | - Michael O Harhay
- Clinical Trials Methods and Outcomes Lab, Palliative and Advanced Illness Research Center (MOH), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Liangyuan Hu
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Aditya Biswas
- Department of Internal Medicine, Clinical and Translational Research Accelerator, School of Public Health, Yale University, New Haven, Connecticut
| | - Aldo J Peixoto
- Section of Nephrology, School of Medicine, School of Public Health, Yale University, New Haven, Connecticut
| | - Fan Li
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut; Center for Methods in Implementation and Prevention Science, School of Public Health, Yale University, New Haven, Connecticut
| | - F Perry Wilson
- Department of Internal Medicine, Clinical and Translational Research Accelerator, School of Public Health, Yale University, New Haven, Connecticut; Section of Nephrology, School of Medicine, School of Public Health, Yale University, New Haven, Connecticut
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31
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Kerdegari N, Singh CT, MacAskill F, Allen C, Malde S, Nair R, Thurairaja R, Khan MS, George M, Schizas A, Sahai A. Urological Outcomes and Adverse Events Following Total Pelvic Exenteration for Locally Advanced and Recurrent Rectal Cancer: A Single-center Retrospective Study. Urology 2025; 198:160-166. [PMID: 39710077 DOI: 10.1016/j.urology.2024.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Revised: 12/02/2024] [Accepted: 12/12/2024] [Indexed: 12/24/2024]
Abstract
OBJECTIVE To assess urological complications in patients undergoing total pelvic exenteration (TPE) for locally advanced (LARC) and recurrent rectal cancer (RRC) as publications in this area are limited. Secondary objectives were to assess whether LARC vs RRC or radiation status affected urological outcomes. METHODS Single-center, retrospective study of TPE patients between January 2017 and December 2022. Electronic records were evaluated to extract data. Postoperative outcomes were analyzed using two-tailed t-tests, Mann-Whitney U tests and chi-squared tests. Urological complications were analyzed using simple logistic regression. RESULTS A total of 128 patients underwent TPE (97 LARC, 31 RRC). 90 (70.3%) received neoadjuvant radiotherapy. The overall urological complication rate was 51.6%. Transient acute kidney injury and urinary tract infection were the two most common complications occurring in 38 (29.7%) and 33 (25.8%) respectively. 23 (18.0%) had at least one major complication of Clavien-Dindo III/IV related to the urinary system. Ureteroenteric stricture rate was 7.0% and 14.1% needed a reoperation for urological complications. There was no association between the overall incidence of urological complications and radiation status (OR 0.81 [0.37-1.73], P=.586) or between patients with LARC and RRC (OR 1.68 [0.75-3.93], P=.216). CONCLUSION Urological complications are common post-TPE. The urological complication rate is similar in LARC and RRC and radiation status did not affect outcomes in this cohort.
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Affiliation(s)
| | | | - Findlay MacAskill
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rajesh Nair
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ramesh Thurairaja
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Muhammad S Khan
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mark George
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alexis Schizas
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Arun Sahai
- King's College London, London, United Kingdom; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
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32
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Zhang X, Yuan W, Li T, Sha H, Hui Z. The Association Between Body Mass Index and 28-day Mortality in Patients With Sepsis: A Retrospective Cohort Study. Am Surg 2025; 91:494-504. [PMID: 39606891 DOI: 10.1177/00031348241304040] [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] [Indexed: 11/29/2024]
Abstract
BackgroundSepsis is a severe clinical syndrome with high morbidity and mortality in intensive care units (ICUs). Body Mass Index (BMI) shows a rising trend of obese patients being admitted to ICUs. The relationship between BMI and the clinical outcome of sepsis remains highly debated.MethodsThe data used in this study were sourced from the Intensive Care Information Center IV (MIMIC-IV) database. Baseline information extracted within 24 hours of ICU admission was categorized according to World Health Organization (WHO)'s BMI classifications. A multivariate Cox regression model and curve fitting assessed the independent correlation between BMI and the primary outcome.ResultsA total of 7836 patients were included in the study and categorized into five groups based on BMI. The overall 28-day mortality rate was 21.94% (1719/7836). Class I obesity (17.14%) and class II/III obesity (13.49%) individuals tended to be younger and male. Compared to patients with normal BMI (32.55%), those with low BMI (5.79%) had a 47% increased risk of 28-day mortality (HR 1.47, 95% CI 1.16-1.85, P = 0.0013), while class II/III obesity patients had a 17% lower 28-day mortality rate (HR 0.83, 95% CI 0.71-0.97, P = 0.0218). Curve fitting revealed a nonlinear relationship between BMI and 28-day mortality. The Kaplan-Meier survival analysis highlighted variations in survival rates across the five groups (P = 0.0123), with underweight patients exhibiting poorer survival outcomes.ConclusionIn sepsis patients, a low BMI is related to higher 28-day mortality compared to those with a normal BMI. Conversely, patients with a BMI≥35 kg/m2 have significantly reduced mortality risks.
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Affiliation(s)
- Xu Zhang
- Yan'an University Affiliated Hospital, Yan'an, China
| | - Weiwei Yuan
- Yan'an University Affiliated Hospital, Yan'an, China
| | - Tingting Li
- Yan'an University Affiliated Hospital, Yan'an, China
| | - Haiwang Sha
- Yan'an University Affiliated Hospital, Yan'an, China
| | - Zhiyan Hui
- Yan'an University Affiliated Hospital, Yan'an, China
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Palumbo KD, Jacko NF, David MZ. Clinical presentation, treatment, and antimicrobial susceptibility of 155 sequential Staphylococcus lugdunensis infections. Microbiol Spectr 2025; 13:e0274924. [PMID: 40062747 PMCID: PMC11960052 DOI: 10.1128/spectrum.02749-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 02/11/2025] [Indexed: 04/02/2025] Open
Abstract
Staphylococcus lugdunensis is known to be virulent, but there are few large-scale epidemiologic studies of this species to define types of infection, susceptibility patterns, and severity. S. lugdunensis isolates from any culture at four U.S. tertiary care hospitals between 1 April 2021 and 1 April 2022 were identified. For the first isolate from each subject, clinical, demographic, and outcome data were recorded. Of 291 isolates, 223 were obtained from a clinically significant infection. Of these 223 isolates, 86 (38.6%) were from monomicrobial cultures; additionally, S. lugdunensis was considered a true pathogen in 69/137 polymicrobial infections. Among 155 subjects with S. lugdunensis infections, 49.7% were female, 46.5% were black, and 41.9% were white; 51.6% of infections were community associated. The most common infection sites were skin and soft tissue (SSTI) (n = 98, 63.2%), urinary tract (n = 16, 10.3%), and sinusitis (n = 14, 9%). Of nine monomicrobial bloodstream infections (BSIs), two were fatal, three involved foreign bodies, and two had infective endocarditis. Greater than half of SSTIs required an invasive procedure for cure. Among 138/291 isolates from colonization or infection, tetracycline, trimethoprim-sulfamethoxazole, oxacillin, and vancomycin susceptibility rates were 94.8% (128/135), 95.9% (94/98), 84.1% (116/138), and 100% (138/138), respectively. There were similarities in types of infection comparing S. lugdunensis in this study and prior reports on Staphylococcus aureus. SSTI was the predominant S. lugdunensis infection type; more than 50% of SSTIs required procedural intervention. Of nine BSIs, three involved a foreign body, and there were two cases of infective endocarditis. Oxacillin resistance was identified in 16% of isolates. IMPORTANCE In recent years, Staphylococcus lugdunensis has been identified with increasing frequency as a human pathogen causing a wide variety of clinical syndromes, from soft tissue infections to fatal cases of bloodstream infection. Despite this, there are few large-scale epidemiologic studies examining this highly virulent organism. Our study adds to the growing literature on this emerging pathogen by analyzing a large case series of sequential S. lugdunensis infections at four U.S. hospitals to define its contemporary epidemiology, including the types of infections it causes, their outcomes, treatment approaches, and antimicrobial susceptibilities. These data provide valuable insights for clinicians in diagnosing and treating patients with these often debilitating infections. The findings also improve upon our understanding of the incidence of each infection syndrome and variability in antimicrobial susceptibilities of isolates to guide the design of future studies on the genomic epidemiology of this important pathogen.
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Affiliation(s)
- Kurt D. Palumbo
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Natasia F. Jacko
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Z. David
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Atchade E, Bunel-Gourdy V, Zappella N, Jean-Baptiste S, Tran-Dinh A, Tanaka S, Lortat-Jacob B, Roussel A, Mordant P, Castier Y, Mal H, De Tymowski C, Montravers P. Time on the waiting list is an independent risk factor for day-90 mortality after lung transplantation. Anaesth Crit Care Pain Med 2025; 44:101499. [PMID: 39988229 DOI: 10.1016/j.accpm.2025.101499] [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: 06/04/2024] [Revised: 09/06/2024] [Accepted: 11/17/2024] [Indexed: 02/25/2025]
Abstract
BACKGROUND The waitlist deaths of transplantation candidates based on their time on the waiting list (TWL) have already been studied, but the short-term mortality and early complications of lung transplant (LT) recipients based on their TWL have not been specifically studied. The first aim of this study was to assess the relationship between increased TWL and short-term mortality in LT recipients. METHODS In this observational, monocentric, retrospective study, all patients who underwent LT between January 2016 and August 2022 at Bichat Claude Bernard Hospital, Paris were analyzed. Univariate analysis (chi2 test, Mann-Whitney test, Fisher's exact test) and multivariate analysis (logistic regression) were performed. Ninety-days and one-year survival were studied (Kaplan-Meier curves, log-rank test). p < 0.05 indicated statistical significance. RESULTS 242 LT patients were analyzed. The median TWL was 100 (43-229) days. Postoperative complications, including septic shock (36 versus 18%, p = 0.002), grade 3 primary graft dysfunction (31 versus 20%, p < 0.001), and KDIGO3 acute kidney injury (8 versus 25%, p < 0.001), were more common in the prolonged TWL (pTWL) group (>100 days) than in the short TWL group (≤100 days). The duration of hospitalization in the ICU was longer (18 [11-34] versus 13 [9-23] days, p = 0.02) in the pTWL group. According to our multivariate analysis, TWL was an independent risk factor for 90-days mortality (OR 1.02, 95% CI [1.00-1.04]; p = 0.032). CONCLUSION TWL was an independent risk factor for 90-days mortality after LT. Receiving LT after more than 100 days on the waitlist exposes to increased postoperative complications.
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Affiliation(s)
- Enora Atchade
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 rue Henri Huchard, 75018 Paris, France; Inflammation Research Center, Inserm UMR 1149, Paris, France.
| | - Vincent Bunel-Gourdy
- APHP, CHU Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, 46 rue Henri Huchard, 75018 Paris, France
| | - Nathalie Zappella
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 rue Henri Huchard, 75018 Paris, France
| | - Sylvain Jean-Baptiste
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 rue Henri Huchard, 75018 Paris, France
| | - Alexy Tran-Dinh
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 rue Henri Huchard, 75018 Paris, France; INSERM U1148, LVTS, CHU Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France; Université de Paris, UFR Diderot, France
| | - Sébastien Tanaka
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 rue Henri Huchard, 75018 Paris, France; Université de la Réunion, INSERM UMR 1188, Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de la Réunion, France
| | - Brice Lortat-Jacob
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 rue Henri Huchard, 75018 Paris, France
| | - Arnaud Roussel
- APHP, CHU Bichat-Claude Bernard, Service de Chirurgie Thoracique et Vasculaire, 46 rue Henri Huchard, 75018 Paris, France
| | - Pierre Mordant
- Université de Paris, UFR Diderot, France; APHP, CHU Bichat-Claude Bernard, Service de Chirurgie Thoracique et Vasculaire, 46 rue Henri Huchard, 75018 Paris, France
| | - Yves Castier
- Université de Paris, UFR Diderot, France; APHP, CHU Bichat-Claude Bernard, Service de Chirurgie Thoracique et Vasculaire, 46 rue Henri Huchard, 75018 Paris, France; INSERM UMR 1152, Physiopathologie et Epidémiologie des maladies respiratoires, Paris, France
| | - Hervé Mal
- APHP, CHU Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, 46 rue Henri Huchard, 75018 Paris, France; Université de Paris, UFR Diderot, France; INSERM UMR 1152, Physiopathologie et Epidémiologie des maladies respiratoires, Paris, France
| | - Christian De Tymowski
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 rue Henri Huchard, 75018 Paris, France; INSERM UMR 1149, Immunorecepteur et immunopathologie rénale, CHU Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
| | - Philippe Montravers
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 rue Henri Huchard, 75018 Paris, France; Université de Paris, UFR Diderot, France; INSERM UMR 1152, Physiopathologie et Epidémiologie des maladies respiratoires, Paris, France
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Li S, Liang Y, Feng J, Tan F, Chen Y, Yu L, Liu Q. Soluble average Klotho level as a prognostic marker for acute kidney injury outcomes: a 90-day follow-up study. Biomark Med 2025; 19:243-250. [PMID: 40119637 PMCID: PMC11970795 DOI: 10.1080/17520363.2025.2481018] [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: 12/02/2024] [Accepted: 03/14/2025] [Indexed: 03/24/2025] Open
Abstract
BACKGROUND Klotho is highly expressed in the kidney and confers pleiotropic kidney protective effects. This study aimed to assess the soluble average Klotho level and its relationship to renal function and outcomes in participants with acute kidney injury (AKI). METHODS We recruited 102 participants with AKI and 30 healthy controls (HCs). For patients with AKI, serum soluble (sKlotho) levels upon admission to and discharge from hospital were measured to assess the relationship between sKlotho level and kidney function. Individuals with AKI were followed up for 90 days to determine the association between their average sKlotho level and short-term AKI outcomes. RESULTS The baseline sKlotho level in individuals with AKI at admission was significantly lower than that in HCs. For individuals with AKI, the sKlotho level was significantly lower in stage 3 than in stage 1 or 2. The sKlotho level was restored along with renal function improvement at discharge. During follow-up, a lower average, but not baseline, sKlotho level, or average sKlotho/creatinine ration predicted more AKI clinical outcomes. CONCLUSION The sKlotho level decreased significantly with kidney injury and represented severity. The average sKlotho level inversely correlated with detrimental kidney outcomes and may have potential diagnostic and predictive roles in AKI.
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Affiliation(s)
- ShaSha Li
- Clinical Research & Lab Centre, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, China
| | - Yan Liang
- Gusu School, Nanjing Medical University, The First People’s Hospital of Kunshan, Kunshan, Jiangsu, China
| | - JianHua Feng
- Department of Nephrology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, China
| | - Fang Tan
- Department of Nephrology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, China
| | - Yue Chen
- Department of Nephrology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, China
| | - LiXia Yu
- Department of Nephrology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, China
| | - QiFeng Liu
- Gusu School, Nanjing Medical University, The First People’s Hospital of Kunshan, Kunshan, Jiangsu, China
- Department of Nephrology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, China
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Dongelli H, Oktan MA, Heybeli C, Bildacı YD, Korucu B, Cavdar C, Deger SM. Hemodialysis Prescription and In-Hospital Cardiac Arrest in Patients With Acute Kidney Injury: A Single-Center Study. Hemodial Int 2025; 29:156-163. [PMID: 40000923 DOI: 10.1111/hdi.13207] [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: 08/23/2024] [Revised: 02/01/2025] [Accepted: 02/06/2025] [Indexed: 02/27/2025]
Abstract
INTRODUCTION Cardiac arrest is a common cause of death among patients undergoing maintenance hemodialysis; however, the prevalence and risk factors for cardiac arrest in the setting of acute kidney injury (AKI) are not studied in detail. METHODS Patients who received hemodialysis for AKI between 2014 and 2024 were classified as those who experienced cardiac arrest during hemodialysis (group A) and patients who had cardiac arrest during hospitalization outside the hemodialysis session (group B). Logistic regression analysis was performed to determine the odds of cardiac arrest during the hemodialysis session versus outside the session. FINDINGS Among the 1702 patients who received hemodialysis for AKI, 33 (0.02%) experienced cardiac arrest at the time of hemodialysis (group A), and 100 (0.06%) had cardiac arrest outside the session (group B). Previous history of atrial fibrillation was more common in group A (39% vs. 19%, p = 0.017). Groups were comparable in terms of oxygen or vasopressor requirement and baseline mean serum creatinine. Metabolic acidosis was more severe, and serum blood urea nitrogen and calcium levels were higher in group B (p < 0.05). Ultrafiltration rates were higher in group A than in group B (mean 10.6 mL/h/kg vs. 6.2 mL/h/kg, p < 0.001). There were more deaths in group A within the first 24 h following cardiac arrest (79% vs. 48%, p < 0.05); however, spontaneous recirculation and overall in-hospital mortality were comparable. In the multivariate regression model, atrial fibrillation (OR = 4.91, 95% CI 1.35-17.8, p = 0.016), lower pre-dialysis serum calcium levels (OR = 2.66, 95% CI 1.25-5.65, p = 0.011), and higher ultrafiltration volume (OR = 10.9, 95% CI 3.90-30.5, p < 0.001) were independently associated with an increased risk of cardiac arrest during hemodialysis sessions. DISCUSSION History of atrial fibrillation, lower pre-dialysis serum calcium levels, and higher ultrafiltration volumes are associated with an increased risk of cardiac arrest during hemodialysis than cardiac arrest outside the hemodialysis session in the AKI setting.
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Affiliation(s)
- Huseyin Dongelli
- Faculty of Medicine, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkiye
| | - Mehmet Ası Oktan
- Department of Internal Medicine, Division of Nephrology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkiye
| | - Cihan Heybeli
- Department of Internal Medicine, Division of Nephrology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkiye
| | - Yelda Deligoz Bildacı
- Department of Internal Medicine, Division of Nephrology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkiye
| | - Berfu Korucu
- Department of Internal Medicine, Division of Nephrology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkiye
| | - Caner Cavdar
- Department of Internal Medicine, Division of Nephrology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkiye
| | - Serpil Muge Deger
- Department of Internal Medicine, Division of Nephrology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkiye
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Yilmaz C, Güvendi Şengör B, Zehir R, Kaya AF, Özdil MH, Kültürsay B. Wide pulse pressure as a novel predictor of contrast-induced acute kidney injury in diabetic patients undergoing primary percutaneous coronary intervention. Blood Press Monit 2025; 30:65-72. [PMID: 39831755 DOI: 10.1097/mbp.0000000000000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2025]
Abstract
BACKGROUND Primary percutaneous coronary intervention (p-PCI) is pivotal in managing ST-segment elevation myocardial infarction (STEMI); however, it introduces potential risks, such as contrast-induced acute kidney injury (CI-AKI). This study aimed to investigate the relationship between pulse pressure (PP) and CI-AKI incidence in diabetic patients. METHODS In this retrospective study conducted between 2021 and 2022, 590 diabetic STEMI patients undergoing p-PCI were categorized based on the presence of wide PP. Individuals with PP ≥ 65 mmHg were classified as the 'wide PP (+) group', while those with PP < 65 mmHg were classified as the 'wide PP (-) group'. To determine independent predictors of CI-AKI, multivariable logistic regression models were applied. After establishing the base model, blood pressure indices, including PP, SBP, DBP, mean arterial pressure, and pulsatility were added to the model using the stepwise selection method. RESULTS Among the patients, 18.3% ( n = 108) were in the wide PP (+) group, while 81.7% ( n = 482) were in the wide PP (-) group. The incidence of hypertension, SBP, PP, and the risk of CI-AKI were higher in the wide PP (+) group. Multivariable analysis recognized PP, wide PP, and pulsatility as independent CI-AKI predictors [odds ratio (OR): 1.024, 95% confidence interval (CI): 1.003-1.045, P = 0.025; OR: 1.684, 95% CI: 1.025-2.769, P = 0.040; OR: 13.816, 95% CI: 2.069-92.245, P = 0.007, respectively]. CONCLUSION Increased PP emerges as an independent predictor for CI-AKI in diabetic patients undergoing p-PCI.
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Affiliation(s)
| | - Büşra Güvendi Şengör
- Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, Kartal, Istanbul
| | - Regayip Zehir
- Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, Kartal, Istanbul
| | | | | | - Barkin Kültürsay
- Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, Kartal, Istanbul
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Rahhal A, Bilal O, Salama AM, Sivadasan P, Abdullah AA, Abuyousef S, Shahulhameed S, Zaza KJ, Mulla AA, Alkhulaifi A, Mahfouz A, Alyafei S, Omar A. Predictors of Mortality in Venoarterial Extracorporeal Membrane Oxygenation Regardless of Early Left Ventricular Unloading: A National Experience. J Cardiothorac Vasc Anesth 2025; 39:949-956. [PMID: 39884906 DOI: 10.1053/j.jvca.2025.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 11/23/2024] [Accepted: 01/10/2025] [Indexed: 02/01/2025]
Abstract
OBJECTIVE The use of an intra-aortic balloon pump (IABP) has been suggested to unload the left ventricle while on venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS), leading to possibly improved in-hospital mortality. However, the predictors of mortality on dual mechanical circulatory support have not yet been evaluated, especially in real-world clinical settings. Therefore, a case-control study was conducted to determine the rate of all-cause mortality associated with VA-ECMO use regardless of left ventricular (LV) unloading, and with early LV unloading in the setting of CS, and to identify the predictors of mortality associated with VA-ECMO, with concurrent early LV unloading. DESIGN Retrospective observational case-control study. SETTING National tertiary cardiology center. PARTICIPANTS All patients with CS requiring VA-ECMO cannulation during the index admission between January 06, 2016, and January 0, 2022. INTERVENTION VA-ECMO with or without IABP MEASUREMENTS AND MAIN RESULTS: Patient- and disease-related characteristics associated with in-hospital 30-day mortality following VA-ECMO with and without IABP support were assessed using multivariate logistic regression. Results are presented as odds ratio (OR), and a p-value < 0.05 indicates statistical significance. A total of 110 patients were included. Most were male (90%) with a mean age of 53 ± 11 years. Around 67% were Asian. The majority of patients were admitted with ST-elevation myocardial infarction (87%), with 26% presenting with left main disease. In-hospital 30-day mortality occurred in 42.7% of those who received VA-ECMO support regardless of IABP use, while it was 46.9% among those receiving early LV unloading with IABP. Significant positive predictors of mortality with VA-ECMO regardless of IABP in CS were cardiopulmonary resuscitation (CPR) >20 minutes (adjusted OR 14.74, 95% confidence interval 2.02-107.41, p-value = 0.008), older age (ie, >55 years) and left main disease of more than 50% stenosis were associated with a fourfold increase in the odds of mortality while on VA-ECMO. Conversely, CPR >20 minutes (adjusted OR 12.45, 95% confidence interval 1.79-86.36, p-value = 0.011) was the only significant positive predictor of mortality with VA-ECMO and IABP. CONCLUSION The mortality rate in CS requiring VA-ECMO, regardless of IABP use, remains high. However, only one predictor (ie, prolonged CPR) was found to increase the likelihood of 30-day mortality with early LV unloading, suggesting that concomitant IABP use might minimize the effect of mortality predictors.
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Affiliation(s)
- Alaa Rahhal
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Ousama Bilal
- Department of Anesthesia, Cardiothoracic Surgery/Cardiac ICU Section, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed M Salama
- Department of Anesthesia, Cardiothoracic Surgery/Cardiac ICU Section, Heart Hospital, Hamad Medical Corporation, Doha, Qatar; Assistant Professor, Anaesthesia, Intesive Care Department Al-Azhar University, Cairo, Egypt
| | - Praveen Sivadasan
- Department of Anesthesia, Cardiothoracic Surgery/Cardiac ICU Section, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ammar Al Abdullah
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Safae Abuyousef
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Khaled J Zaza
- General Anesthesia, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdulwahid Al Mulla
- Cardiothoracic Surgery Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdulaziz Alkhulaifi
- Cardiothoracic Surgery Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mahfouz
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sumaya Alyafei
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amr Omar
- Department of Anesthesia, Cardiothoracic Surgery/Cardiac ICU Section, Heart Hospital, Hamad Medical Corporation, Doha, Qatar; Department of Critical Care Medicine, Beni Suef University, Egypt; Weill Cornell Medical College, Doha, Qatar
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De Rubeis G, Alessiani M, Fabiano S, Bertaccini L, Wlderk A, Pezzella FR, Anticoli S, Barber PA, Saba L, Pampana E. Impact on mortality at 90 days of acute kidney injuries in endovascularly treated stroke: A systematic review, meta-analysis, and meta-regression. Neuroradiol J 2025; 38:185-191. [PMID: 39572204 PMCID: PMC11583170 DOI: 10.1177/19714009241303134] [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: 08/26/2024] [Revised: 10/07/2024] [Accepted: 10/11/2024] [Indexed: 11/24/2024] Open
Abstract
AimTo investigate the prognostic implication (mortality at 3 months) of acute kidney injury (AKI) in acute ischemic stroke treated with mechanical thrombectomy (MT).Material and MethodsA literature search was performed using PubMed/OVID/Cochran's CENTRAL database (time frame: inception to January 2023). Study characteristics, patient status, clinical outcomes, AKI incidence, and sample size were recorded. The exclusion criteria were non-English literature, no human subjects, and <10 patients as the sample size. Studies were assessed using the MINORS/GRADE system. Meta-analysis and meta-regression with a random-effects model were performed.Results3314 studies were retrieved. After applying the exclusion criteria, the final population included of 18/3314 studies (0.5%). Among them, only 6/18 (33.3%) studies reported results in two separate groups (AKI vs non-AKI), allowing for inference statistics for a total population of 3229 (538.6 ± 403.7). The I^2 was 34.6 and Q's Cochrane was 7.80. The pooled odds ratio (OR) for mortality at 3 months in patients with AKI was 5.8 (95% confidence interval [95% CI] 95% CI 3.62 to 9.52). Leave-one-out meta-analysis showed no significant sources of heterogeneity. In the meta-regression, diabetes prevalence was associated with a higher mortality rate (OR 1.14, 95% CI 1.03 to 1.28), and lower age and a small amount of contrast media were negatively correlated (0.91 [95% CI 0.83 to 0.99] and OR 0.97 [95% CI 0.94 to 1.00], respectively).ConclusionAKI was significantly associated with the mortality rate in MT-treated stroke patients (OR 5.8 [95% CI 3.62 to 9.36]).
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Affiliation(s)
- Gianluca De Rubeis
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Italy
| | | | - Sebastiano Fabiano
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Italy
| | - Luca Bertaccini
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Italy
| | - Andrea Wlderk
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Italy
| | | | - Sabrina Anticoli
- Emergency Department, UOSD Stroke Unit, S. Camillo-Forlanini Hospital, Italy
| | | | - Luca Saba
- Department of Medical Imaging, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Monserrato, Italy
| | - Enrico Pampana
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Italy
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Doola R, Griffin A, Forbes JM, Kruger PS, Deane AM, Schalkwijk CG, White KC. Association between enteral carboxymethyllysine intake and daily glycemic variability in critically ill adults: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2025; 49:324-331. [PMID: 39875314 PMCID: PMC11992550 DOI: 10.1002/jpen.2727] [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: 09/24/2024] [Revised: 12/19/2024] [Accepted: 01/09/2025] [Indexed: 01/30/2025]
Abstract
BACKGROUND Advanced glycation end-products (AGEs) can enter patients' circulation through exogenous sources, such as enteral nutrition formulae. Circulating AGEs, specifically carboxymethyllysine, can promote insulin resistance and activation of pro-inflammatory pathways leading to oxidative stress, cell death, and organ failure. Suboptimal kidney function increases the risk of elevated circulating AGEs because levels are controlled through urinary excretion. Our aim was to determine associations between carboxymethyllysine intake and glycemic control as well as clinical outcomes in critically ill patients and explore these in the subset of patients with an acute kidney injury (AKI). METHODS This was a retrospective cohort study. Data were extracted from electronic medical records. Patients were eligible if they were ≥18 years and received enteral nutrition, with known carboxymethyllysine content, for ≥3 days. AKI was defined using the Kidney Disease: Improving Global Outcomes guidelines. Linear and logistic regression models were used to determine adjusted associations. RESULTS Between 2015 and 2021, 2636 patients met the eligibility criteria, with 848 (32%) patients having an AKI. Most were male (n = 1752, 67%) with a median (interquartile range) Acute Physiology And Chronic Health Evaluation III score of 59 (45-77). For every 10-μmol increase in carboxymethyllysine provision, mean blood glucose increased by 0.05 mmol (95% CI, 0.03-0.07), and the odds of dying increased by 16% (odds ratio = 1.16; 95% CI, 1.06-1.27). A subgroup analysis indicated these associations persisted in patients with AKI but not in those without. CONCLUSION Carboxymethyllysine intake was associated with increased mean blood glucose and odds of dying in our study cohort.
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Affiliation(s)
- Ra'eesa Doola
- Centre for Functioning and Health Research, Metro South HealthBrisbaneAustralia
- Nutrition and Dietetics DepartmentPrincess Alexandra HospitalBrisbaneAustralia
- The University of QueenslandBrisbaneAustralia
| | - Alison Griffin
- QIMR Berghofer Medical Research InstituteBrisbaneAustralia
| | - Josephine M. Forbes
- The University of QueenslandBrisbaneAustralia
- Mater Research Institute – The University of Queensland, The Translational Research InstituteBrisbaneAustralia
| | - Peter S. Kruger
- The University of QueenslandBrisbaneAustralia
- Intensive Care Unit, Princess Alexandra HospitalBrisbaneAustralia
| | - Adam M. Deane
- Department of Critical Care, Melbourne Medical SchoolUniversity of MelbourneParkvilleMelbourneAustralia
| | - Casper G. Schalkwijk
- Department of Internal MedicineMaastricht University Medical Centre+MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIM, Maastricht UniversityMaastrichtThe Netherlands
| | - Kyle C. White
- The University of QueenslandBrisbaneAustralia
- Intensive Care Unit, Princess Alexandra HospitalBrisbaneAustralia
- Faculty of Health, School of Clinical MedicineQueensland University of TechnologyBrisbaneAustralia
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Phothikun N, Pantatong O, Kulpanun M, Wongpunkamol S, Lapisatepun W, Phothikun A, Lapisatepun W. The impact of perioperative positive fluid balance on postoperative acute kidney injury in patients undergoing open hepatectomy: A retrospective single center cohort study. PLoS One 2025; 20:e0319856. [PMID: 40168322 PMCID: PMC11960907 DOI: 10.1371/journal.pone.0319856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 02/11/2025] [Indexed: 04/03/2025] Open
Abstract
BACKGROUND Low central venous pressure (CVP) or fluid restriction strategies are frequently employed during liver parenchymal resection to minimize intraoperative blood loss. However, both hypovolemia and excessive fluid administration can impair organ perfusion, increasing the risk of renal dysfunction and acute kidney injury (AKI). This study explores the relationship between perioperative fluid management strategies and renal outcomes in patients undergoing hepatectomy. METHOD A retrospective single-center cohort study was conducted involving 691 patients who underwent an open hepatectomy. Patients were categorized by positive fluid balance: <1 Liter, 1-2 Liters, and >2 Liters. Propensity score was used for matching among the groups. The incidence of acute kidney injury (AKI) was compared. Multivariable logistic regression analyzed the correlation between fluid balance and AKI risk. RESULT The overall incidence of AKI was 11.58%, with the highest occurrence in the group with a fluid balance greater than 2 Liters. This group demonstrated a significantly higher relative risk of developing AKI compared to those with positive fluid balances of <1 Liter and 1-2 Liters (adjusted RR 1.85, p = 0.042, 95% CI 1.02-3.38). An increase in fluid balance was associated with a higher incidence rate ratio for AKI (p = 0.016). Additionally, an operating time >5 hours, blood loss >1000 ml, and Child-Turcotte-Pugh class B and C were significantly associated with an increased risk of post-hepatectomy AKI. CONCLUSION Maintaining a fluid balance of 1-2 liters during hepatectomy is crucial to reducing the risk of postoperative AKI, while balances above 2 liters significantly increase it. Prolonged operating times, high blood loss, and advanced liver disease also elevate AKI risk, emphasizing the need for careful fluid management.
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Affiliation(s)
- Natsuda Phothikun
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Orapan Pantatong
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Maytinee Kulpanun
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somchai Wongpunkamol
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Worakitti Lapisatepun
- Division of Hepato-biliary and Pancreas, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Bioinformatics and Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Amarit Phothikun
- Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand
- Cardiovascular Thoracic Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Bioinformatics and Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Warangkana Lapisatepun
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Cardiovascular Thoracic Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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van Slobbe R, Herrmannova D, Boeke DJ, Lima-Walton ES, Abu-Hanna A, Vagliano I. Multimodal convolutional neural networks for the prediction of acute kidney injury in the intensive care. Int J Med Inform 2025; 196:105815. [PMID: 39914070 DOI: 10.1016/j.ijmedinf.2025.105815] [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: 12/20/2024] [Revised: 01/20/2025] [Accepted: 01/26/2025] [Indexed: 02/28/2025]
Abstract
Increased monitoring of health-related data for ICU patients holds great potential for the early prediction of medical outcomes. Research on whether the use of clinical notes and concepts from knowledge bases can improve the performance of prediction models is limited. We investigated the effects of combining clinical variables, clinical notes, and clinical concepts. We focus on the early prediction of Acute Kidney Injury (AKI) in the intensive care unit (ICU). AKI is a sudden reduction in kidney function measured by increased serum creatinine (SCr) or decreased urine output. AKI may occur in up to 30% of ICU stays. We developed three models based on convolutional neural networks using data from the Medical Information Mart for Intensive Care (MIMIC) database. The models used clinical variables, free-text notes, and concepts from the Elsevier H-Graph. Our models achieved good predictive performance (AUROC 0.73-0.90). These models were assessed both when using Scr and urine output as predictors and when omitting them. When Scr and urine output were used as predictors, models that included clinical notes and concepts together with clinical variables performed on par with models that only used clinical variables. When excluding SCr and urine output, predictive performance improved by combining multiple modalities. The models that used only clinical variables were externally validated on the eICU dataset and transported fairly to the new population (AUROC 0.68-0.77). Our in-depth comparison of modalities and text representations may further guide researchers and practitioners in applying multimodal models for predicting AKI and inspire them to investigate multimodality and contextualized embeddings for other tasks. Our models can support clinicians to promptly recognize and treat deteriorating AKI patients and may improve patient outcomes in the ICU.
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Affiliation(s)
| | | | - D J Boeke
- Elsevier B.V., Amsterdam, the Netherlands
| | | | - A Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - I Vagliano
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands.
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Berton G, Hospital M, Garciaz S, Rouzaud C, Maisano V, Hicheri Y, D'Incan Corda E, Rey J, Bisbal M, Sannini A, Chine LC, Servan L, Gonzalez F, Vey N, Mokart D, Saillard C. Outcomes of Elderly Patients Admitted to the Intensive Care Unit for Newly Diagnosed Acute Myeloid Leukemia. Eur J Haematol 2025; 114:679-689. [PMID: 39761963 PMCID: PMC11880976 DOI: 10.1111/ejh.14366] [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: 10/27/2024] [Revised: 12/09/2024] [Accepted: 12/10/2024] [Indexed: 03/06/2025]
Abstract
Acute myeloid leukemias (AMLs) are the hematological malignancies with the highest need for intensive care unit (ICU) admission due to their association with various life-threatening situations. Limited data exist regarding the outcomes of elderly individuals with AML admitted to the ICU. However, current therapeutic protocols offer the potential for extended survival in this population. This retrospective, monocentric study focused on the outcomes of individuals aged ≥ 60 years admitted to the ICU for newly diagnosed AML. It included 139 patients admitted to the ICU at the Paoli-Calmettes Institute between April 2010 and October 2020, during the initial phase of AML management. Patients were categorized into three groups based on the presence of biological criteria indicating "high risk" for complications (thrombocytopenia < 50 000/mm3 and leukocytosis > 50 000/mm3) and organ failure. Multiple logistic regression models were employed to identify predictive factors for in-hospital and day 90 mortality, while Cox regression was used for 1-year mortality. The rates of in-hospital, day 90, and 1-year mortality were 37%, 42%, and 60%, respectively. Variables associated with in-hospital mortality included the Charlson Comorbidity Index, the need for invasive mechanical ventilation (MV), and multi-organ failure. ELN17 risk was significantly associated with 1-year mortality rates. This study demonstrates the benefits of ICU management for individuals aged ≥ 60 years during the initial phase of AML. It illustrates the effects of age, comorbidities, and the severity of organ failures on short-term mortality and highlights the impact of classical prognostic markers on long-term mortality.
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Affiliation(s)
- Guillaume Berton
- Department of Hematology, Institut Paoli‐CalmettesINSERM UMR 1068, CNRS UMR725, CNRS, Aix‐Marseille UniversityMarseilleFrance
| | - Marie‐Anne Hospital
- Department of Hematology, Institut Paoli‐CalmettesINSERM UMR 1068, CNRS UMR725, CNRS, Aix‐Marseille UniversityMarseilleFrance
| | - Sylvain Garciaz
- Department of Hematology, Institut Paoli‐CalmettesINSERM UMR 1068, CNRS UMR725, CNRS, Aix‐Marseille UniversityMarseilleFrance
| | - Camille Rouzaud
- Department of Hematology, Institut Paoli‐CalmettesINSERM UMR 1068, CNRS UMR725, CNRS, Aix‐Marseille UniversityMarseilleFrance
| | - Valerio Maisano
- Department of Hematology, Institut Paoli‐CalmettesINSERM UMR 1068, CNRS UMR725, CNRS, Aix‐Marseille UniversityMarseilleFrance
| | - Yosr Hicheri
- Department of Hematology, Institut Paoli‐CalmettesINSERM UMR 1068, CNRS UMR725, CNRS, Aix‐Marseille UniversityMarseilleFrance
| | - Evelyne D'Incan Corda
- Department of Hematology, Institut Paoli‐CalmettesINSERM UMR 1068, CNRS UMR725, CNRS, Aix‐Marseille UniversityMarseilleFrance
| | - Jerome Rey
- Department of Hematology, Institut Paoli‐CalmettesINSERM UMR 1068, CNRS UMR725, CNRS, Aix‐Marseille UniversityMarseilleFrance
| | - Magali Bisbal
- Intensive Care UnitInstitut Paoli‐CalmettesMarseilleFrance
| | | | | | - Luca Servan
- Intensive Care UnitInstitut Paoli‐CalmettesMarseilleFrance
| | | | - Norbert Vey
- Department of Hematology, Institut Paoli‐CalmettesINSERM UMR 1068, CNRS UMR725, CNRS, Aix‐Marseille UniversityMarseilleFrance
| | - Djamel Mokart
- Intensive Care UnitInstitut Paoli‐CalmettesMarseilleFrance
| | - Colombe Saillard
- Department of Hematology, Institut Paoli‐CalmettesINSERM UMR 1068, CNRS UMR725, CNRS, Aix‐Marseille UniversityMarseilleFrance
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Zhao Q, Huang J, Qin M, Tang Y, Liu Z, Li Y, Guo Z, Dan J, Nie Y, He X. Protective value of ischemia-free liver transplantation on post-transplant acute kidney injury. JHEP Rep 2025; 7:101339. [PMID: 40226114 PMCID: PMC11986513 DOI: 10.1016/j.jhepr.2025.101339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 01/21/2025] [Accepted: 01/22/2025] [Indexed: 04/15/2025] Open
Abstract
Background & Aims Ischemia-free liver transplantation (IFLT) completely avoids ischemia-reperfusion injury (IRI), thus potentially reducing acute kidney injury (AKI) after liver transplantation (LT). Therefore, this study investigated whether IFLT has a protective effect against AKI after LT. Methods In total, 862 patients who had undergone LT between 2017 to 2022 were divided into an ischemia-free liver transplantation group (IFLT group) and conventional liver transplantation group (CLT group) based on the surgical methods used. Propensity score matching (PSM) was used for post hoc randomization in the 1:1 matching between the groups. Post-transplant kidney function, graft function, and patient survival were compared between the groups. Multivariate logistic regression analysis was used to identify the risk factors of AKI after LT. Results Overall, 745 out of 862 patients were finally enrolled, of whom 98 underwent IFLT. PSM created 94 pairs of patients. IFLT resulted in a significant reduction in Stage-3 AKI (3.2% vs. 16.0%, p = 0.003), severe AKI (SAKI) (13.8% vs. 25.5%, p = 0.044), and renal replacement therapy (RRT) ratio (3.2% vs. 12.8%, p = 0.015) compared with the CLT group. The early allograft dysfunction (EAD) incidence of the IFLT group significantly decreased (8.5% vs. 44.7%, p <0.001). Livers from the extended criteria donation (ECD) were received in 49 patients who underwent IFLT and 46 patients who underwent CLT. Compared with the ECD-CLT group, the Stage-3 AKI and SAKI incidence in the ECD-IFLT group were both decreased (p <0.05). Multivariate logistic regression analysis further confirmed that both using IFLT and avoiding ECD were protective factors for post-transplant Stage-3 AKI. Conclusions IFLT significantly reduces the incidence of post-transplant SCKI, Stage-3 AKI, and RRT. Importantly, this protective effect is also present in patients receiving ECD livers. Impact and implications Ischemia-free liver transplantation significantly reduces the incidence of severe acute kidney injury, Stage-3 acute kidney injury and renal replacement therapy after liver transplantation. Importantly, this protective effect is also present in patients receiving extended criteria donation livers. Clinical trial number ChiCTR2400081755.
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Affiliation(s)
- Qiang Zhao
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China
| | - Jinbo Huang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China
| | - Meiting Qin
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China
| | - Yunhua Tang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China
| | - Zhiying Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Yefu Li
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China
| | - Zhiyong Guo
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China
| | - Jia Dan
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China
| | - Yu Nie
- General Surgery Center, Department of Hepatobiliary Surgery II, Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoshun He
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, China
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Brandewie K, Alten JA, Goldstein SL, Rose J, Kim ME, Ollberding NJ, Zang H, Gist KM. C-C motif chemokine ligand 14 characterization for prediction of persistent severe AKI in post-cardiac surgery children. Pediatr Nephrol 2025; 40:1103-1109. [PMID: 39557702 DOI: 10.1007/s00467-024-06592-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 10/22/2024] [Accepted: 10/28/2024] [Indexed: 11/20/2024]
Abstract
BACKGROUND We evaluate the association of early postoperative urinary c-c motif chemokine ligand 14 (CCL14) and persistent severe acute kidney injury (AKI) in pediatric post-cardiac surgery patients. METHODS This is a retrospective single-center cohort study of patients < 18 years of age undergoing cardiac surgery who provided a biorepository urine sample within the first 24 postoperative hours. Persistent severe AKI was defined as any AKI stage lasting for ≥ 72 h with at least one time point of AKI stage 2 or 3 during that time frame. Patients with persistent severe AKI were matched 2:1 with non-AKI patients on age and sex. Urine samples were measured for CCL14 concentration. Logistic regression was used to evaluate associations between CCL14 and persistent severe AKI. RESULTS Persistent severe AKI occurred in 14 (5.4%) patients and was more common in patients with higher surgical complexity and longer cardiopulmonary bypass and cross-clamp duration. Patients with persistent severe AKI had longer median cardiac intensive care unit (CICU) (5 [3, 10] vs. 2 [1.5, 5.5], p-value = 0.039) and hospital length of stays (13.5 [7.8, 16.8] vs. 6 [4,8], p-value = 0.009). There was no difference in CCL14 levels between patients with and without persistent severe AKI (46.7 pg/ml [31.0, 82.9] vs. 44.2 pg/ml [25.1, 74.9], p-value = 0.49) in univariable and logistic regression. CONCLUSIONS In this heterogenous cohort of children undergoing cardiac surgery, CCL14 was not associated with persistent severe AKI. Future studies are needed to evaluate the use of CCL14 for predicting persistent severe AKI in children.
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Affiliation(s)
- Katie Brandewie
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Jeffrey A Alten
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James Rose
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael E Kim
- Divison of Critical Care Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nicholas J Ollberding
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Huaiyu Zang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katja M Gist
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Nusca A, Di Bitonto MP, Spanò A, Bernardini F, Mangiacapra F, Ricottini E, Melfi R, Giannone S, Ussia GP, Grigioni F. Effects of Novel Antidiabetic Agents on Contrast-Associated Acute Kidney Injury in Diabetic Patients Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2025; 240:50-56. [PMID: 39805357 DOI: 10.1016/j.amjcard.2025.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 01/03/2025] [Accepted: 01/09/2025] [Indexed: 01/16/2025]
Abstract
Contrast-associated acute kidney injury (CA-AKI) remains a serious complication after percutaneous coronary revascularization (PCI), with limited effective preventive strategies especially for diabetic patients. This study aimed to assess the effects of novel antidiabetic agents (NAD), i.e., glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium-glucose transporter-2 inhibitors (SGLT2i), and dipeptidyl peptidase-4 inhibitors (DPP4i), on the occurrence of this outcome in diabetic patients undergoing PCI. We enrolled 293 consecutive diabetic patients receiving NAD at the time of PCI (NAD group) and paired them with 293 diabetic individuals undergoing revascularization who were not on NAD (no-NAD group), matched according to age and sex. CA-AKI was defined as an increase in serum creatinine (SCr) ≥0.3 mg/dl or >50% from baseline within 48 to 72 hours after contrast exposure. A propensity score-adjusted logistic regression analysis was performed to account for potential selection bias. NAD treatment was associated with a significantly reduced incidence of CA-AKI than standard glucose-lowering therapies (4.1 vs. 8.5%, p = 0.023). Furthermore, patients using SGLT2i and GLP-1RAs exhibited a lower incidence of CA-AKI compared to those taking DPP4i. Both multivariate and propensity-score-adjusted regression analyses identified NAD therapy as an independent predictor of CA-AKI (OR 0.45, 95% CI 0.22-0.98, p = 0.040 and OR 0.48, 95% CI 0.23-0.98, p = 0.045). In conclusion, this study is the first to explore the potential benefit of all three NAD classes on CA-AKI incidence. The use of these agents is associated with a lower incidence of renal damage in diabetic patients undergoing PCI, with the greatest benefit observed with SGLT2i and GLP-1RAs use.
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Affiliation(s)
- Annunziata Nusca
- Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.
| | - Maria Pia Di Bitonto
- Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Agostino Spanò
- Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Federico Bernardini
- Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Fabio Mangiacapra
- Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Elisabetta Ricottini
- Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Rosetta Melfi
- Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Sara Giannone
- Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Gian Paolo Ussia
- Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Francesco Grigioni
- Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
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Grins E, Wijk J, Bjursten H, Zeaiter M, Lindstedt S, Dellgren G, Ederoth P, Lannemyr L. Acute kidney injury after lung transplantation, incidence, risk factors, and effects: A Swedish nationwide study. Acta Anaesthesiol Scand 2025; 69:e70014. [PMID: 40066686 PMCID: PMC11894586 DOI: 10.1111/aas.70014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 01/26/2025] [Accepted: 02/22/2025] [Indexed: 03/14/2025]
Abstract
BACKGROUND Acute kidney injury (AKI) is a serious complication after lung transplantation, but the reported incidence varies in the literature. No data on AKI have been published from the Swedish lung transplantation program. METHODS The aim of our study was to investigate the incidence, perioperative risk factors, and effects of early postoperative acute kidney injury (Kidney Disease Improving Global Outcomes [KDIGO] criteria) after lung transplantation. A retrospective, nationwide study of 568 lung-transplanted patients in Sweden between 2011 and 2020 was performed. RESULTS The incidence of AKI (any grade) was 42%. Renal replacement therapy was used in 5% of the patients. Preoperative factors independently associated with increased incidence of AKI were higher body mass index (odds ratio [OR]: 1.07, 95% CI: 1.02, 1.12) longer time on transplantation waiting list (OR: 1.05 [1.01, 1.09]), re-transplantation (OR: 2.24 [1.05, 4.80]) and moderate to severe tricuspid regurgitation (OR: 2.61 [1.36, 5.03]). Intraoperative factors independently associated with increased incidence of AKI were use of cardiopulmonary bypass (OR: 2.70 [1.57, 4.63]), increasing number of transfused red blood cell units, and use of immunosuppressive therapy other than routine (OR: 2,56 [1.47, 4.46]). A higher diuresis (OR: 0.70, 95% CI: 0.58-0.85) was associated with less incidence of acute kidney injury. Development of AKI was associated with increased time to extubation (median 30 h, IQR [9, 118] vs. 6 [3, 16]), length of stay in the intensive care unit (9 days [4, 25] vs. 3 [2, 5]) and increased rate of primary graft dysfunction (OR 2.33 [1.66, 3.29]) and 30-day mortality (OR: 10.8 [3.0, 69]). CONCLUSIONS Acute kidney injury is common after lung transplantation and affects clinical outcomes negatively. Preoperative factors may be used for risk assessment. The use of cardiopulmonary bypass is a potentially modifiable intraoperative risk factor. EDITORIAL COMMENT Acute kidney injury is a common complication after lung transplantation that severely influences patient outcomes. This large study of more than 500 patients treated over a decade identified potentially modifiable factors associated with the development of acute kidney injury.
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Affiliation(s)
- Edgars Grins
- Department of Anesthesiology and Intensive Care, Department of Clinical SciencesLund UniversityLundSweden
- Department of Cardiothoracic and Vascular Surgery, Anesthesia and Intensive CareSkane University HospitalLundSweden
| | - Johanna Wijk
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg and Section for Cardiothoracic Anesthesia and Intensive CareSahlgrenska University HospitalGothenburgSweden
| | - Henrik Bjursten
- Department of Cardiothoracic and Vascular Surgery, Anesthesia and Intensive CareSkane University HospitalLundSweden
| | - Maria Zeaiter
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg and Section for Cardiothoracic Anesthesia and Intensive CareSahlgrenska University HospitalGothenburgSweden
| | - Sandra Lindstedt
- Department of Cardiothoracic and Vascular Surgery, Anesthesia and Intensive CareSkane University HospitalLundSweden
- Lund Stem Cell CentreLund UniversityLundSweden
| | - Göran Dellgren
- Department of Molecular and Clinical MedicineSahlgrenska Academy, Gothenburg UniversityGothenburgSweden
- Department of Cardiothoracic SurgerySahlgrenska University HospitalGothenburgSweden
| | - Per Ederoth
- Department of Anesthesiology and Intensive Care, Department of Clinical SciencesLund UniversityLundSweden
- Department of Cardiothoracic and Vascular Surgery, Anesthesia and Intensive CareSkane University HospitalLundSweden
| | - Lukas Lannemyr
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg and Section for Cardiothoracic Anesthesia and Intensive CareSahlgrenska University HospitalGothenburgSweden
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Frenzel T, Wels T, Pietsch H, Schöckel L, Seidensticker P, Endrikat J. Recent Developments and Future Perspectives in Magnetic Resonance Imaging and Computed Tomography Contrast Media. Invest Radiol 2025:00004424-990000000-00313. [PMID: 40163898 DOI: 10.1097/rli.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
ABSTRACT This review provides a comprehensive analysis of recent advancements in computed tomography (CT) and magnetic resonance imaging (MRI) contrast media, offering a critical evaluation of current trends and exploring future directions in the field. New clinical developments within the last 5-8 years are considered as well as clinical efficacy and safety aspects.For CT, the general safety of low- and iso-osmolar iodinated contrast agents and their effect on renal and thyroid function are reviewed. Special attention is given to contrast-enhanced mammography and a short outlook to photon-counting CT is provided.For MRI, a brief update on general safety, nephrogenic systemic fibrosis and the presence of gadolinium in the brain is given. The 2 new high-relaxivity gadolinium-based contrast agents, gadopiclenol and gadoquatrane (in late-stage clinical development), are highlighted.The review also describes targeted gadolinium-based contrast agents, superparamagnetic iron oxide particles, and developments of manganese-based contrast agents. It also introduces the emerging field of glymphatic imaging.
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Affiliation(s)
- Thomas Frenzel
- From the Bayer AG, Radiology, Berlin, Germany (T.F., H.P., L.S., J.E.); Wels - Omnino Medico, Rotkreuz, Switzerland (T.W.); Bayer U.S. LLC, Indianola, PA (P.S.); and Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany (J.E.)
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Rane RP, Soundranayagam S, Shade DA, Nauer K, DuMont T, Nashar K, Balaan MR. Renal Involvement in Sepsis: Acute Kidney Injury. Crit Care Nurs Q 2025; 48:100-108. [PMID: 40009857 DOI: 10.1097/cnq.0000000000000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2025]
Abstract
Acute kidney injury (AKI) is a common complication of sepsis due to a myriad of contributing factors and leads to significant morbidity and mortality in critically ill patients. Prompt identification and management are vital to reverse and/or prevent the worsening of AKI. When renal function is severely compromised, there may be a need for dialytic therapy to meet the metabolic needs of patients. This article will review the definition of AKI, epidemiology, risk factors, and pathophysiology of AKI in sepsis, along with both non-dialytic and dialytic treatment strategies. We will also review landmark trials in fluid resuscitation in sepsis.
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Affiliation(s)
- Rahul Prakash Rane
- Author Affiliations: Division of Pulmonary and Critical Care, Medicine Institute, Allegheny Health Network, Pittsburgh, Pennsylvania (Dr Rane, Dr Shade, Mr Nauer, Dr DuMont, and Dr Balaan); Division of Nephrology and Critical Care, Medicine Institute, Allegheny Health Network, Pittsburgh, Pennsylvania (Dr Soundranayagam); and Division of Nephrology, Medicine Institute, Allegheny Health Network , Pittsburgh, Pennsylvania (Dr Nashar)
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Yi Y, Tae M, Shin S, Choi SI. Predicting acute kidney injury in trauma using an extreme gradient boosting model. Clin Kidney J 2025; 18:sfaf002. [PMID: 40207098 PMCID: PMC11980976 DOI: 10.1093/ckj/sfaf002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Indexed: 04/11/2025] Open
Abstract
Background Acute kidney injury (AKI) is a significant complication in patients with trauma. The early identification of AKI in these patients poses challenges. This study aimed to predict AKI in trauma patients 24 or 48 hours in advance using an extreme gradient boosting (XGBoost) model. Methods We analyzed 17 859 trauma patients admitted to a regional trauma center between January 2015 and July 2023. Demographic, clinical, and laboratory parameters were collected. The model was developed using data until July 2021 and validated using data from August 2021. We developed models to predict AKI stages 1-3 and AKI stages 2 and 3 occurring 48 and 24 hours later and measured predictive performance in the validation group. The models' performance was evaluated using the area under the receiver operating characteristic curve (AUROC), and feature importance was assessed through SHapley Additive exPlanations values. Results The study population exhibited an incidence of AKI of 6.6% in the development group and 5.4% in the validation group. The models demonstrated predictive performance with AUROCs of 0.864 and 0.886 for 48-hour predictions of AKI stages 1-3 and stages 2 and 3, and 0.904 and 0.903 for 24-hour predictions of AKI stages 1-3 and stages 2 and 3, respectively. Key features influencing model predictions included baseline and in-hospital serum creatinine values, injury severity score, age, lactate dehydrogenase, D-dimer, platelets, albumin, and C-reactive protein levels. Conclusions The XGBoost models effectively predicted AKI in trauma patients up to 48 hours in advance using clinical data.
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Affiliation(s)
- Yongjin Yi
- Department of Internal Medicine, College of Medicine, Dankook University, Dongnam-gu, Chungcheongnam-do, Cheonan-si, Republic of Korea
| | - Minwoo Tae
- Department of Artificial Intelligence-based Convergence, Dankook University, Suji-gu, Gyeonggi-do, Yongin-si, Republic of Korea
| | - Sujong Shin
- Department of Artificial Intelligence-based Convergence, Dankook University, Suji-gu, Gyeonggi-do, Yongin-si, Republic of Korea
| | - Sang-Il Choi
- Department of Computer Engineering, Dankook University, Gyeonggi-do, Yongin-si, Republic of Korea
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