ABSTRACT
<p><b>BACKGROUND</b>Urine output (UO) is an essential criterion of the Kidney Disease Improving Global Outcomes (KDIGO) definition and classification system for acute kidney injury (AKI), of which the diagnostic value has not been extensively studied. We aimed to determine whether AKI based on KDIGO UO criteria (KDIGOUO) could improve the diagnostic and prognostic accuracy, compared with KDIGO serum creatinine criteria (KDIGOSCr).</p><p><b>METHODS</b>We conducted a secondary analysis of the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a 2-month prospective cohort study (July 1, 2009 to August 31, 2009) involving 3063 patients in 22 tertiary Intensive Care Units in Mainland of China. AKI was diagnosed and classified separately based on KDIGOUOand KDIGOSCr. Hospital mortality of patients with more severe AKI classification based on KDIGOUOwas compared with other patients by univariate and multivariate regression analyses.</p><p><b>RESULTS</b>The prevalence of AKI increased from 52.4% based on KDIGOSCrto 55.4% based on KDIGOSCrcombined with KDIGOUO. KDIGOUOalso resulted in an upgrade of AKI classification in 7.3% of patients, representing those with more severe AKI classification based on KDIGOUO. Compared with non-AKI patients or those with maximum AKI classification by KDIGOSCr, those with maximum AKI classification by KDIGOUOhad a significantly higher hospital mortality of 58.4% (odds ratio [OR]: 7.580, 95% confidence interval [CI]: 4.141-13.873, P< 0.001). In a multivariate logistic regression analysis, AKI based on KDIGOUO (OR: 2.891, 95% CI: 1.964-4.254, P< 0.001), but not based on KDIGOSCr (OR: 1.322, 95% CI: 0.902-1.939, P = 0.152), was an independent risk factor for hospital mortality.</p><p><b>CONCLUSION</b>UO was a criterion with additional value beyond creatinine criterion for AKI diagnosis and classification, which can help identify a group of patients with high risk of death.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Acute Disease , Mortality , Creatinine , Blood , Critical Illness , Mortality , Hospital Mortality , Kaplan-Meier Estimate , Kidney Diseases , Blood , Mortality , Pathology , Urine , Logistic Models , Prognosis , Prospective Studies , Risk FactorsABSTRACT
<p><b>AIM</b>To evaluate the therapeutic effects of a left ventricular assist device (LVAD) on pump failure caused by acute myocardial infarction (AMI) in dogs.</p><p><b>METHODS</b>The pump failure caused by AMI was established in 18 dogs, 9 of them were treated with a LVAD that could expel the autoblood from the left ventricle into the aorta and named the experimental group, and the rest of them were treated with intravenous infusion and served as the control group. The changes of arrhythmia, mortality, pulmonary capillary wedge pressure (PCWP), left ventricular end-diastolic pressure (LVEDP), peripheral artery pressure and the diameter of left ventricular chamber were observed.</p><p><b>RESULTS</b>The ratio of ventricular extrasystole and the mortality resulted from ventricular fibrillation of the experimental group were lower than that of the control group. The systolic blood pressure of peripheral artery of the control group was significantly lower (< 100 mmHg) than that of the experimental group (>100 mmHg, P < 0.01). The PCWP and LVEDP of the experimental group during all the stages 45 minutes after the procedures were significantly lower than that of the control group (P < 0.01). The left ventricular end-diastolic diameter of the control group was larger than that of the experimental groups (P < 0.01).</p><p><b>CONCLUSION</b>To assist circulation by expelling autoblood from left ventricle into aorta in dogs with AMI could reduce the frequency of ventricular fibrillation, improve hemodynamics, and prevent the enlargement of left ventricle. Therefore, it could play an important role in assisting the left ventricular functions.</p>