Risk factors and outcomes of sepsis-associated acute kidney injury in intensive care units in Johannesburg, South Africa

Background. Sepsis-associated acute kidney injury (SA-AKI) has been shown to be a significant contributor to morbidity and mortality in both children and adults with critical illness. In sub-Saharan Africa, there is a lack of information on factors associated with development of SA-AKI and outcomes after intensive care unit (ICU) admission. Objectives. To assess the rate of SA-AKI, factors associated with its development, and predictors of mortality at 90 days in critically ill patients admitted to the ICU with sepsis. Methods. This was a prospective observational study conducted at two of the biggest teaching hospitals in Johannesburg, South Africa, from 15 February 2016 to 15 February 2020. The study included consecutive patients with confirmed sepsis who were admitted to the ICU within 24 hours of admission to hospital. The primary outcome of the study was development of SA-AKI (defined according to Kidney Disease Improving Global Outcome (KDIGO) criteria), and secondary outcomes were risk factors for SA-AKI and predictors of mortality at 90 days. Multivariate logistic regression analysis was employed to determine the factors associated with SA-AKI and 90-day mortality. Results. In total, 327 critically ill patients with sepsis admitted to the ICUs were included in the study. The median (interquartile range) age was 39 (30 - 52) years, and 185 patients (56.6%) developed SA-AKI. Of these patients, blacks and whites comprised 91.0% and 6.1%, respectively, and the prevalent comorbidities were HIV/AIDS (19.3%), hypertension (14.2%) and diabetes mellitus (10.1%). Patients with SA-AKI were likely to be older and of male gender, and to have cardiovascular disease, malignancies, hypotension and a low serum albumin level. In multivariate analysis, the predictors of SA-AKI were age ≥55 years (odds ratio (OR) 2.43; 95% confidence interval (CI) 1.27 - 4.65), inotropic support (OR 3.61; 95% CI 2.18 - 5.96) and a low serum albumin level (OR 2.93; 95% CI 1.40 - 6.13). SA-AKI and need for inotropic support were respectively associated with 1.9-fold and 1.7-fold increased mortality at 90 days after ICU admission. Conclusion. SA-AKI was found to be frequent in this study in two tertiary hospital ICUs in Johannesburg, and the need for inotropic support predicted mortality after ICU admission.

Seroprevalence of Hepatitis B Surface Antigen (HBsAg) among Children of Primary School Age in a Community; North-Central; Nigeria

Globally; Hepatitis B Virus has been identified as one of the most common infectious diseases and a major public health problem.This study was therefore carried out to assess the prevalence of Hepatitis B virus infection among primary school children attending LGE primary school; Sabon Pegi; Kuru; Nigeria. Three hundred and sixty (360) blood samples were collected from the pupils and sera separated and analyzed for HBsAg using one step Hepatitis B surface antigen test strip. Of the 360 samples screened; 35 (9.7) were sero-positive. Pupils within the age 7-9 years had the highest prevalence of 3.9. Male subjects recorded a prevalence of 6.1compared to 3.6for females. Risk factors such as blood transfusion recorded 1.6. Furthermore; family history of HBV infection accounted for 3.6; while male subjects that had traditional method of circumcision recorded a high prevalence of 3.3. Unfortunately; the prevalence of this ravaging infectious agent appears to be high amongst the subjects studied. It is strongly suggested that public awareness be accorded urgent attention while socioeconomic development in these areas be given priority as a measure to preventing further spread of this virus amongst children; particularly the school age group