ABSTRACT
ABSTRACT Objective To investigate the impacts of continuous venovenous hemodiafiltration on the microcirculation in patients with acute kidney injury. Methods A prospective observational pilot study conducted in a 40-bed, open clinical-surgical intensive care unit of a private tertiary care hospital located in the city of São Paulo (SP), Brazil. Microcirculation was assessed using near-infrared spectroscopy by means of a 15mm probe placed over the thenar eminence. Vascular occlusion test was performed on the forearm to be submitted to near-infrared spectroscopy by inflation of a sphygmomanometer cuff to 30mmHg higher than the systolic arterial pressure. The primary endpoint was the assessment of near-infrared spectroscopy-derived parameters immediately before, 1, 4 and 24 hours after the initiation of continuous venovenous hemodiafiltration. Results Nine patients were included in this pilot study over a period of 2 months. Minimum tissue oxygen saturation measured during the vascular occlusion test was the only near-infrared spectroscopy-derived parameter to differed over the time (decrease compared to baseline values up to 24 hours after initiation of continuous venovenous hemodiafiltration). Conclusion The impacts of microcirculatory dysfunction on clinical outcomes of patients undergoing to continuous venovenous hemodiafiltration need to be further investigated.
RESUMO Objetivo Avaliar o impacto da hemodiafiltração venovenosa contínua na microcirculação de pacientes com lesão renal aguda. Métodos Estudo piloto, prospectivo e observacional conduzido em uma unidade de terapia intensiva clínico-cirúrgica aberta, com 40 leitos, localizada em um hospital terciário, privado, na cidade de São Paulo (SP), Brasil. A microcirculação foi avaliada empregando-se a espectroscopia no infravermelho próximo, por meio de uma sonda de 15mm posicionada sobre a eminência tenar. O teste de oclusão vascular foi realizado no antebraço a ser submetido à espectroscopia no infravermelho próximo, inflando-se o manguito de um esfigmomanômetro a um valor 30mmHg acima da pressão arterial sistólica. O desfecho primário foi a avaliação dos parâmetros derivados por espectroscopia no infravermelho próximo imediatamente antes, 1, 4 e 24 horas após o início da hemodiafiltração venovenosa contínua. Resultados Foram incluídos nove pacientes neste estudo piloto ao longo de 2 meses. A saturação de oxigênio tecidual mínima mensurada durante o teste de oclusão vascular foi o único parâmetro derivado por espectroscopia no infravermelho próximo que diferiu ao longo do tempo, com queda em relação aos valores iniciais nas primeiras 24 horas após o início da hemodiafiltração venovenosa contínua. Conclusão A influência da disfunção microcirculatória sobre os desfechos clínicos de pacientes submetidos à hemodiafiltração venovenosa contínua precisa ser melhor investigada.
Subject(s)
Humans , Male , Female , Hemodiafiltration/methods , Acute Kidney Injury/diagnostic imaging , Microcirculation/physiology , Pilot Projects , Prospective Studies , Spectroscopy, Near-Infrared , Acute Kidney Injury/physiopathology , Acute Kidney Injury/therapy , Middle AgedABSTRACT
Objective To investigate the incidence and mortality of acute kidney injury (AKI) in posttraumatic patients, and to analyze the risk factors influencing the incidence and outcomes of AKI. Methods Totally 4 221 patients with trauma who were admitted to No. 309 Hospital of PLA between Jan. 2004 and Jan. 2014 were screened and subjected to a retrospective study, and the incidence rate of AKI and mortality were analyzed. Multivariate logistic regression analysis was conducted to identify the risk factors for the incidence and prognosis of the patients with AKI. Results The incidence of AKI in posttraumatic patients in this study was 11. 6% (489/4 221) according to the classification and diagnosis criteria from Kidney Disease:Improving Global Outcomes (KDIGO), and 46. 0% (225/489) of them died prior to hospital discharge. There was an increasing hospital mortality tendency with the increase of AKI severity, with the hospital mortality rates being 30. 1% (84/279), 54. 6% (53/97), and 77. 9% (88/113) in AKI patients with KDIGO 1, 2, and 3 stage, respectively. Multivariate logistic regression analysis showed that increase of age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores on admission > 17, injury severity score (ISS) on admission > 16, severe head injury, abdominal organ injury, rhabdomyolysis, shock and respiration system dysfunction were risk factors for occurrence of AKI (P25, severe head injury, KDIGO stage 3, cardiovascular and respiratory system dysfunction (P < 0. 05, P < 0. 01). Conclusion AKI is a common clinical complication with high mortality in posttraumatic patients. To prevent severe complications after trauma is the key for improving the prognosis of patients.
ABSTRACT
BACKGROUND/AIMS: The frequency of symptomatic acute HAV infections in adulthood are increasing in Korea. This study analyzes the clinical severity in patients with acute HAV infection and investigates risk factors associated with three severe complications: prolonged cholestasis, acute kidney injury, and acute liver failure. METHODS: We performed a retrospective analysis of 726 patients diagnosed from January 2006 to December 2010 at three tertiary hospitals in Jeonbuk Province, Republic of Korea with acute HAV infection. RESULTS: In the group of 726 patients, the mean age was 30.3 years, 426 (58.6%) were male, and 34 (4.7%) were HBsAg positive. Severe complications from acute HAV infection occurred as follows: prolonged cholestasis in 33 (4.6%), acute kidney injury in 17 (2.3%), and acute liver failure in 16 (2.2%). Through multivariate analysis, age > or =40 years (OR 2.63, p=0.024) and peak PT (INR) > or =1.5 (OR 5.81, p=0.035) were found to be significant risk factors for prolonged cholestasis. Age > or =40 years (OR 5.24, p=0.002) and female gender (OR 3.11, p=0.036) were significant risk factors for acute kidney injury. Age > or =40 years (OR 6.91, p=0.002), HBsAg positivity (OR 5.02, p=0.049), and peak total bilirubin (OR 1.11, p=0.001) were significant risk factors for acute liver failure. CONCLUSIONS: Age > or =40 years, female gender, HBsAg positivity, peak PT (INR) > or =1.5, and peak total bilirubin were significant risk factors for severe complications in acute HAV infections.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Acute Disease , Acute Kidney Injury/complications , Cholestasis/complications , Hepatitis A/complications , Hepatitis B Surface Antigens/blood , Liver Failure, Acute/complications , Odds Ratio , Republic of Korea , Retrospective Studies , Risk Factors , Tertiary Care CentersABSTRACT
Objective: To investigate the protective effect of erythropoietin (EPO) on the acute renal injuries caused by abdomen open injury plus seawater immersion in rats. Methods: Sixty healthy male Wistar rats (clean grade) were evenly randomized into four groups,namely,EPO pre-treatment group,observation group,low-dose EPO treatment group and high-dose EPO treatment group. Acute renal injury was induced by abdomen open injury plus artificial seawater immersion (22°C). The serum creatine, BUN, creatine kinase, creatine kinase isoenzyme, TNF-α, IL-6, complement C3a, C-reactive protein, renal homogenate superoxide dismutase (SOD) , and the renal pathological changes were observed and compared between different groups. Results: Acute renal injury was observed in all groups 3 hours after abdomen open injury plus seawater immersion,with increased serum creatine and BUN,but the rats survived after treatment. The serum creatine,BUN,creatine kinase,and creatine kinase isoenzyme in EPO pre-treatment group were significantly lower than those of the other 3 groups; the levels of TNF-α,IL6, complement C3a ,and C-reactive protein were also obviously decreased; the renal homogenate SOD was obviously increased; and the score of renal proximal tubule necrosis was obviously decreased. However,no significant differences were found between the high- and low-dose EPO groups concerning all the parameters (P>0.05). Conclusion: EPO pre-treatment has a protective effect on the acute renal injury induced by abdomen open injury plus seawater immersion in rats.