ABSTRACT
Objective:This study aimed to explore the performance of renal resistive index (RRI), semiquantitative power Doppler ultrasound (PDU) score, and renal venous Doppler waveform (RVDW) pattern in predicting 28-day renal dysfunction in critically ill patients and establish nomogram model.Methods:This was a prospective, observational study. Critically ill patients admitted to the emergency intensive care unit (ICU) of Cangzhou Central Hospital from January 2018 to October 2022 were included. Patients underwent renal ultrasound examination to obtain RRI, PDU score and RVDW pattern within 24 h after ICU admission. The following clinical variables were collected during the renal ultrasound examination session, including heart rate, mean arterial pressure, type and dose of vasoactive drugs, oxygen therapy parameters, and average urine volume per hour derived from a period of 6 h prior to the ultrasound examination. The data on duration of AKI and mortality were recorded on the 28th day of follow-up. Patients were divided into 28-day normal renal function group and 28-day renal dysfunction group according to 28-day renal dysfunction. 28-days of renal dysfunction was defined as failure to achieve renal function recovery within 28 days of ICU admission. The difference of each index between the two groups was compared. Associated factors for 28-day renal dysfunction were determined by univariate and multivariate COX regression analyses. A nomogram was developed based on the independently factors associated with 28-day renal dysfunction. Survival receiver operator characteristic (ROC) curves were plotted to assess diagnostic performance in predicting 28-day renal dysfunction. Delong’s test was used to compare area under the curves (AUC) between each predictor.Results:187 patients were enrolled for the final analysis: 97 with no AKI, 48 with AKI stage 1, 24 with AKI stage 2, and 18 with AKI stage 3 upon enrollment. At 28-day follow up, 16 patients had renal dysfunction and 2 required continuous renal replacement therapy (CRRT). The multivariate COX regression showed that RVDW and SCr upon enrollment were the independent risk predictors. Nomogram based on RVDW and SCr upon enrollment showed the best performance in predicting 14-day renal dysfunction (AUC = 0.918, 95% CI:0.871-0.964, P<0.05), and the AUC was statistically significantly higher than single index (all P<0.05). Nomogram also showed the best performance in predicting 28-day renal dysfunction (AUC = 0.924, 95% CI:0.865-0.983, P<0.05), and the AUC was statistically significantly higher than single index (all P<0.05) except for SCr upon enrollment. The optimal cutoff for nomogram in predicting 28-day renal dysfunction was ≤89.5 (sensitivity, 81.2%; specificity, 90.6%; Youden index, 0.719). Kaplan-Meier analysis showed that the median duration of renal dysfunction in the groups with total nomogram score >85.9 and ≤85.9 was 0 and 22 days (HR=0.220, 95% CI:0.129-0.376, P<0.001). Conclusions:SCr and RVDW pattern within 24 h from ICU admission were independent factors associated with 28-day renal dysfunction in critically ill patients. The value of the nomogram model based on these two factors in predicting 28-day renal dysfunction is superior to each single intrarenal Doppler spectrum indicator and clinical indicator.
ABSTRACT
Background: Risk stratification of deep vein thrombosis in patients admitted to ICU and incorporating DVT risk assessment score as a regular practice were the aim of the present study.Methods: This study was carried out in 67 patients admitted in ICU >18 years of age, over one year. Patients with confirmed DVT, <48 hours of stay, thrombocytopenia, diagnosed coagulation disorders, those who have received DVT prophylaxis in last 1 month and those with active bleeding were excluded. It was a cross sectional observational study. A SMART assessment score and pretest probability scoring card was used. Mechanical or pharmacological prophylaxis was given to those with moderate and high risk for DVT.Results: As per SMART assessment score 4.5%, 41.8%, 6% and 23.9% had no, moderate, high and highest risk of developing DVT. As per the pretest probability scores 76%, 20.9% and 3% were in low, moderate and high-risk group. Both scoring systems are comparable (p=0.001). There was significant association between paralysis (p value was 0.003), central venous access (p value was 0.006), patient bed ridden for >72 hours (p value was 0.009) and risk group.Conclusions: Prolonged bed rest, paralysis and central venous access are the most important contributing conditions for high risk of DVT. Risk stratification should be routinely performed in ICU. SMART assessment tool and pre-test probability scores are both equally efficacious in identifying high risk patients for DVT. Both mechanical and pharmacological means of DVT prophylaxis are equally effective in preventing DVT.
ABSTRACT
Se logró un consenso entre especialistas del Diagnóstico por Imágenes y cirujanos flebólogos en el protocolo de realización de los estudios Doppler para la insuficiencia venosa de miembros inferiores (MMII), incluyendo un acuerdo sobre la fisiopatología de la enfermedad, la nomenclatura y diámetros de los vasos que componen los distintos sistemas venosos y los parámetros Doppler a utilizar en la confección del informe de los estudios. Se realizó una reunión entre 6 cirujanos vasculares y 10 especialistas en Diagnóstico por Imágenes, donde se discutieron los distintos ítems planteados. Además, durante el encuentro se realizaron dos estudios Doppler de miembros inferiores a manera de ejemplo y se elaboró un documento preliminar con los puntos acordados. El resultado de este encuentro multidisciplinario es el punto de partida para comenzar a manejar una terminología común que permita mejorar el diagnóstico y la conducta terapéutica de esta patología
A consensus among Diagnostic Imaging specialists and vascular surgeons on a protocol for carrying out Doppler studies for lower limb venous insufficiency is presented. This includes an agreement on the pathophysiology of the disease, the nomenclature and vessel diameters that make up the different venous systems, as well as the Doppler parameters to be used in the for reporting the studies. A meeting was held with 6 vascular surgeons and 10 imaging specialists in which these different items were discussed. Two Doppler studies of the lower limbs were performed during this meeting as an example, and a draft document was prepared on the points agreed
Subject(s)
Humans , Ultrasonic Therapy , Venous Insufficiency , Ultrasonography, Doppler , Ultrasonics , Diagnostic Imaging , Doppler EffectABSTRACT
Venous insufficiency is defined as an impaired venous return, which affects the superficial, or the deep system, or both. This condition may be caused either by an alteration in the muscle pump, a venous obstruction, a valvular incompetence or right-sided heart failure. It translates into a dynamic venous hypertension manifested through the development of varicose veins or trophic skin changes. The surface failure is due to the presence of veno-venous shunts that provoke a flow loss from the deep system through a vanishing point and then returns through another entry point. The study is performed with the patient in standing position, stimulating muscle pump through various exercises or increasing central pressure with Valsalva maneuver. The mapping is a graphic expression of the study, and it must show the type of shunt, location and pattern of varicose veins.
La insuficiencia venosa se define como una alteración en el retorno venoso, que compromete el sistema superficial, profundo o ambos, cuya causa puede ser alteración en la bomba muscular, obstrucción venosa, incompetencia valvular o falla cardíaca derecha. Se traduce en una hipertensión venosa dinámica que se manifiesta a través del desarrollo de várices, o cambios tróficos de la piel. La insuficiencia superficial se debe a la presencia de shunts veno-venosos, que consisten en cortocircuitos en que se pierde flujo desde el sistema profundo a través de un punto de fuga y luego regresa por otro punto de entrada. El estudio se realiza de pie, estimulando la bomba muscular a través de distintas maniobras o aumentando la presión central con Valsalva. El mapeo es la expresión gráfica del estudio, y debe demostrar el tipo de shunt, localización y patrón varicoso.