Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 344
Filter
1.
Arch. argent. pediatr ; 119(4): e353-e356, agosto 2021. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1281861

ABSTRACT

La bibliografía no incluye frecuentemente alteraciones en el ritmo cardíaco de los pacientes que reciben corticoesteroides; se desconoce su mecanismo exacto. En este artículo, presentamos el caso de un paciente con bradicardia sinusal asociada con una dosis de estrés de corticoesteroides. Se ingresó a un niño de 9 años con antecedentes de panhipopituitarismo con gastroenteritis y neumonía y presentó choque septicémico el día de la hospitalización. El tratamiento con líquidos intravenosos, dosis de estrés de hidrocortisona y antibióticos permitió la recuperación. Sin embargo, luego se documentó bradicardia sinusal con una frecuencia cardíaca de 45 latidos por minuto. Esta se resolvió después de reducir gradualmente la hidrocortisona. La bradicardia sinusal inducida por corticoesteroides es un efecto adverso que suele resolverse tras interrumpir el tratamiento. Se debe considerar el monitoreo hemodinámico en estos casos. Este es el primer informe de bradicardia sinusal posterior al uso de hidrocortisona en niños con insuficiencia suprarrenal


The literature does not commonly describe cardiac rhythm disturbances, including bradycardia, in patients who are receiving corticosteroids, and the exact mechanism of such disturbances remains unknown. Herein, we present a case of sinus bradycardia associated with stress-dose corticosteroid therapy. A nine-year-old boy with a history of panhypopituitarism was admitted with gastroenteritis and pneumonia and developed septic shock on the day of admission. Management using intravenous fluids, stress doses of hydrocortisone, and antibiotics resulted in full recovery. However, within 24 hours following treatment, sinus bradycardia was documented, with a heart rate of 45 beats per minute (BPM). The bradycardia resolved after the dose of hydrocortisone was decreased gradually. Corticosteroidinduced sinus bradycardia is an adverse effect that usually resolves after corticosteroid treatment is discontinued. During stress-dose corticosteroid therapy, hemodynamic monitoring should be considered. To our knowledge, this is the first report of sinus bradycardia following the use of hydrocortisone in children who have adrenal insufficiency.


Subject(s)
Humans , Male , Child , Sinoatrial Node , Bradycardia/chemically induced , Hydrocortisone/adverse effects , Adrenal Insufficiency/drug therapy , Sepsis/drug therapy , Bradycardia/diagnosis , Bradycardia/drug therapy , Hydrocortisone/administration & dosage , Adrenal Insufficiency/complications , Sepsis/complications
2.
Clin. biomed. res ; 41(1): 75-83, 2021.
Article in Portuguese | LILACS | ID: biblio-1255309

ABSTRACT

A sepse é uma disfunção orgânica aguda secundária à infecção e suas taxas de mortalidade hospitalar vêm reduzindo em muitos países nos últimos anos. Esta redução da mortalidade resulta em um maior número de pacientes que recebem alta hospitalar, porém frequentemente os sobreviventes experimentam novas incapacidades (físicas, cognitivas e psicológicas) e piora das condições crônicas de saúde em longo-prazo. Além disso, sua evolução pós-alta hospitalar cursa com elevado risco de morte e frequentes reinternações nos primeiros meses pós-hospitalização, bem como elevado uso de recursos de saúde. Esta revisão tem como objetivo descrever a morbimortalidade em longo prazo dos pacientes sobreviventes de sepse, seus efeitos sobre o sistema de saúde e as possíveis ações voltadas a minimizar as sequelas desta síndrome que acomete aproximadamente 1/3 dos pacientes admitidos em unidades de tratamento intensivo. (AU)


Sepsis is an acute organ dysfunction secondary to infection and its hospital mortality rates have been decreasing in many countries in recent years. This reduction in mortality results in a greater number of patients being discharged from the hospital, but survivors often experience new disabilities (physical, cognitive and psychological) and worsening chronic long-term health conditions. In addition, the post-discharge evolution leads to a high risk of death and frequent readmissions in the first months after hospitalization, as well as a high use of health resources. This review aims to describe the long-term morbidity and mortality of survivors of sepsis, its effects on the health system and the possible actions aimed at minimizing the sequelae of this syndrome that affects approximately 1/3 of patients admitted to intensive care units. (AU)


Subject(s)
Patient Discharge , Sepsis/mortality , Intensive Care Units , Patient Readmission , Sepsis/complications
3.
Braz. J. Vet. Res. Anim. Sci. (Online) ; 57(2): e167299, mai. 2020. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1122175

ABSTRACT

The hypothalamus-pituitary-adrenal axis function may be impaired in patients with critical illnesses, especially cases of sepsis, named critical illness-related corticosteroid insufficiency (CIRCI). This study examined the function of the hypothalamic-pituitary-adrenal axis in normal dogs (n = 10) and dogs with critical diseases (n = 16), through determinations of endogenous ACTH (adrenocorticotropic hormone), basal cortisol and cortisol after stimulation in low doses of synthetic ACTH (1.0µg/kg/IV). The stimulation test with ACTH dose tested was verified as effective for evaluation of adrenal function in healthy and sick dogs. Ill dogs differed from healthy dogs by presenting higher basal cortisol values. Eight sick dogs presented a decrease in endogenous ACTH, basal cortisol, or Δ-cortisol. No significant differences were found between the control groups and critically ill dogs for the values of endogenous ACTH, cortisol after stimulation or Δ-cortisol. We concluded that the stimulation test with low-dose ACTH was effective for evaluation of adrenal function, as well as the fact that a considerable portion of critically ill dogs studied here, especially with sepsis, had evidence of inadequate corticosteroid response to stress.(AU)


A função do eixo hipotálamo-hipófise-adrenal pode estar comprometida em pacientes com doenças críticas, em especial casos de sepse, sendo nomeada de Insuficiência Corticosteroide Relacionada à Doença Crítica (ICRDC). O presente trabalho analisou a função do eixo hipotálamo-hipófise-adrenal em cães normais (n=10) e cães portadores de doenças críticas (n=16), por meio de determinações de ACTH (hormônio adrenocorticotrófico) endógeno, de cortisol basal e de cortisol após estímulo com baixa dose de ACTH sintético (1,0µg/kg/IV). Constatou-se que o teste de estimulação com ACTH na dose testada se mostrou eficaz para avaliação da função adrenal em cães sadios e doentes. Os cães doentes diferiram dos sadios ao apresentar valores maiores de cortisol basal. Oito cães doentes apresentaram diminuição do ACTH endógeno, do cortisol basal ou do Δ-cortisol. Não foram encontradas diferenças significativas entre os grupos Controle e Criticamente enfermos para os valores de ACTH endógeno, cortisol após estimulação ou Δ-cortisol. Concluiu-se que o teste de estimulação com baixa dose de ACTH mostrou-se eficaz para avaliação da função adrenal, assim como, uma parcela considerável da população de cães críticos aqui estudados, em especial com sepse, apresentaram evidências de resposta corticosteroide inadequada frente ao estresse.(AU)


Subject(s)
Animals , Dogs , Cosyntropin/administration & dosage , Adrenocorticotropic Hormone , Sepsis/complications , Glucocorticoids/therapeutic use , Hypothalamo-Hypophyseal System/physiopathology , Catastrophic Illness
4.
Rev. habanera cienc. méd ; 19(1): 63-75, ene.-feb. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1099146

ABSTRACT

Introducción: La sepsis fue definida como una disfunción orgánica potencialmente mortal causada por una respuesta desregulada del huésped a la infección. Objetivo: Identificar factores pronósticos de mortalidad en pacientes con 65 años o más ingresados con sepsis en la Unidad de Cuidados Intensivos del Hospital Aleida Fernández Chardiet entre 2012-2017. Material y Métodos: Se realizó un estudio observacional, analítico y retrospectivo. La población objeto de estudio fue de 129 pacientes con 65 años o más que ingresaron con sepsis. Resultados: Ingresaron 316 pacientes con sepsis; 187 con ˂ 65 años y 129 tenían ≥65 años. Los valores de media del APACHE II fue muy superior en los pacientes que no lograron sobrevivir (16,1; p˂0,01); al igual que el SOFA (6,3±2,4; IC 95 por cvi 5,8-6,8; p˂0,01). La curva ROC mostró un área bajo la curva para el APACHE II es de 0,834 (IC 95 por ciento 0,761-0,907) y para el SOFA es de 0,941 (IC 95 por ciento 0,903-0,980). El 77,6% de los pacientes que murieron presentaban un shock séptico (OR=47,5; IC 95 por ciento 13,2-170,5; p˂0,01); y un síndrome de disfunción múltiple de órganos, 67,1 por ciento (OR=47,8; IC 95 por ciento 9,6-189,5; p˂0,01). Las variables significativamente asociadas a la mortalidad fueron el APACHE II≥15 puntos (OR ajustado 10,7; IC 95 por ciento 2,8-40,4) y el SOFA ≥5 puntos (OR ajustado 43,9; IC 95 por ciento 2,3-826,8). La calibración del modelo fue adecuada (X2=5,7; p=0,336). Conclusiones: Los factores pronósticos que se relacionaron con la mortalidad en los ancianos fueron el APACHE II≥ 15 puntos y el SOFA ≥5 puntos(AU)


Introduction: Sepsis is defined as a life-threatening organ dysfunction caused by an unregulated host response to infection. Objective: To identify prognostic factors for mortality in patients 65 years old or older admitted with sepsis to the Intensive Care Unit of Aleida Fernandez Chardiet Teaching General Hospital between 2012 and 2017. Material and Methods: An observational analytical retrospective study was conducted. The study population was 129 elderly patients who were diagnosed with sepsis. Results: A total of 316 patients were admitted with sepsis; 187 of them were under 65 years old and 129 were 65 years old or older. The average APACHE II scores were much higher in those patients who could not survive (161; p˂0, 01); SOFA scores were (6, 3±2,4; 95 percent CI 5,8-6,8; p˂0,01). The ROC curve showed an area under the curve for APACHE II which was found to be 0,834 (95 percent CI 0,761-0,907) and for SOFA it was 0,941 (95 percent CI 0,903-0,980). On the other hand, 77,6 percent of patients died with septic shock (OR=47,5; 95 percent CI 13,2-170,5; p˂0,01) and a multiple-organ dysfunction syndrome, which was observed in 67,1 percent of them (OR=47,8; 95 percent CI 9,6-189,5; p˂0,01). According to multivariate logistic regression model, the variables significantly associated to mortality were APACHE II score ≥15 points (adjusted OR 10, 7; 95 percent CI 2, 8-40, 4) and SOFA ≥5 points (adjusted OR 43, 9; 95 percent CI 2, 3-826, 8). The model calibration was adequate (X2=5,7; p=0,336). Conclusions: The prognostic factors for mortality in elderly patients admitted with sepsis in the service were as follows: APACHE II score ≥ 15 points and SOFA score ≥5 points (AU)


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Sepsis/complications , Intensive Care Units , Prognosis , Health of the Elderly , Retrospective Studies , Sepsis/mortality
6.
J. bras. nefrol ; 41(4): 462-471, Out.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056610

ABSTRACT

Abstract Acute kidney injury (AKI) has an incidence rate of 5-6% among intensive care unit (ICU) patients and sepsis is the most frequent etiology. Aims: To assess patients in the ICU that developed AKI, AKI on chronic kidney disease (CKD), and/or sepsis, and identify the risk factors and outcomes of these diseases. Methods: A prospective observational cohort quantitative study that included patients who stayed in the ICU > 48 hours and had not been on dialysis previously was carried out. Results: 302 patients were included and divided into: no sepsis and no AKI (nsnAKI), sepsis alone (S), septic AKI (sAKI), non-septic AKI (nsAKI), septic AKI on CKD (sAKI/CKD), and non-septic AKI on CKD (nsAKI/CKD). It was observed that 94% of the patients developed some degree of AKI. Kidney Disease Improving Global Outcomes (KDIGO) stage 3 was predominant in the septic groups (p = 0.018). Nephrologist follow-up in the non-septic patients was only 23% vs. 54% in the septic groups (p < 0.001). Dialysis was performed in 8% of the non-septic and 37% of the septic groups (p < 0.001). Mechanical ventilation (MV) requirement was higher in the septic groups (p < 0.001). Mortality was 38 and 39% in the sAKI and sAKI/CKD groups vs 16% and 0% in the nsAKI and nsAKI/CKD groups, respectively (p < 0.001). Conclusions: Patients with sAKI and sAKI/CKD had worse prognosis than those with nsAKI and nsAKI/CKD. The nephrologist was not contacted in a large number of AKI cases, except for KDIGO stage 3, which directly influenced mortality rates. The urine output was considerably impaired, ICU stay was longer, use of MV and mortality were higher when kidney injury was combined with sepsis.


Resumo A Lesão Renal Aguda (LRA), cuja etiologia mais frequente é sepse, tem incidência de 5-6% na Unidade de Terapia Intensiva (UTI). Objetivo: Avaliar pacientes que permaneceram mais de 48 horas na UTI e desenvolveram LRA ou Doença Renal Crônica agudizada (DRCag) e/ou sepse; identificar fatores associados e causas que possam afetar a evolução desses pacientes. Método: Estudo prospectivo, observacional, coorte e quantitativo dos pacientes em UTI entre maio a dezembro de 2013 com sepse e LRA. Excluídos pacientes < 48 horas e/ou dialíticos prévios. Resultados: Dos 1156 pacientes admitidos, 302 foram incluídos e divididos em grupos: sem sepse e sem LRA (SSSLRA), apenas sepse (S), LRA séptica (LRAs), LRA não séptica (LRAns), DRCag séptica (DRCags), DRCag não séptica (DRCagns). Foi verificado que 94% apresentaram algum grau de lesão renal; Kidney Disease Improving Global Outcomes (KDIGO) 3 foi predominante nos grupos sépticos (p = 0.018); o nefrologista foi chamado apenas em 23% dos pacientes não sépticos vs. 54% dos sépticos (p < 0.001); houve necessidade de diálise em 8% dos não sépticos vs. 37% dos sépticos (p < 0.001); necessidade de Ventilação Mecânica (VM) em 61% da LRAns versus 90% na LRAs (p < 0.001). A mortalidade foi 38% e 39% na LRAs e DRCags vs. 16% e 0% na LRAns e DRCagns, respectivamente (p < 0.001). Conclusão: LRAs e DRCags têm pior prognóstico que a não séptica. O nefrologista ainda não é solicitado em grande parte dos casos com influência direta na mortalidade (p < 0.001), o débito urinário é consideravelmente prejudicado; o tempo de permanência na UTI, necessidade de VM e mortalidade são maiores quando há associação da sepse e LRA.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Sepsis/complications , Acute Kidney Injury/microbiology , Acute Kidney Injury/mortality , Intensive Care Units/statistics & numerical data , Respiration, Artificial/mortality , Brazil/epidemiology , Incidence , Prospective Studies , Risk Factors , Mortality/trends , Renal Dialysis/methods , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Evaluation Studies as Topic , Acute Kidney Injury/epidemiology , Length of Stay , Nephrology/statistics & numerical data
7.
Rev. bras. ter. intensiva ; 31(3): 368-378, jul.-set. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1042582

ABSTRACT

RESUMO A sepse persiste como importante sobrecarga à saúde pública nos Estados Unidos e em todo o mundo. Com o crescente uso de tecnologias laboratoriais, tem se renovado o interesse na utilização de biomarcadores na sepse, para auxiliar em um processo mais preciso e direcionado para tomadas de decisão. Os peptídeos natriuréticos vem sendo cada vez mais reconhecidos por seu papel que vai além da insuficiência cardíaca. Estes peptídeos estão comumente elevados em pacientes críticos que apresentam condições de disfunção cardiopulmonar e podem ter papel na identificação de pacientes com sepse e choque séptico. São poucos os dados disponíveis em relação ao papel destes biomarcadores no diagnóstico, no controle, nos desfechos e no prognóstico de pacientes sépticos. Esta revisão procura descrever o papel dos peptídeos natriuréticos na ressuscitação volêmica, no diagnóstico de disfunção ventricular, nos desfechos e no prognóstico de pacientes com sepse. Tem sido observado que o peptídeo natriurético tipo B (BNP) e o fragmento N-terminal do peptídeo natriurético tipo B (NT-proBNP) se associam com disfunção ventricular sistólica e diastólica, tanto esquerda quanto direita, em pacientes com cardiomiopatia séptica. O BNP e o NT-proBNP podem predizer a responsividade a volume, e as tendências de medidas seriadas destes peptídeos podem ser importantes na ressuscitação volêmica. A despeito da sugestão de correlação com mortalidade, o papel do BNP nos desfechos de mortalidade e prognóstico, durante a sepse, ainda necessita melhor avaliação.


ABSTRACT Sepsis continues to be a leading public health burden in the United States and worldwide. With the increasing use of advanced laboratory technology, there is a renewed interest in the use of biomarkers in sepsis to aid in more precise and targeted decision-making. Natriuretic peptides have been increasingly recognized to play a role outside of heart failure. They are commonly elevated among critically ill patients in the setting of cardiopulmonary dysfunction and may play a role in identifying patients with sepsis and septic shock. There are limited data on the role of these biomarkers in the diagnosis, management, outcomes and prognosis of septic patients. This review seeks to describe the role of natriuretic peptides in fluid resuscitation, diagnosis of ventricular dysfunction and outcomes and the prognosis of patients with sepsis. B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) have been noted to be associated with left ventricular systolic and diastolic and right ventricular dysfunction in patients with septic cardiomyopathy. BNP/NT-proBNP may predict fluid responsiveness, and trends of these peptides may play a role in fluid resuscitation. Despite suggestions of a correlation with mortality, the role of BNP in mortality outcomes and prognosis during sepsis needs further evaluation.


Subject(s)
Humans , Peptide Fragments/physiology , Sepsis/complications , Sepsis/etiology , Sepsis/mortality , Sepsis/therapy , Natriuretic Peptide, Brain/physiology , Prognosis , Shock, Septic/complications , Shock, Septic/etiology , Shock, Septic/mortality , Shock, Septic/therapy , Treatment Outcome , Ventricular Dysfunction, Left/etiology , Fluid Therapy
8.
Autops. Case Rep ; 9(2): e2018070, Abr.-Jun. 2019. ilus
Article in English | LILACS | ID: biblio-994653

ABSTRACT

Esophageal infection by Candida spp. is a common opportunistic entity in immunocompromised hosts; however, systemic fungal dissemination due to perforation or transmural necrosis, also known as necrotizing Candida esophagitis (NCE), is rare. We report the case of a 61-year-old male patient with diagnosed ankylosing spondylitis, severe arteriosclerosis, and vasculitis under immunosuppressive therapy who presented NCE with fungal and bacterial septicemia diagnosed at autopsy. Necrotizing esophagitis is a rare manifestation of Candida infection, which may be a final complication in severely ill patients. Unfortunately, it may be underdiagnosed, and we call attention to this devastating complication in patients with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis.


Subject(s)
Humans , Male , Middle Aged , Esophagitis/pathology , Candidiasis, Invasive/pathology , Mycoses/pathology , Necrosis , Autopsy , Spondylitis, Ankylosing/complications , Fatal Outcome , Vasculitis, Leukocytoclastic, Cutaneous/complications , Sepsis/complications
9.
Rev. méd. Chile ; 147(2): 145-152, Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-1004326

ABSTRACT

ABSTRACT Background: Mean platelet volume (MPV) is a risk factor for cardiovascular and inflammatory diseases. Aim: To evaluate the association between high MPV and 90-day mortality after an episode of venous thromboembolism (VTE). Material and Methods: Retrospective cohort of 594 patients with a median age of 73 years (58% women) with a first episode VTE, included in an institutional Thromboembolic Disease registry between 2014 and 2015. MPV values were obtained from the automated blood cell count measured at the moment of VTE diagnosis. Volumes ≥ 11 fL were classified as high. All patients were followed for 90 days to assess survival. Results: The main comorbidities were cancer in 221 patients (37%), sepsis in 172 (29%) and coronary artery disease in 107 (18%). Median MPV was 8 fl (8-9), brain natriuretic peptide 2,000 pg/ml (1,025-3,900) and troponin 40 pg/ml (19.5-75). Overall mortality was 20% (121/594) during the 90 days of follow-up. Thirty three deaths occurred within 7 days and 43 within the first month. The loss of patients from follow-up was 5% (28/594) at 90 days. Mortality among patients with high MP was 36% (23/63). The crude mortality hazard ratio (HR) for high MPV was 2.2 (95% confidence intervals (CI) 1.4-3.5). When adjusted for sepsis, oncological disease, heart disease, kidney failure and surgery, the mortality HR of high MPV was 2.4 (CI95% 1.5-3.9) in the VTE group, 2.3 (CI95% 1.5-4.4) in the deep venous thrombosis group, and 2.9 (CI95% 1.6 −5.6) in the pulmonary embolism group. Conclusions: High MPV is an independent risk factor for mortality following an episode of VTE.


Antecedentes: El volumen plaquetario medio (VPM) es un factor de riesgo de complicaciones cardiovasculares y enfermedades inflamatorias. Objetivo: Evaluar la asociación entre VPM alto y la mortalidad a los 90 días después de un episodio de tromboembolismo venoso (ETV). Material y Métodos: Cohorte retrospectiva de 594 pacientes adultos con una edad media de 73 años (58% mujeres) con un primer episodio de ETV incluidos en un registro de enfermedad tromboembólica institucional entre 2014 y 2015. Se obtuvieron valores de VPM desde el hemograma tomado en el momento del diagnóstico de ETV y un volumen ≥ 11 fL fue clasificado como alto. Todos los pacientes fueron seguidos durante 90 días para determinar sobrevida. Resultados: Las comorbilidades fueron cáncer en 221 pacientes (37%), sepsis en 172 (29%) y enfermedad coronaria en 107 (18%). La mediana de VPM fue 8 fl (89), el péptido natriurético cerebral fue de 2.000 pg/ml (1.025-3.900) y la troponina fue de 40 pg/ml (19,5-75). La mortalidad global a 90 días fue 20% (121/594). Treinta y tres muertes ocurrieron dentro de los 7 días y 43 en el primer mes. La pérdida de seguimiento de pacientes fue de 5% (28/594) a los 90 días. La mortalidad en el grupo con VPM alto fue 36% (23/63). La razón de riesgo (HR) cruda de la mortalidad para un VPM alto fue de 2,2 (intervalos de confianza (IC) de 95% 1,4-3,5). Cuando se ajustó por sepsis, enfermedad oncológica, enfermedad cardíaca, insuficiencia renal y cirugía, la HR de muerte para un VPM alto fue de 2,4 (IC95% 1,5-3,9) en el grupo de ETV; 2,3 (IC95% 1,5-4,4) en el grupo de trombosis venosa profunda; y 2,9 (CI95% 1,6 −5,6) en el grupo de embolia pulmonar. Conclusiones: Un VPM alto es un factor de riesgo independiente de mortalidad después de un episodio de ETV.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Venous Thromboembolism/mortality , Mean Platelet Volume , Peptide Fragments/blood , Prognosis , Pulmonary Embolism/mortality , Pulmonary Embolism/blood , Troponin/blood , Blood Platelets , Survival Analysis , Acute Disease , Retrospective Studies , Risk Factors , Follow-Up Studies , Sepsis/complications , Risk Assessment , Venous Thrombosis/mortality , Venous Thrombosis/blood , Natriuretic Peptide, Brain/blood , Venous Thromboembolism/complications , Venous Thromboembolism/blood , Neoplasms/complications
10.
Acta cir. bras ; 34(2): e201900209, 2019. graf
Article in English | LILACS | ID: biblio-989056

ABSTRACT

Abstract Purpose: To explore the effect of milk fat globule-epidermal growth factor 8 (MFG-E8) on sepsis-induced acute kidney injury (SAKI). Methods: Male C57BL/6 mice were randomized to control, sham, CLP, CLP+PBS, and CLP+rmMFG-E8 groups. SAKI was induced by cecal ligation and puncture (CLP). Recombinant mouse MFG-E8 (rmMFG-E8) (20 μg/kg) or PBS (vehicle) was administered intraperitoneally. Blood, urine and renal tissue were collected at 24 h after CLP. Blood samples were tested for serum kidney injury biomarker and cytokines. Urine samples were collected to detect KIM-1, and NGAL. Real-time PCR was tested for Bax and Bcl-2. TUNEL staining was used to determine renal apoptosis. Western blot was used to detect the expression of Bax, Bcl-2, and proteins in the NF-κB pathway. Results: MFG-E8 alleviated SAKI by decreasing serum Cre, BUN, urine KIM-1 and NGAL and by mitigating renal pathological changes significant (p < 0.05). IL-1β, IL-6, TNF-α were significantly inhibited by MFG-E8 (p < 0.05). Apoptosis induced by SAKI was markedly suppressed by MFG-E8. Finally, MFG-E8 attenuated the activation of the NF-��B signaling pathway in SAKI. Conclusion: MFG-E8 has beneficial effects on SAKI, which may be achieved by inhibiting the NF-κB pathway.


Subject(s)
Animals , Male , Rats , NF-kappa B/antagonists & inhibitors , Sepsis/complications , Protective Agents/therapeutic use , Acute Kidney Injury/prevention & control , Milk Proteins/therapeutic use , Antigens, Surface/therapeutic use , Signal Transduction/drug effects , Acute Kidney Injury/etiology , Mice, Inbred C57BL
11.
Biol. Res ; 52: 29, 2019. tab, graf
Article in English | LILACS | ID: biblio-1011431

ABSTRACT

BACKGROUND: Acute kidney injury (AKI), which is mainly caused by sepsis, has high morbidity and mortality rates. CXCL8(3-72) K11R/G31P (G31P) can exert therapeutic effect on inflammatory diseases and malignancies. We aimed to investigate the effect and mechanism of G31P on septic AKI. METHODS: An AKI mouse model was established, and kidney injury was assessed by histological analysis. The contents of serum creatinine (SCr) and blood urea nitrogen (BUN) were measured by commercial kits, whereas neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) were detected by enzyme-linked immunosorbent assay (ELISA) kits. The expressions of CXCL8 in serum and kidney tissues were determined using ELISA and immunohistochemical analysis, respectively. Apoptosis rate of renal tissue was detected by terminal deoxynucleotidyl transfer-mediated dUTP nick end labeling (TUNEL) analysis. The expressions of inflammatory cytokines were measured by quantitative real-time PCR and Western blot, respectively. The apoptosis-related proteins, JAK2, STAT3, NF-κB and IκB were determined by Western blot. RESULTS: G31P could reduce the levels of SCr, BUN, HGAL and KIM-1 and inhibit the renal tissue injury in AKI mice. G31P was also found to suppress the serum and nephric CXCL8 expressions and attenuated the apoptosis rate. The levels of inflammatory cytokines, pro-apoptotic proteins were decreased, while the anti-apoptotic proteins were increased by G31P in AKI mice. G31P also inhibited the activation of JAK2, STAT3 and NF-κB in AKI mice. CONCLUSION: These results suggest that G31P could protect renal function and attenuate the septic AKI. Our findings provide a potential target for the treatment of AKI.


Subject(s)
Animals , Male , Mice , NF-kappa B/metabolism , Sepsis/complications , STAT3 Transcription Factor/metabolism , Janus Kinase 2/metabolism , Acute Kidney Injury/etiology , Signal Transduction , Apoptosis , Sepsis/pathology , Disease Models, Animal , Acute Kidney Injury/metabolism , Acute Kidney Injury/pathology , Mice, Inbred C57BL
12.
Rev. bras. ter. intensiva ; 30(3): 286-293, jul.-set. 2018. tab
Article in Portuguese | LILACS | ID: biblio-977969

ABSTRACT

RESUMO Objetivo: Verificar a incidência da hiperglicemia de estresse em crianças em condição grave e investigar a etiologia da hiperglicemia com base em um modelo de avaliação da homeostasia. Métodos: Estudo prospectivo de coorte, conduzido em uma unidade de terapia intensiva pediátrica da Cairo University, que incluiu 60 crianças com doença grave e 21 controles saudáveis. Utilizaram-se os níveis séricos de glicose, insulina e peptídeo C, avaliados em até 24 horas após a admissão. O modelo de avaliação da homeostasia foi utilizado para analisar a função das células beta e a sensibilidade à insulina. Resultados: A hiperglicemia foi estimada em 70% dos pacientes. Valores de glicemia ≥ 180mg/dL se associaram com desfechos piores. Os níveis de glicemia se correlacionaram de forma positiva com o Pediatric Risk for Mortality (PRISM III) e o número de órgãos com disfunção (p = 0,019 e p = 0,022, respectivamente), enquanto os níveis de insulina se correlacionaram de forma negativa com o número de órgãos com disfunção (r = -0,33; p = 0,01). O modelo de avaliação da homeostasia revelou que 26 (43,3%) das crianças em condições graves tinham baixa função de células beta e 18 (30%) baixa sensibilidade à insulina. Detectou-se patologia combinada em apenas dois (3,3%) pacientes. Baixa função de células beta se associou de forma significante com a presença de disfunção de múltiplos órgãos, disfunção respiratória, cardiovascular e hematológica, e presença de sepse. Conclusões: A disfunção de células beta pareceu ser prevalente em nossa coorte e se associou com disfunção de múltiplos órgãos.


ABSTRACT Objective: This study aimed to study the incidence of stress hyperglycemia in critically ill children and to investigate the etiological basis of the hyperglycemia based on homeostasis model assessment. Methods: This was a prospective cohort study in one of the pediatric intensive care units of Cairo University, including 60 critically ill children and 21 healthy controls. Serum blood glucose, insulin, and C-peptide levels were measured within 24 hours of admission. Homeostasis model assessment was used to assess β-cell function and insulin sensitivity. Results: Hyperglycemia was estimated in 70% of patients. Blood glucose values ≥ 180mg/dL were associated with a poor outcome. Blood glucose levels were positively correlated with Pediatric Risk for Mortality (PRISM III) score and number of organ dysfunctions (p = 0.019 and p = 0.022, respectively), while insulin levels were negatively correlated with number of organ dysfunctions (r = −0.33, p = 0.01). Homeostasis model assessment revealed that 26 (43.3%) of the critically ill patients had low β-cell function, and 18 (30%) had low insulin sensitivity. Combined pathology was detected in 2 (3.3%) patients only. Low β-cell function was significantly associated with the presence of multi-organ dysfunction; respiratory, cardiovascular, and hematological dysfunctions; and the presence of sepsis. Conclusions: β-Cell dysfunction appeared to be prevalent in our cohort and was associated with multi-organ dysfunction.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Stress, Physiological/physiology , Sepsis/complications , Hyperglycemia/etiology , Multiple Organ Failure/physiopathology , Blood Glucose/metabolism , C-Peptide/blood , Intensive Care Units, Pediatric , Case-Control Studies , Incidence , Prospective Studies , Cohort Studies , Critical Illness , Sepsis/epidemiology , Egypt , Insulin-Secreting Cells/pathology , Homeostasis , Hyperglycemia/epidemiology , Insulin/blood , Multiple Organ Failure/epidemiology
13.
Rev. bras. enferm ; 71(4): 1921-1927, Jul.-Aug. 2018. tab, graf
Article in English | LILACS, BDENF | ID: biblio-958662

ABSTRACT

ABSTRACT Objective: To evaluate the antioxidant action of N-acetylcysteine and diosmin-hesperidin in an experimental model of sepsis-induced acute kidney injury in rats. Methods: The study used 20 Wistar adult male rats divided into the following groups: control (laparotomy with no induction of abdominal sepsis), sepsis (experimental model of sepsis with cecal ligation and puncture), N-acetylcysteine + sepsis and diosmin-hesperidin + sepsis. The evaluation contemplated physiological parameters (temperature, glycemia, and average blood pressure), kidney function (creatinine clearance), oxidative stress (urinary peroxides) and kidney histology. Results: The animals submitted to cecal ligation and puncture (sepsis) presented lower body temperature, lower average blood pressure, reduced creatinine clearance and increased urinary hydrogen peroxide levels. Treatment with diosmin-hesperidin improved kidney function and led to a reduction in the excretion of oxidative metabolites. Conclusion: The present study highlighted the protective antioxidant action of diosmin-hesperidin in the experimental model of sepsis-induced acute kidney injury.


RESUMEN Objetivo: Evaluar la acción antioxidante de agentes como la N-acetilcisteína y Diosmina-Hesperidina en modelo experimental de lesión renal aguda inducida por sepsis en ratones. Método: Fueron utilizados veinte ratones Wistar, adultos y machos, divididos en los grupos: Control (laparotomía sin inducción de sepsis abdominal), Sepsis (modelo experimental de sepsis con ligadura y punción de ciego-LPC), N-acelsisteína+Sepsis y Diosmina Hesperidina+Sepsis. Se evaluaron parámetros fisiológicos (temperatura, glucemia y presión arterial promedio), la función renal (clearance de creatinina), el estrés oxidativo (peróxidos urinarios) e histología renal. Resultados: Los animales sometidos a LPC (sepsis) presentaron reducción de la temperatura corporal, de la presión arterial promedio, del clearance de creatinina e incremento de niveles de peróxidos de hidrógeno urinarios. El tratamiento con Diosmina-Hesperidina mejoró la función renal, reduciendo la excreción de metabolitos oxidativos. Conclusión: Este estudio destacó la acción renoprotectora antioxidante de la Diosmina-Hesperidina en el modelo experimental de lesión renal aguda inducida por sepsis.


RESUMO Objetivo: Avaliar a ação antioxidante de agentes como a N-acetilcisteína e diosmina-hesperidina em modelo experimental de lesão renal aguda induzida pela sepse em ratos. Método: Foram utilizados vinte ratos Wistar, adultos e machos, divididos nos seguintes grupos: Controle (laparotomia sem indução de sepse abdominal), Sepse (modelo experimental de sepse com ligadura e punção do cécum- LPC), N-acetilcisteína+Sepse e Diosmina Hesperidina+Sepse. Foram avaliados parâmetros fisiológicos (temperatura, glicemia e pressão arterial média), função renal (clearance de creatinina), estresse oxidativo (peróxidos urinários) e histologia renal. Resultados: Os animais submetidos à LPC (sepse) apresentaram redução da temperatura corporal, da pressão arterial média, do clearance de creatinina e elevação nos níveis de peróxidos de hidrogênio urinários. O tratamento com a Diosmina-Hesperidina melhorou a função renal com redução na excreção dos metabólitos oxidativos. Conclusão: Este estudo destacou a ação renoprotetora antioxidante da Diosmina-Hesperidina no modelo experimental de lesão renal aguda induzida pela sepse.


Subject(s)
Animals , Rats , Sepsis/complications , Oxidative Stress/drug effects , Acute Kidney Injury/drug therapy , Antioxidants/pharmacology , Acetylcysteine/therapeutic use , Acetylcysteine/pharmacology , Brazil , Cecum/drug effects , Cecum/injuries , Sepsis/drug therapy , Diosmin/therapeutic use , Diosmin/pharmacology , Disease Models, Animal , Acute Kidney Injury/prevention & control , Hesperidin/therapeutic use , Hesperidin/pharmacology , Antioxidants/therapeutic use
14.
Bol. méd. postgrado ; 34(1): 44-48, Ene-Jun. 2018. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1121153

ABSTRACT

Con el objetivo de determinar los factores de riesgo de pacientes con sepsis ingresados en la Unidad de Cuidados Intensivos Pediátricos del Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga durante el lapso noviembre 2016 - febrero 2017, se realizó una investigación de tipo descriptivo transversal con una muestra de 24 pacientes con sepsis, la mayor parte de los cuales eran lactantes menores (66,6%), con ligero predominio del sexo masculino (62,5%). El estado nutricional de los pacientes fue normal en 45,8% de los casos, sin embargo, se registró desnutrición crónica en 25% de los pacientes. Se presentaron sin enfermedad asociada 79,1% de los pacientes estudiados, mientras que 20,8% registraron cardiopatía congénita, enfermedad renal crónica o malformación cerebrovascular. La estancia hospitalaria fue superior a los 7 días en 83,3% de los casos. La mayoría de los pacientes pediátricos fueron sometidos a procedimientos invasivos (95,8%). Los resultados de este estudio permiten obtener información real de los factores de riesgo que inciden en el desarrollo de sepsis en la edad pediátrica(AU)


To determine the risk factors of patients with sepsis admitted to the Unidad de Cuidados Intensivos Pediátricos of the Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga during November 2016 - February 2017 a descriptive transversal study was carried out with 24 patients with sepsis most of which were lower infants (66.6%), with a slight prevalence of male sex (62.5%). Nutritional status of patients was normal in 45.8% of cases; however, chronic malnutrition was seen in 25% of patients. 20.8% of patients had an associated disease such as congenital cardiopathy, chronic renal disease and vascular brain malformations. Hospital stay was greater than 7 days in 83.3% of patients. In most cases, pediatric patients were subjected to invasive procedures (95.8%). The results allowed us to obtain real information of the risk factors that affect the development of sepsis in the pediatric age(AU)


Subject(s)
Humans , Male , Female , Infant , Bacterial Infections , Risk Factors , Sepsis/complications , Critical Care , Pediatrics , Infant Mortality , Hospitalization
15.
Bol. méd. postgrado ; 34(1): 55-60, Ene-Jun. 2018. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1121152

ABSTRACT

El score Quick-SOFA (qSOFA) no ha sido diseñado para utilizarlo en niños, aunque se ha utilizado en numerosos estudios como marcador de disfunción orgánica en sepsis a falta de un score propio para tal fin. Con el objetivo de determinar la utilidad del score Quick-SOFA en el diagnóstico de sepsis en pacientes pediátricos que asistieron al Servicio de Emergencias del Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga durante el lapso marzo-abril 2018, se realizó un estudio descriptivo transversal seleccionando un total de 60 pacientes los cuales se caracterizaron por un promedio de edad de 3,03 ± 3,76 años con predominio de lactantes menores (40%,) así como del sexo masculino (63,3%). Los principales focos de infección fueron respiratorio (41,6%) y digestivo (31,6%). 61,6% de los pacientes contaban con un puntaje de Glasgow mayor de 13 puntos, 68,3% una frecuencia respiratoria elevada y 55% registraron una presión arterial sistólica menor del percentil para la edad. 75% reportaron un qSOFA ≥ 2 puntos y 38,3% presentaron sepsis. De los pacientes con sepsis, 37,7% registraron un puntaje ≥ 2 y 40% menor de 2 puntos. La sensibilidad del qSOFA en este estudio fue de 73,9%, especificidad de 24,3%, valor predictivo positivo de 37,7% y el valor predictivo negativo de 60%. El qSOFA es una escala sencilla de aplicar en cualquier nivel asistencial, lo cual puede facilitar la identificación y estratificación adecuada del riesgo en los pacientes pediátricos con sepsis(AU)


The Quick-SOFA score (qSOFA) has not been designed for use in children, although it has been used in numerous studies as a marker of organic dysfunction in sepsis in the absence of a proper score. In order to determine the usefulness of the Quick-SOFA score in the diagnosis of sepsis in pediatric patients who were attended at the Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga during the period March-April 2018, a cross-sectional descriptive study was conducted with a total of 60 patients with an average age of 3.03 + 3.76 years of age, predominantly younger infants (40%) as well as male sex (63.3%). The main sites of infection were respiratory (41.6%) and digestive (31.6%). 61.6% of patients had a Glasgow value > 13 points, 68.3% had an elevated respiratory rate and 55% had a systolic blood pressure lower than the percentile for their age. Overall, 75% reported a qSOFA > 2 points and 38.3% presented sepsis. 37.7% of patients with sepsis had a score > 2 and 40% less than 2 points. In this study, qSOFA had a sensitivity of 73.9%, specificity of 24.3%, positive predictive value of 37.78% and negative predictive value of 60%. qSOFA is a simple scale which can facilitate the adequate stratification of risk in pediatric patients with sepsis(AU)


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Risk Factors , Sepsis/complications , Medication Therapy Management , Organ Dysfunction Scores , Pneumonia/etiology , Diarrhea, Infantile , Infections/complications
16.
Rev. bras. anestesiol ; 68(2): 186-189, Mar.-Apr. 2018. graf
Article in English | LILACS | ID: biblio-897827

ABSTRACT

Abstract Introduction and objectives: Quadratus Lumborum block was recently described and has already shown good results as an analgesic technique in abdominal surgeries, having the potential to significantly reduce opioids consumption and be a valid alternative to epidural catheter. We performed a type II Quadratus Lumborum block for analgesia in a septic patient having a sub-total gastrectomy. Case report: An 80 year-old, ASA III, male patient, weighting 50 kg, with a history of arterial hypertension and hypercholesterolemia, diagnosed with sepsis due to purulent peritonitis was submitted to an open laparotomy. Bilateral ultrasound-guided type II Quadratus Lumborum block was performed before surgery, using 10 mL of levobupivacaine 0.25% and 5 mL of mepivacaine 1%, per side. Pain relief was achieved 5 minutes after injection and the patient referred no pain in the immediate postoperative period. Discussion: Type II Quadratus Lumborum block may be considered a valid alternative for postoperative analgesia in a septic patient undergoing major abdominal surgery with some relative contraindications to epidural catheter placement. It allowed us to achieve excellent pain management avoiding opioids usage. However, more reports are still needed to properly access its usefulness.


Resumo Introdução e objetivo: O bloqueio do quadrado lombar (QL) foi descrito recentemente e já mostrou bons resultados como técnica analgésica em cirurgias abdominais, com potencial para reduzir significativamente o consumo de opioides e ser uma opção válida ao cateter peridural. Fizemos um bloqueio do QL tipo II para analgesia em um paciente séptico para gastrectomia subtotal. Relato de caso: Paciente do sexo masculino, 80 anos de, ASA III, 50 kg, com história de hipertensão arterial e hipercolesterolemia, diagnosticado com sepsis devido a peritonite purulenta, foi submetido a uma laparotomia aberta. O bloqueio bilateral do QL tipo II guiado por ultrassom foi feito antes da cirurgia com 10 mL de levobupivacaína a 0,25% e 5 mL de mepivacaína a 1%, por lado. O alívio da dor foi obtido em 5 minutos após a injeção e o paciente não referiu dor no pós-operatório imediato. Discussão: O bloqueio do quadrado lombar (QL) tipo II pode ser considerado uma opção válida para analgesia no pós-operatório em um paciente séptico submetido a cirurgia abdominal de grande porte, com algumas contraindicações relativas à colocação do cateter peridural. Permitiu-nos obter um excelente manejo da dor e evitar o uso de opioides. Contudo, mais relatos ainda são necessários para avaliar corretamente a sua utilidade.


Subject(s)
Humans , Male , Aged, 80 and over , Stomach Neoplasms/surgery , Gastrectomy/methods , Analgesia , Nerve Block/methods , Stomach Neoplasms/complications , Abdominal Muscles , Sepsis/complications
17.
Rev. méd. Chile ; 146(4): 502-510, abr. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-961421

ABSTRACT

Stress hyperglycemia is frequently diagnosed in septic patients in critical care units (ICU) and it is associated with greater illness severity and higher morbimortality rates. In response to an acute injury, high levels of counterregulatory hormones such as glucocorticoids and catecholamines are released causing increased hepatic gluconeogenesis and insulin resistance. Furthermore, during sepsis, proinflammatory cytokines also participate in the pathogenesis of this phenomenon. Septic patients represent a subtype of the critical ill patients in the ICU: this metabolic disarrangement management strategies and insulin therapy recommendations had been inconsistent. In this article, we describe the pathophysiological mechanisms of stress hyperglycemia in critical patients including the action of hormones, inflammatory cytokines and tissue resistance to insulin. In addition, we analyzed the main published studies for the treatment of acute hyperglycemia in critical patients.


Subject(s)
Humans , Sepsis/complications , Hyperglycemia/etiology , Stress, Physiological , Sepsis/physiopathology , Sepsis/metabolism , Glucose Transport Proteins, Facilitative/metabolism , Glucose/metabolism , Hyperglycemia/physiopathology , Hyperglycemia/metabolism , Hyperglycemia/therapy , Intensive Care Units
19.
Braz. j. med. biol. res ; 51(11): e7655, 2018. tab, graf
Article in English | LILACS | ID: biblio-974247

ABSTRACT

Previous studies have indicated that propofol has immunomodulatory and antioxidative properties. However, the renoprotection effect and the precise mechanisms of propofol in sepsis-induced renal injury remain unclear. The purpose of the present study was to investigate the role of miR-290-5p/CCL-2 signaling in septic mice treatment with propofol. Mice were treated with propofol (50 mg/kg) twice within 24 h. Survival outcome was monitored within 48 h. The mRNA and protein levels were assayed by qRT-PCR and western blotting, respectively. Mouse podocytes (MPC5) were treated with lipopolysaccharide (LPS) to establish the cell model in vitro. The proliferation of MPC5 was monitored using the MTS assay. Cell apoptosis was analyzed by flow cytometry. Propofol improved survival outcome and alleviated acute kidney injury in cecal ligation and puncture-operated mice. Propofol increased miR-290-5p expression and decreased CCL-2 and inflammatory cytokines levels in the kidney for septic mice. We found that miR-290-5p was a direct regulator of CCL-2 in MPC5. Propofol could abrogate LPS-induced growth inhibition and apoptosis in MPC5. Meanwhile, propofol inhibited CCL-2 expression in LPS-treated MPC5, however, knockdown of miR-290-5p abrogated the inhibitory effect propofol on the mRNA and protein expressions of CCL-2. Propofol could serve as an effective therapeutic medication to suppress sepsis-induced renal injury in vivo and in vitro by regulating the miR-290-5p/CCL-2 signaling pathway.


Subject(s)
Animals , Male , Rabbits , Signal Transduction/drug effects , Propofol/pharmacology , Sepsis/complications , Chemokine CCL2/drug effects , MicroRNAs/drug effects , Acute Kidney Injury/prevention & control , Blotting, Western , Sepsis/metabolism , Chemokine CCL2/metabolism , Reverse Transcriptase Polymerase Chain Reaction , MicroRNAs/physiology , Acute Kidney Injury/etiology , Flow Cytometry
20.
Rev. bras. ter. intensiva ; 29(4): 444-452, out.-dez. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899536

ABSTRACT

RESUMEN Objetivo: Describir la epidemiología de la injuria renal aguda, la relación con la enfermedad renal crónica y los factores asociados a su incidencia. Métodos: Estudio de cohorte y seguimiento en una unidad de terapia intensiva de Montevideo - Uruguay. Se incluyeron pacientes ingresados entre noviembre 2014 a octubre 2015, mayores de 15 años con dos mediciones de creatinina sérica. Se excluyeron pacientes con menos de 48 horas de internación o fallecidos en ese tiempo y portadores de enfermedad renal crónica en hemodiálisis o diálisis peritoneal. No hubo intervenciones. La injuria renal aguda se definió según criterios Acute Kidney Injury Disease Improving Global Outcomes y la enfermedad renal crónica según Cronic Kidney Disease Work Group. Resultados: Se incluyeron 401 pacientes, sexo masculino 56,6%, mediana de edad 68 (rango intercuartílico - RIC 51 - 79) años. El diagnóstico al ingreso fue sepsis grave 36,3%, neurocrítico 16,3%, politrauma 15,2% y otros 32,2%. La incidencia de injuria renal aguda fue de 50,1%. El 14,1% eran portadores de enfermedad renal crónica. La incidencia de injuria renal aguda séptica fue de 75,3%. La mortalidad en los pacientes con o sin injuria renal aguda fue de 41,8 y 14% respectivamente (p < 0,001). En el análisis multivariado las variables de mayor significación para la injuria renal aguda fueron enfermedad renal crónica (odds ratio - OR 5,39 IC95% 2,04 - 14,29 p = 0,001), shock (OR 3,94 IC95% 1,72 - 9,07 p = 0,001) y sepsis grave (OR 7,79 IC 95% 2,02 - 29,97 p = 0,003). Conclusión: La incidencia de injuria renal aguda es elevada principalmente en pacientes sépticos. La enfermedad renal crónica se asoció de forma independiente al desarrollo de injuria renal aguda.


ABSTRACT Objective: To describe the epidemiology of acute kidney injury, its relationship to chronic kidney disease, and the factors associated with its incidence. Methods: A cohort study and follow-up were conducted in an intensive care unit in Montevideo, Uruguay. We included patients admitted between November 2014 and October 2015 who were older than 15 years of age and who had at least two measurements of serum creatinine. We excluded patients who were hospitalized for less than 48 hours, patients who died at the time of hospitalization, and patients with chronic renal disease who were on hemodialysis or peritoneal dialysis. There were no interventions. Acute kidney injury was defined according to the criteria set forth in Acute Kidney Injury Disease: Improving Global Outcomes, and chronic kidney disease was defined according to the Chronic Kidney Disease Work Group. Results: We included 401 patients, 56.6% male, median age of 68 years (interquartile range (IQR) 51-79 years). The diagnosis at admission was severe sepsis 36.3%, neurocritical 16.3%, polytrauma 15.2%, and other 32.2%. The incidence of acute kidney injury was 50.1%, and 14.1% of the patients suffered from chronic kidney disease. The incidence of acute septic kidney injury was 75.3%. Mortality in patients with or without acute kidney injury was 41.8% and 14%, respectively (p < 0.001). In the multivariate analysis, the most significant variables for acute kidney injury were chronic kidney disease (odds ratio (OR) 5.39, 95%CI 2.04 - 14.29, p = 0.001), shock (OR 3.94, 95%CI 1.72 - 9.07, p = 0.001), and severe sepsis (OR 7.79, 95%CI 2.02 - 29.97, p = 0.003). Conclusion: The incidence of acute kidney injury is high mainly in septic patients. Chronic kidney disease was independently associated with the development of acute kidney injury.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Sepsis/epidemiology , Renal Insufficiency, Chronic/epidemiology , Acute Kidney Injury/epidemiology , Intensive Care Units , Uruguay/epidemiology , Incidence , Multivariate Analysis , Prospective Studies , Risk Factors , Cohort Studies , Follow-Up Studies , Hospital Mortality , Sepsis/complications , Creatinine/blood , Acute Kidney Injury/etiology , Acute Kidney Injury/mortality , Hospitalization , Middle Aged
SELECTION OF CITATIONS
SEARCH DETAIL