ABSTRACT
Acute kidney injury (AKI) is detrimental after cardiac surgery. In this multicenter study, the novel biomarker hemojuvelin (HJV) was evaluated for AKI prediction following cardiac surgery. Urinary HJV, neutrophil gelatinase-associated lipocalin (NGAL), and urinary creatinine were measured in 151 patients after surgery. The outcomes of advanced AKI (KDIGO stages 2 and 3) and all causes of in-hospital mortality as the composite outcome were recorded. Areas under the receiver operator characteristic curves (AUC) and a multivariate generalized additive model (GAM) were applied to predict these outcomes of interest. Urinary HJV differentiated patients with/without AKI, advanced AKI or composite outcome after surgery (p < 0.001, by a generalized estimating equation) in this study. At three hours post-surgery, urinary HJV predicted advanced AKI (p < 0.001) and composite outcome (p < 0.001) with corresponding AUC values of 0.768 and 0.828, respectively. The performance of creatinine-adjusted HJV was also superior to NGAL in predicting advanced AKI (AUC = 0.784 and 0.694; p = 0.037) and composite outcome (AUC = 0.842 and 0.676; p = 0.002). The integration of HJV into the Cleveland Clinic score for advanced AKI led to a significant increase in risk stratification (net reclassification improvement [NRI] = 0.598; p < 0.001).
Subject(s)
Acute Kidney Injury/etiology , Acute Kidney Injury/urine , Cardiac Surgical Procedures/adverse effects , GPI-Linked Proteins/urine , Acute Kidney Injury/mortality , Cardiac Surgical Procedures/mortality , Creatinine/urine , Female , Hemochromatosis Protein , Hospital Mortality , Humans , Lipocalin-2/urine , Male , Middle Aged , Models, Biological , Multivariate Analysis , ROC Curve , Time Factors , Treatment OutcomeABSTRACT
AIMS: To compare prediction power between ICNARC model and RIFLE classification in postoperative patients receiving acute dialysis. MATERIAL AND METHOD: Between January 2002 and December 2008, 529 patients received acute dialysis during their ICU stay were enrolled. Patients' demographic, clinical and laboratory variables were analyzed as predictors of mortality. The RIFLE logistic regression and the ICNARC model on ICU admission were evaluated to predict the patient's hospital mortality. RESULTS: Hospital mortality for the study group was 29.3%. Between two score systems, the ICNARC model showed better mortality prediction in this patient group by using the area under the receiver operating characteristic curve (ICNARC 0.836, RIFLE 0.702, p < 0.05). Multiple logistic regression analysis indicated that age, surgery category, metastatic carcinoma, ventilator use, and previous history of hypertension were also affecting factors for hospital mortality. CONCLUSIONS: The RIFLE classification and the ICNARC model were both correlated with mortality in critically ill patient with acute dialysis. However, the ICNARC model was a better mortality predictor compared to the RIFLE classification.
Subject(s)
Health Status Indicators , Kidney Diseases/mortality , Kidney Diseases/therapy , Postoperative Complications/mortality , Postoperative Complications/therapy , Renal Dialysis/mortality , APACHE , Aged , Chi-Square Distribution , Critical Illness , Female , Hospital Mortality , Humans , Intensive Care Units , Kidney Diseases/etiology , Logistic Models , Male , Middle Aged , Postoperative Complications/etiology , Prognosis , ROC Curve , Renal Dialysis/adverse effects , Risk Assessment , Risk Factors , Survival Analysis , Taiwan/epidemiologyABSTRACT
We report a fatal case of community-acquired empyema thoracis and candidemia caused by Candida albicans. The patient responded poorly to human recombinant activated protein C and intravenous fluconazole treatment and died of profound shock with multiple organ failure 8 days after admission.
Subject(s)
Candida albicans/pathogenicity , Candidemia/microbiology , Community-Acquired Infections/microbiology , Empyema/microbiology , Thoracic Cavity/microbiology , Antifungal Agents/therapeutic use , Candidemia/complications , Candidemia/drug therapy , Community-Acquired Infections/complications , Community-Acquired Infections/drug therapy , Empyema/complications , Fluconazole/therapeutic use , Follow-Up Studies , Humans , Intensive Care Units , Male , Middle Aged , Protein C/therapeutic use , Recombinant Proteins/therapeutic use , Thoracic Cavity/pathologyABSTRACT
Painful ophthalmoplegia due to extramedullary plasmacytoma is a rare initial manifestation of multiple myeloma. The present report describes a 48-year-old man who suffered an acute onset of retro-orbital pain, left abducens palsy and left facial hypoesthesia. In addition, he exhibited an elevated erythrocyte sedimentation rate and partial responsiveness to corticosteroid treatment, all of which resemble the features of Tolosa-Hunt syndrome. Imaging studies revealed a multilobulated tumour invading the left sphenoid bone and sphenoid sinus, later confirmed as a plasmacytoma at pathology. Multiple myeloma was also diagnosed by bone marrow examination. After completion of chemotherapy and radiotherapy, the patient has been free of symptoms for 10 months. Although cranial neuropathies with any combination of oculomotor, abducens, trochlear, ophthalmic and maxillary nerves may indicate a cavernous sinus lesion, neuropathies exclusive to the abducens and maxillary nerves may raise the possibility of extracavernous sinus origin. Cranial imaging is crucial in diagnosing painful ophthalmoplegia with additional minimal cranial nerve signs.
