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BACKGROUND: Despite recent advancements in techniques, peri- and post-procedural complications still pose a significant challenge in the high-risk transcatheter aortic valve replacement (TAVR) patient population. This study aims to investigate and assess the prevalence of acute kidney injury (AKI) following TAVR, and to identify the risk factors associated with its occurrence. METHODS: We conducted the study at King Abdulaziz Medical City, Riyadh, Saudi Arabia from January 2016 to December 2022. We extracted data from electronic medical records. We categorized and compared patients based on their diagnosis of AKI+ following TAVR, or their absence of AKI- after the procedure. RESULTS: The study included a total of 344 patients who underwent TAVR. The mean age of the patients was 77.8 ± 8.9 years, 61.8% were male, and the average body mass index was 30.5±7.0. In terms of comorbidities, 70.8% of the patients had diabetes mellitus, 80.5% had hypertension, 8.7% had hypothyroidism, 2.0% had hematological disorders, 23.6% had congestive heart disease, 20.4% had cerebrovascular disease, 4.1% had peripheral vascular disease, 7.3% had cancer, and 34.4% had other comorbidities. The prevalence of AKI was 60 (17.50%) following the procedure. Cerebrovascular diseases showed a significant association with AKI (OR= 3.381, 95% CI, 1.65-6.91, p = 0.001). Chronic kidney disease has a significant effect on AKI (OR = 2.56, 95%CI, 1.02-6.39, p = 0.044). The creatinine level on Day 0 has a significant association with AKI (OR = 1.01, 95%CI, 1.006-1.017, p = 0.0001). CONCLUSIONS: These findings highlight the importance of assessing and managing these risk factors (cerebrovascular diseases, chronic kidney disease, and creatinine level on Day 0) in TAVR patients to mitigate the occurrence and severity of AKI. By understanding and addressing these factors, healthcare providers can potentially improve patient outcomes and reduce the incidence of AKI-associated TAVR procedures.
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Cerebral palsy (CP) is a developmental and physical disorder with different degrees of severity. Since CP manifests itself in early childhood, numerous research studies have concentrated on children with CP. Patients with CP encounter different severity of motor impairments attributed to the damage or disturbance to the fetal or infant developing brain, which begins in early childhood and persists through adulthood. Patients with CP are more prone to mortality compared to the general population. This systematic review and meta-analysis aimed to assess the risk factors that predict and influence mortality in patients with CP. Systematic search for studies assessing the risk factors for mortality in CP patients that were conducted from 2000 to 2023 in Google Scholar, PubMed, and Cochrane Library was performed. R-One Group Proportion was used for statistical analysis and Newcastle-Ottawa Quality Assessment Scale (NOS) for quality appraisal. Of the 1791 total database searches, nine studies were included. Based on the NOS tool for quality appraisal, seven studies were of moderate quality, and two studies were rated as of high quality. The risk factors included pneumonia and other respiratory infections, neurological disorders, circulatory diseases, gastrointestinal infections, and accidents. Pneumonia (OR = 0.40, 95% CI = 0.31 - 0.51), neurological disorders (OR = 0.11, 95% CI = 0.08 - 0.16), respiratory infections (OR = 0.36, 95% CI = 0.31 - 0.51), cardiovascular and circulatory diseases (OR = 0.11, 95% CI = 0.04 - 0.27), gastrointestinal and metabolic causes (OR = 0.12, 95% CI = 0.06 - 0.22), and accidents (OR = 0.05, 95% CI = 0.04 - 0.07) were the risk factors assessed. It was concluded that multiple factors predict the risk of mortality in patients with CP. Pneumonia and other respiratory infections are associated with a high risk of mortality. Cardiovascular and circulatory diseases, gastrointestinal and metabolic disorders, and accidents are strongly linked to mortality in CP patients.
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INTRODUCTION: The procedure of percutaneous nephrolithotomy (PCNL) is considered a minimally invasive method for removing stones from the kidneys or ureters. PCNL can cause a wide range of complications, such as urosepsis, a rare but serious complication. METHODS: A retrospective cohort study of patients who underwent PCNL from the period 2016 to 2022 was conducted at King Abdulaziz Medical City. Data were collected by chart review using the BestCARE system. SPSS version 23 (IBM Corporation, Armonk, NY, USA) was used. Qualitative variables were expressed as percentages and frequencies. The chi-square test was used to compare the qualitative variables. The K-S test was used to check the normality of the data. Quantitative variables were compared between groups using the independent sample t-test and the nonparametric Mann-Whitney test. Fisher's exact test was used to compare categorical variables. RESULTS: A total of 155 patients were included in this study. The mean age of the participants overall was found to be 49. About 108 (69.7%) of the participants were male. Regarding risk factors for urosepsis, diabetes mellitus was found in 54 (34.8%) of the participants. The incidence of urosepsis following PCNL was found to be 3 (1.9%) of the patients. The most frequently reported indication was found to be unilateral renal stones. The most frequently reported type of stone in the analysis was found to be calcium oxalate in nearly two-thirds 98 (63.2%) of the patients. CONCLUSION: The incidence of urosepsis among the patients who underwent PCNL was less than 2%. Diabetes mellitus, followed by hypertension, were the most prevalent co-morbidities among the participants. Cefuroxime was the antibiotic of choice when treating patients and following urosepsis.
