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acute renal failure in the icu patient

Ulkem Kocoglu Barlas, Hasan Serdar Kıhtır, Nilufer Goknar, Melike Ersoy, Nihal Akcay, Esra Sevketoglu
BACKGROUND: Hemolytic uremic syndrome (HUS) is a clinical syndrome characterized by hemolytic anemia, thrombocytopenia, and acute kidney injury. Atypical hemolytic uremic syndrome (aHUS) is a devastating disease with significant mortality and high risk of progression to end-stage kidney disease. It is mostly caused by dysregulation of the alternative complement pathway. Cobalamin C (Cbl C) defect is a genetic disorder of cobalamin metabolism and is a rare cause of HUS. CASE-DIAGNOSIS/TREATMENT: We present a 6-month-old male infant who was admitted to the pediatric intensive care unit (PICU) due to restlessness, severe hypertension, anemia, respiratory distress, and acute kidney injury...
March 20, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Yanhua Wu, Yuanhan Chen, Shaowen Li, Wei Dong, Huaban Liang, Miaoyi Deng, Yingnan Chen, Shixin Chen, Xinling Liang
PURPOSE: To investigate the application value of "electronic alerts" ("e-alerts") for acute kidney injury (AKI) among high-risk wards of hospitals. METHODS: A prospective, randomized, controlled study was conducted. We developed an e-alert system for AKI and ran the system in intensive care units and divisions focusing on cardiovascular disease. The e-alert system diagnosed AKI automatically based on serum creatinine levels. Patients were assigned randomly to an e-alert group (467 patients) or non-e-alert group (408 patients)...
March 19, 2018: International Urology and Nephrology
Timothy D Girard, Jennifer L Thompson, Pratik P Pandharipande, Nathan E Brummel, James C Jackson, Mayur B Patel, Christopher G Hughes, Rameela Chandrasekhar, Brenda T Pun, Leanne M Boehm, Mark R Elstad, Richard B Goodman, Gordon R Bernard, Robert S Dittus, E W Ely
BACKGROUND: Delirium during critical illness results from numerous insults, which might be interconnected and yet individually contribute to long-term cognitive impairment. We sought to describe the prevalence and duration of clinical phenotypes of delirium (ie, phenotypes defined by clinical risk factors) and to understand associations between these clinical phenotypes and severity of subsequent long-term cognitive impairment. METHODS: In this multicentre, prospective cohort study, we included adult (≥18 years) medical or surgical ICU patients with respiratory failure, shock, or both as part of two parallel studies: the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors (BRAIN-ICU) study, and the Delirium and Dementia in Veterans Surviving ICU Care (MIND-ICU) study...
March 2018: Lancet Respiratory Medicine
Astrid Ruiz-Margáin, Alessandra Pohlmann, Patrick Ryan, Robert Schierwagen, Luis A Chi-Cervera, Christian Jansen, Osvely Mendez-Guerrero, Nayelli C Flores-García, Jennifer Lehmann, Aldo Torre, Ricardo Ulises Macías-Rodríguez, Jonel Trebicka
OBJECTIVE: Acute-on-chronic liver failure (ACLF) develops in acute decompensation of cirrhosis and shows high mortality. In critically ill patients, early diagnosis of ACLF could be important for therapeutic decisions (e.g. renal replacement, artificial liver support, liver transplantation). This study evaluated fibroblast growth factor 21 (FGF21), as a marker of mitochondrial dysfunction in the context of ACLF. DESIGN: The study included 154 individuals (112 critically patients and 42 healthy controls) divided into a training and a validation cohort...
February 24, 2018: Liver Transplantation
Lara Zafrani, Matthieu Resche-Rigon, Nathalie De Freitas Caires, Alexandre Gaudet, Daniel Mathieu, Erika Parmentier-Decrucq, Virginie Lemiale, Djamel Mokart, Frédéric Pène, Achille Kouatchet, Julien Mayaux, François Vincent, Martine N'yunga, Fabrice Bruneel, Antoine Rabbat, Christine Lebert, Pierre Perez, Anne-Pascale Meert, Dominique Benoit, Michael Darmon, Elie Azoulay
OBJECTIVES: To assess whether serum concentration of endothelial cell-specific molecule-1 (Endocan) at ICU admission is associated with the use of ICU resources and outcomes in critically ill hematology patients. DESIGN: Prospective multicenter cohort study. SETTING: Seventeen ICUs in France and Belgium. PATIENTS: Seven hundred forty-four consecutive critically ill hematology patients; 72 critically ill septic patients without hematologic malignancy; 276 healthy subjects...
March 2018: Critical Care Medicine
Jameela Abdulaziz Kari, Mohamed Ahmed Shalaby, Kholoud Sofyani, Ahmad Saleh Sanad, Albaraa Fuad Ossra, Rayan Smeer Halabi, Maha Hassan Aljuhani, Wael Mohammad Toffaha, Feras Aymen Moria, Samar Sabry, Hanan AbdelAziz Ahmed, Khalid Abdulaziz Alhasan, Sara Sharief, Osama Safdar
BACKGROUND: Acute kidney injury (AKI) is common in critically ill children with significant mortality and morbidity. Serum creatinine is an insensitive and late biomarker compared to newly proposed AKI biomarkers. METHODS: Prospective study in pediatric intensive care unit (PICU) over three months to compare between serum cystatin-C (s-Cys-C) and urinary neutrophil gelatinase-associated lipocalin (uNGAL) as AKI biomarkers at multiple time points with pediatric risk, injury, failure, loss, end-stage renal disease (pRIFLE) classification in diagnosing AKI...
February 20, 2018: World Journal of Pediatrics: WJP
S I Alam, M A Hossain, M Aftabuddin, M A Hye, M K Mondal
The aim of the study was to describe the characteristics of patients admitted to intensive care unit and their outcome in Bangabandhu Sheikh Mujib Medical University, Bangladesh. This retrospective, descriptive study was conducted in the intensive care unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2016 to June 2016. Data was retrieved from hospital records of all admitted patients regarding age, gender, admission source, reason for admission, length of ICU stay, requirement of mechanical ventilation, number of organ failure and their outcome...
January 2018: Mymensingh Medical Journal: MMJ
Emiliano A Rodríguez-Caulo, Ana Guijarro-Contreras, Juan Otero-Forero, María José Mataró, Gemma Sánchez-Espín, Arantza Guzón, Carlos Porras, Miguel Such, Antonio Ordóñez, José María Melero-Tejedor, Manuel Jiménez-Navarro
BACKGROUND: During the last decade, the use of ministernotomy in cardiac surgery has increased. Quality of life and patient satisfaction after ministernotomy have never been compared to conventional full sternotomy in randomised trials. The aim of the study is to determine if this minimally invasive approach improves quality of life, satisfaction and clinical morbimortality outcomes. METHODS/DESIGN: The QUALITY-AVR trial is a single-blind, single-centre, independent, and pragmatic randomised clinical trial comparing ministernotomy ("J" shaped upper hemisternotomy toward right 4th intercostal space) to full sternotomy in patients with isolated severe aortic stenosis scheduled for elective aortic valve replacement...
February 17, 2018: Trials
Sven Bercker, Tanja Winkelmann, Thilo Busch, Sven Laudi, Dirk Lindner, Jürgen Meixensberger
BACKGROUND: Hydroxyethyl starch (HES) was part of "triple-H" therapy for prophylaxis and therapy of vasospasm in patients with subarachnoid haemorrhage (SAH). The European Medicines Agency restricted the use of HES in 2013 due to an increase of renal failure in critically ill patients receiving HES compared to crystalloid fluids. The occurrence of renal insufficiency in patients with SAH due to HES is still uncertain. The purpose of our study was to evaluate whether there was an association with renal impairment in patients receiving HES after subarachnoid haemorrhage...
2018: PloS One
Adrien Joseph, Stephanie Harel, Marion Venot, Sandrine Valade, Eric Mariotte, Claire Pichereau, Akli Chermak, Lara Zafrani, Elie Azoulay, Emmanuel Canet
Background: Despite substantial improvements in the management of multiple myeloma, renal failure remains an important burden that tremendously impairs prognosis. The purpose of this study was to describe the characteristics and to establish prognostic factors of renal recovery in myeloma patients admitted to the intensive care unit (ICU) for acute kidney injury (AKI) Stage 3 treated with renal replacement therapy (RRT). Methods: A retrospective single-centre cohort study was performed, including consecutive myeloma patients admitted to one medical ICU between 1 January 2007 and 1 September 2015 and treated with RRT...
February 2018: Clinical Kidney Journal
Anish Gupta, Deven Juneja, Omender Singh, Suneel Kumar Garg, Varun Arora, Desh Deepak
Objective: Chikungunya is generally a mild disease, rarely requiring Intensive Care Unit (ICU) admission. However, certain populations may develop organ dysfunction necessitating ICU admission. The purpose of the study was to assess the clinical profile and course of chikungunya patients admitted to the ICU, and to ascertain factors linked with poor outcome. Methods: All patients with chikungunya admitted to ICU were included in the study. Admission Acute Physiology and Chronic Health Evaluation (APACHE) II score and sequential organ failure assessment (SOFA) score were calculated...
January 2018: Indian Journal of Critical Care Medicine
Azusa Murata, Takatoshi Kasai, Yuya Matsue, Hiroki Matsumoto, Shoichiro Yatsu, Takao Kato, Shoko Suda, Masaru Hiki, Atsutoshi Takagi, Hiroyuki Daida
Although elevated blood urea nitrogen (BUN)-to-creatinine (BUN/Cr) ratio at hospital admission has been reported to be associated with poor short-term prognosis, its association to long-term mortality in patients with acute decompensated heart failure (ADHF) remains to be elucidated. Moreover, an additive prognostic value to preexisting renal markers including creatinine and BUN has not been well described. A cohort of 557 consecutive ADHF patients admitted to the cardiac intensive care unit was studied. All cohorts were divided into high and low BUN/Cr ratios according to the median value of BUN/Cr ratio at admission...
February 7, 2018: Heart and Vessels
D Vandroux, N Allou, J Jabot, G Li Pat Yuen, E Brottet, B Roquebert, O Martinet
BACKGROUND: Coronavirus OC43 infection causes severe pneumonia in patients presenting with comorbidities, but clinical signs alone do not allow for viral identification. OBJECTIVES: To analyze acute manifestations of Coronavirus OC43 infections and outcomes of patients admitted to an intensive care unit (ICU). PATIENTS AND METHODS: Retrospective and monocentric study performed during a Coronavirus OC43 outbreak. We used multiplex PCR to detect an OC43 outbreak in Reunion Island during the 2016 Southern Hemisphere's winter: seven admissions to the ICU...
February 2, 2018: Médecine et Maladies Infectieuses
Felix Zubia-Olaskoaga, Enrique Maraví-Poma, Iratxe Urreta-Barallobre, María-Rosario Ramírez-Puerta, Mónica Mourelo-Fariña, María-Pilar Marcos-Neira, Miguel Ángel García-García
BACKGROUND/OBJECTIVES: Development and validation of a multivariate prediction model for patients with acute pancreatitis (AP) admitted in Intensive Care Units (ICU). METHODS: A prospective multicenter observational study, in 1 year period, in 46 international ICUs (EPAMI study). PATIENTS: adults admitted to an ICU with AP and at least one organ failure. INTERVENTIONS: Development of a multivariate prediction model, using the worst data of the stay in ICU, based in multivariate analysis, simple imputation in a development cohort...
March 2018: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
Azrina Md Ralib, Mohd Basri Mat Nor
BACKGROUND AND OBJECTIVES: Refeeding hypophosphataemia (RH) is characterized by an acute electrolyte derangement following nutrition therapy. Complications associated include heart failure, respiratory failure, paraesthesia, seizure and death. We aim to assess its incidence, risk factors, and outcome in our local intensive care unit (ICU). METHODS AND STUDY DESIGN: A prospective observational cohort study was conducted at the mixed medical- surgical of a tertiary ICU in Kuantan, Malaysia...
2018: Asia Pacific Journal of Clinical Nutrition
Catherine Courteau, Alex Al Khoury, Rene P Michel, Catherine L Weber
A 35-year-old man presented with severe hypo-osmolar hyponatremia (serum sodium 99 mmol/L), profound nonoliguric renal failure (serum creatinine 1240 μmol/L), and nephrotic range proteinuria. Computed tomography of the abdomen revealed nephromegaly and no obstruction. The patient was admitted to the intensive care unit (ICU) and conventional hemodialysis was initiated. To avoid rapid sodium correction, we prescribed concurrent dialysate flow, a low dialysate sodium concentration, a small surface area dialyzer, and a low blood flow rate...
January 30, 2018: Hemodialysis International
Marlène Cherruault, Marielle Le Goff, Jérôme Tamburini, Frédéric Pène
OBJECTIVES: Hematologic malignancies may result in multiple organ involvement including pulmonary and renal dysfunctions, and the less common acute circulatory failure. We herein addressed the outcome of patients with sepsis-like shock related to aggressive hematologic malignancies. DESIGN: A 10-year (2007-2016) monocenter retrospective study. SETTINGS: A medical ICU in a tertiary care center. PATIENTS: Patients with circulatory shock requiring vasopressors and who subsequently received chemotherapy...
January 25, 2018: Critical Care Medicine
Ron C Li, Trit Garg, Tony Cun, Lisa Shieh, Gomathi Krishnan, Daniel Fang, Jonathan H Chen
Objective: Problem-based charting (PBC) is a method for clinician documentation in commercially available electronic medical record systems that integrates note writing and problem list management. We report the effect of PBC on problem list utilization and accuracy at an academic intensive care unit (ICU). Materials and Methods: An interrupted time series design was used to assess the effect of PBC on problem list utilization, which is defined as the number of new problems added to the problem list by clinicians per patient encounter, and of problem list accuracy, which was determined by calculating the recall and precision of the problem list in capturing 5 common ICU diagnoses...
January 18, 2018: Journal of the American Medical Informatics Association: JAMIA
Leison Maharjan, Aarzoo Shah, Udaya Bajracharya, Gambhir Shrestha
BACKGROUND: Multiple organ failure is recognized as the final pathway preceding majority of deaths in intensive care unit. This study aims to find out the prevalence of organ dysfunctions/ failures in patients at the time of their demise irrespective of the underlying diseases in a tertiary care hospital. METHODS: This study was done in medical intensive care unit of Blue Cross Hospital. Medical records of all deceased patients in two years period were thoroughly reviewed retrospectively...
January 1, 2018: Journal of Nepal Health Research Council
Qian Jia, Yu-Rong Wang, Ping He, Xue-Liang Huang, Wei Yan, Yang Mu, Kun-Lun He, Ya-Ping Tian
Objectives: The aim of this study was to develop a clinical risk model that is predictive of in-hospital mortality in elderly patients hospitalized with acute heart failure (AHF). Methods: 2486 patients who were 60 years and older from intensive care units of Cardiology Department in the hospital were analyzed. Independent risk factors for in-hospital mortality were obtained by binary logistic regression and then used to establish the risk prediction score system (RPSS)...
November 2017: Journal of Geriatric Cardiology: JGC
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