Acute and Critical Care

Original Articles

Pediatrics
Prevalence of extracorporeal blood purification techniques in critically ill patients before and during the COVID-19 pandemic in Egypt: Aya Osama Mohammed, Hanaa I. Rady; Acute Crit Care. 2024;39(1):70-77. Published online February 1, 2024; DOI: https://doi.org/10.4266/acc.2023.00654

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Abstract PDF: Background
Extracorporeal blood-purification techniques are frequently needed in the pediatric intensive care unit (PICU), yet data on their clinical application are lacking. This study aims to review the indications, rate of application, clinical characteristics, complications, and outcomes of patients undergoing extracorporeal blood purification (i.e., by continuous renal replacement therapy [CRRT] or therapeutic plasma exchange [TPE]) in our PICU, including before the coronavirus disease 2019 (COVID-19) pandemic in 2019 and during the pandemic from 2020 to 2022. Methods: This study included children admitted for extracorporeal blood-purification therapy in the PICU. The indications for TPE were analyzed and compared to the American Society for Apheresis categories. Results: In 82 children, 380 TPE sessions and 37 CRRT sessions were carried out children, with 65 patients (79%) receiving TPE, 17 (20.7%) receiving CRRT, and four (4.8%) receiving both therapies. The most common indications for TPE were neurological diseases (39/82, 47.5%), followed by hematological diseases (18/82, 21.9%). CRRT was mainly performed for patients suffering from acute kidney injury. Patients with neurological diseases received the greatest number of TPE sessions (295, 77.6%). Also, the year 2022 contained the greatest number of patients receiving extracorporeal blood-purification therapy (either CRRT or TPE). Conclusions: The use of extracorporeal blood-purification techniques increased from 2019 through 2022 due to mainly autoimmune dysregulation among affected patients. TPE can be safely used in an experienced PICU. No serious adverse events were observed in the patients that received TPE, and overall survival over the 4 years was 86.5%.

Pulmonary
Outcomes of patients with COVID-19 requiring extracorporeal membrane oxygenation and continuous renal replacement therapy in the United States: Carlos R Franco Palacios, Rudiona Hoxhaj, Catlyn Thigpen, Jeffrey Jacob, Atul Bhatnagar, Asif Saberi; Acute Crit Care. 2023;38(3):308-314. Published online August 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00115

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Background
Coronavirus disease 2019 (COVID-19) infection is associated with significant morbidity and mortality. Some patients develop severe acute respiratory distress syndrome and kidney failure requiring the combination of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT).
Methods
Retrospective cohort study of 127 consecutive patients requiring combined ECMO and CRRT support in intensive care units at an ECMO center in Marietta, GA, United States.
Results
Sixty and 67 patients with and without COVID-19, respectively, required ECMO-CRRT support. After adjusting for confounding variables, patients with COVID-19 had increased mortality at 30 days (hazard ratio [HR], 5.19; 95% confidence interval [CI], 2.51–10.7; P<0.001) and 90 days (HR, 6.23; 95% CI, 2.60–14.9; P<0.001).
Conclusions
In this retrospective study, patients with COVID-19 who required ECMO-CRRT had increased mortality when compared to patients without COVID-19.

Citations

Citations to this article as recorded by

Factors associated with post-hospitalization dialysis dependence in ECMO patients who required continuous renal replacement therapy
Carlos Rodrigo Franco Palacios, Rudiona Hoxhaj, Catlyn Thigpen, Jeffrey Jacob
Renal Failure.2024;[Epub] CrossRef

Nephrology
Radiomic analysis of abdominal organs during sepsis of digestive origin in a French intensive care unit: Louis Boutin, Louis Morisson, Florence Riché, Romain Barthélémy, Alexandre Mebazaa, Philippe Soyer, Benoit Gallix, Anthony Dohan, Benjamin G Chousterman; Acute Crit Care. 2023;38(3):343-352. Published online August 21, 2023; DOI: https://doi.org/10.4266/acc.2023.00136

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Abstract PDF Supplementary Material: Background
Sepsis is a severe and common cause of admission to the intensive care unit (ICU). Radiomic analysis (RA) may predict organ failure and patient outcomes. The objective of this study was to assess a model of RA and to evaluate its performance in predicting in-ICU mortality and acute kidney injury (AKI) during abdominal sepsis.
Methods
This single-center, retrospective study included patients admitted to the ICU for abdominal sepsis. To predict in-ICU mortality or AKI, elastic net regularized logistic regression and the random forest algorithm were used in a five-fold cross-validation set repeated 10 times.
Results
Fifty-five patients were included. In-ICU mortality was 25.5%, and 76.4% of patients developed AKI. To predict in-ICU mortality, elastic net and random forest models, respectively, achieved areas under the curve (AUCs) of 0.48 (95% confidence interval [CI], 0.43–0.54) and 0.51 (95% CI, 0.46–0.57) and were not improved combined with Simplified Acute Physiology Score (SAPS) II. To predict AKI with RA, the AUC was 0.71 (95% CI, 0.66–0.77) for elastic net and 0.69 (95% CI, 0.64–0.74) for random forest, and these were improved combined with SAPS II, respectively; AUC of 0.94 (95% CI, 0.91–0.96) and 0.75 (95% CI, 0.70–0.80) for elastic net and random forest, respectively.
Conclusions
This study suggests that RA has poor predictive performance for in-ICU mortality but good predictive performance for AKI in patients with abdominal sepsis. A secondary validation cohort is needed to confirm these results and the assessed model.

Nephrology
Epidemiology and outcome of an acute kidney injuries in the polytrauma victims admitted at the apex trauma center in Dubai: Bhushan Sudhakar Wankhade, Zeyad Faoor Alrais, Ghaya Zeyad Alrais, Ammar Mohamed Abdel Hadi, Gopala Arun Kumar Naidu, Mohammed Shahid Abbas, Ahmed Tarek Youssef Aboul Kheir, Hasan Hadad, Sundareswaran Sharma, Mohammad Sait; Acute Crit Care. 2023;38(2):217-225. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2023.00388

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Abstract PDF: Background
Polytrauma from road accidents is a common cause of hospital admissions and deaths, frequently leading to acute kidney injury (AKI) and impacting patient outcomes. Methods: This retrospective, single-center study included polytrauma victims with an Injury Severity Score (ISS) >25 at a tertiary healthcare center in Dubai. Results: The incidence of AKI in polytrauma victims is 30.5%, associated with higher Carlson comorbidity index (P=0.021) and ISS (P=0.001). Logistic regression shows a significant relationship between ISS and AKI (odds ratio [OR], 1.191; 95% confidence interval [CI], 1.150–1.233; P<0.05). The main causes of trauma-induced AKI are hemorrhagic shock (P=0.001), need for massive transfusion (P<0.001), rhabdomyolysis (P=0.001), and abdominal compartment syndrome (ACS; P<0.001). On multivariate logistic regression AKI can be predicated by higher ISS (OR, 1.08; 95% CI, 1.00–1.17; P=0.05) and low mixed venous oxygen saturation (OR, 1.13; 95% CI, 1.05–1.22; P<0.001). The development of AKI after polytrauma increases length of stay (LOS)-hospital (P=0.006), LOS-intensive care unit (ICU; P=0.003), need for mechanical ventilation (MV) (P<0.001), ventilator days (P=0.001), and mortality (P<0.001). Conclusions: After polytrauma, the occurrence of AKI leads to prolonged hospital and ICU stays, increased need for mechanical ventilation, more ventilator days, and a higher mortality rate. AKI could significantly impact their prognosis.

Pulmonary
Relationship between positive end-expiratory pressure levels, central venous pressure, systemic inflammation and acute renal failure in critically ill ventilated COVID-19 patients: a monocenter retrospective study in France: Pierre Basse, Louis Morisson, Romain Barthélémy, Nathan Julian, Manuel Kindermans, Magalie Collet, Benjamin Huot, Etienne Gayat, Alexandre Mebazaa, Benjamin G. Chousterman; Acute Crit Care. 2023;38(2):172-181. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01494

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Abstract PDF Supplementary Material: Background
The role of positive pressure ventilation, central venous pressure (CVP) and inflammation on the occurrence of acute kidney injury (AKI) have been poorly described in mechanically ventilated patient secondary to coronavirus disease 2019 (COVID-19). Methods: This was a monocenter retrospective cohort study of consecutive ventilated COVID-19 patients admitted in a French surgical intensive care unit between March 2020 and July 2020. Worsening renal function (WRF) was defined as development of a new AKI or a persistent AKI during the 5 days after mechanical ventilation initiation. We studied the association between WRF and ventilatory parameters including positive end-expiratory pressure (PEEP), CVP, and leukocytes count. Results: Fifty-seven patients were included, 12 (21%) presented WRF. Daily PEEP, 5 days mean PEEP and daily CVP values were not associated with occurrence of WRF. 5 days mean CVP was higher in the WRF group compared to patients without WRF (median [IQR], 12 mm Hg [11-13] vs. 10 mm Hg [9–12]; P=0.03). Multivariate models with adjustment on leukocytes and Simplified Acute Physiology Score (SAPS) II confirmed the association between CVP value and risk of WRF (odd ratio, 1.97; 95% confidence interval, 1.12–4.33). Leukocytes count was also associated with occurrence of WRF in the WRF group (14 G/L [11–18]) and the no-WRF group (9 G/L [8–11]) (P=0.002). Conclusions: In mechanically ventilated COVID-19 patients, PEEP levels did not appear to influence occurrence of WRF. High CVP levels and leukocytes count are associated with risk of WRF.

Trauma
Selection of appropriate reference creatinine estimate for acute kidney injury diagnosis in patients with severe trauma: Kangho Lee, Dongyeon Ryu, Hohyun Kim, Sungjin Park, Sangbong Lee, Chanik Park, Gilhwan Kim, Sunhyun Kim, Nahyeon Lee; Acute Crit Care. 2023;38(1):95-103. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01046

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Abstract PDF: Background
In patients with severe trauma, the diagnosis of acute kidney injury (AKI) is important because it is a predictive factor for poor prognosis and can affect patient care. The diagnosis and staging of AKI are based on change in serum creatinine (SCr) levels from baseline. However, baseline creatinine levels in patients with traumatic injuries are often unknown, making the diagnosis of AKI in trauma patients difficult. This study aimed to enhance the accuracy of AKI diagnosis in trauma patients by presenting an appropriate reference creatinine estimate (RCE). Methods: We reviewed adult patients with severe trauma requiring intensive care unit admission between 2015 and 2019 (n=3,228) at a single regional trauma center in South Korea. AKI was diagnosed based on the current guideline published by the Kidney Disease: Improving Global Outcomes organization. AKI was determined using the following RCEs: estimated SCr75-modification of diet in renal disease (MDRD), trauma MDRD (TMDRD), admission creatinine level, and first-day creatinine nadir. We assessed inclusivity, prognostic ability, and incrementality using the different RCEs. Results: The incidence of AKI varied from 15% to 46% according to the RCE used. The receiver operating characteristic curve of TMDRD used to predict mortality and the need for renal replacement therapy (RRT) had the highest value and was statistically significant (0.797, P<0.001; 0.890, P=0.002, respectively). In addition, the use of TMDRD resulted in a mortality prognostic ability and the need for RRT was incremental with AKI stage. Conclusions: In this study, TMDRD was feasible as a RCE, resulting in optimal post-traumatic AKI diagnosis and prognosis.

Nephrology
Impact of intradialytic hypotension on mortality following the transition from continuous renal replacement therapy to intermittent hemodialysis: Seong Geun Kim, Donghwan Yun, Jinwoo Lee, Yong Chul Kim, Dong Ki Kim, Kook-Hwan Oh, Kwon Wook Joo, Yon Su Kim, Seung Seok Han; Acute Crit Care. 2023;38(1):86-94. Published online October 26, 2022; DOI: https://doi.org/10.4266/acc.2022.00948

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Abstract PDF: Background
The transition of dialysis modalities from continuous renal replacement therapy (CRRT) to intermittent hemodialysis (iHD) is frequently conducted during the recovery phase of critically ill patients with acute kidney injury. Herein, we addressed the occurrence of intradialytic hypotension (IDH) after this transition, and its association with the mortality risk. Methods: A total of 541 patients with acute kidney injury who attempted to transition from CRRT to iHD at Seoul National University Hospital, Korea from 2010 to 2020 were retrospectively collected. IDH was defined as a discontinuation of dialysis because of hemodynamic instability plus a nadir systolic blood pressure <90 mm Hg or a decrease in systolic blood pressure ≥30 mm Hg during the first session of iHD. Odds ratios (ORs) of outcomes, such as in-hospital mortality and weaning from RRT, were measured using a logistic regression model after adjusting for multiple variables. Results: IDH occurred in 197 patients (36%), and their mortality rate (44%) was higher than that of those without IDH (19%; OR, 2.64; 95% confidence interval [CI], 1.70–4.08). For patients exhibiting IDH, the iHD sessions delayed successful weaning from RRT (OR, 0.62; 95% CI, 0.43–0.90) compared with sessions on those without IDH. Factors such as low blood pressure, high pulse rate, low urine output, use of mechanical ventilations and vasopressors, and hypoalbuminemia were associated with IDH risk. Conclusions: IDH occurrence following the transition from CRRT to iHD is associated with high mortality and delayed weaning from RRT.

Nephrology
Clinical efficacy of blood purification using a polymethylmethacrylate hemofilter for the treatment of severe acute pancreatitis: Kiyohiko Kinjoh, Ryoji Nagamura, Yutaka Sakuda, Shoki Yamauchi, Hideta Takushi, Tadashi Iraha, Koji Idomari; Acute Crit Care. 2022;37(3):398-406. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00192

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Abstract PDF

Background
Severe acute pancreatitis (SAP) is a systemic inflammatory disease, and it can often complicate into acute kidney injury (AKI) and acute lung injury/acute respiratory distress syndrome (ALI/ARDS). This study aimed to evaluate the clinical effectiveness of blood purification using a polymethylmethacrylate (PMMA) hemofilter.
Methods
We retrospectively examined 54 patients, who were diagnosed with SAP according to the Japanese criteria from January 2011 to December 2019.
Results
Of a total of 54 SAP patients, 26 patients progressively developed AKI and required continuous hemodialysis with a PMMA membrane hemofilter (PMMA-CHD). Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score were significantly higher in patients requiring PMMA-CHD than in patients not requiring hemodialysis. The lung injury scores were also significantly higher in patients requiring PMMA-CHD. Of the 26 patients, 16 patients developed ALI/ARDS and required mechanical ventilation. A total of seven patients developed severe ALI/ARDS and received additional intermittent hemodiafiltration using a PMMA hemofilter (PMMA-HDF). Although the length of intensive care unit stay was significantly longer in patients with severe ALI/ARDS, blood purification therapy was discontinued in all the patients. The survival rates at the time of discharge were 92.3% and 92.9% in patients with and without PMMA-CHD, respectively. These real mortality ratios were obviously lower than the estimated mortality ratios predicted by APACHE II scores.
Conclusions
These finding suggest that the blood purification using a PMMA hemofilter would be effective for the treatment of AKI and ALI/ARDS in SAP patients.

Citations

Citations to this article as recorded by

A Retrospective Study on the Start and End of Continuous Hemodialysis using a Polymethylmethacrylate Hemofilter for Severe Acute Pancreatitis
Kiyohiko Kinjoh, Ryoji Nagamura, Yutaka Sakuda
Internal Medicine.2024;[Epub] CrossRef
Evaluation of the therapeutic efficiency and efficacy of blood purification in the treatment of severe acute pancreatitis
Hongwei Huang, Zhongshi Huang, Menghua Chen, Ken Okamoto, Chiara Lazzeri
PLOS ONE.2024; 19(1): e0296641. CrossRef
Enhancing Immune Protection in Hemodialysis Patients: Role of the Polymethyl Methacrylate Membrane
Rossana Franzin, Alessandra Stasi, Gianvito Caggiano, Elena Squiccimarro, Vincenzo Losappio, Marco Fiorentino, Carlo Alfieri, Giovanni Stallone, Loreto Gesualdo, Giuseppe Castellano
Blood Purification.2023; : 27. CrossRef

Nephrology
COVID-19–induced acute kidney injury in critically ill patients: epidemiology, risk factors, and outcome: Ahlem Trifi, Sami Abdellatif, Yosri Masseoudi, Asma Mehdi, Oussama Benjima, Eya Seghir, Fatma Cherif, Yosr Touil, Bedis Jeribi, Foued Daly, Cyrine Abdennebi, Adel Ammous, Salah Ben Lakhal; Acute Crit Care. 2021;36(4):308-316. Published online November 22, 2021; DOI: https://doi.org/10.4266/acc.2021.00934

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Abstract PDF

Background
The kidney represents a potential target for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Acute kidney injury (AKI) can occur through several mechanisms and includes intrinsic tissue injury by direct viral invasion. Clinical data about the clinical course of AKI are lacking. We aimed to investigate the proportion, risk factors, and prognosis of AKI in critical patients affected with coronavirus disease 2019 (COVID-19).
Methods
A case/control study conducted in two intensive care units of a tertiary teaching hospital from September to December 2020.
Results
Among 109 patients, 75 were male (69%), and the median age was 64 years (interquartile range [IQR], 57–71 years); 48 (44%) developed AKI within 4 days (IQR, 1–9). Of these 48 patients, 11 (23%), 9 (19%), and 28 (58%) were classified as stage 1, 2, and 3, respectively. Eight patients received renal replacement therapy. AKI patients were older and had more frequent sepsis, acute respiratory distress syndrome, and rhabdomyolysis; higher initial urea and creatinine; more marked inflammatory syndrome and hematological disorders; and required more frequent mechanical ventilation and vasopressors. An elevated level of D-dimers (odds ratio [OR], 12.83; 95% confidence interval [CI], 1.9–85) was an independent factor of AKI. Sepsis was near to significance (OR, 5.22; 95% CI, 0.94–28; P=0.058). Renal recovery was identified in three patients. AKI, hypoxemia with the ratio of the arterial partial pressure of oxygen and the inspiratory concentration of oxygen <70, and vasopressors were identified as mortality factors.
Conclusions
AKI occurred in almost half the patients with critical COVID-19. A high level of D-dimers and sepsis contributed significantly to its development. AKI significantly worsened the prognosis in these patients.

Citations

Citations to this article as recorded by

Acute kidney injury in adult patients with COVID-19: an integrative review
Ana Clara Alcântara Mendes Pereira, Jéssica Cristina Almeida, Beatriz Regina Lima de Aguiar, Elaine Barros Ferreira, Priscilla Roberta Silva Rocha
Acta Paulista de Enfermagem.2024;[Epub] CrossRef
Lesão renal aguda em pacientes adultos com COVID-19: revisão integrativa
Ana Clara Alcântara Mendes Pereira, Jéssica Cristina Almeida, Beatriz Regina Lima de Aguiar, Elaine Barros Ferreira, Priscilla Roberta Silva Rocha
Acta Paulista de Enfermagem.2024;[Epub] CrossRef
Impact of COVID-19 in patients hospitalized with stress cardiomyopathy: A nationwide analysis
Adrija Hajra, Aaqib Malik, Dhrubajyoti Bandyopadhyay, Akshay Goel, Ameesh Isath, Rahul Gupta, Suraj Krishnan, Devesh Rai, Chayakrit Krittanawong, Salim S. Virani, Gregg C. Fonarow, Carl J. Lavie
Progress in Cardiovascular Diseases.2023; 76: 25. CrossRef
Prior bariatric surgery and risk of poor in-hospital outcomes in COVID-19: findings from a National Inpatient Sample
Daniel Sungku Rim, Byung Sik Kim, Kavita Sharma, Jeong-Hun Shin, Dong Wook Kim
Surgery for Obesity and Related Diseases.2023; 19(12): 1435. CrossRef
Clinical Features and Outcomes of Acute Kidney Injury in Critically Ill COVID-19 Patients: A Retrospective Observational Study
Nabil Bouguezzi, Imen Ben Saida, Radhouane Toumi, Khaoula Meddeb, Emna Ennouri, Amir Bedhiafi, Dhouha Hamdi, Mohamed Boussarsar
Journal of Clinical Medicine.2023; 12(15): 5127. CrossRef
Acute Kidney Injury in Coronavirus Disease and Association with Thrombosis
Anand Narayanan, Patrick Cunningham, Malavika Mehta, Theodore Lang, Mary Hammes
American Journal of Nephrology.2023; 54(3-4): 156. CrossRef
Predictive Values of Procalcitonin and Presepsin for Acute Kidney Injury and 30-Day Hospital Mortality in Patients with COVID-19
Sin-Young Kim, Dae-Young Hong, Jong-Won Kim, Sang-O Park, Kyeong-Ryong Lee, Kwang-Je Baek
Medicina.2022; 58(6): 727. CrossRef
HYDROCORTISONE, ASCORBIC ACID, AND THIAMINE THERAPY DECREASE RENAL OXIDATIVE STRESS AND ACUTE KIDNEY INJURY IN MURINE SEPSIS
John Kim, Allan Stolarski, Qiuyang Zhang, Katherine Wee, Daniel Remick
Shock.2022; 58(5): 426. CrossRef

Thoracic Surgery
Perfusion parameters during cardiopulmonary bypass as a predictor of acute kidney injury after aortic valve replacement: Yeiwon Lee, Sue Hyun Kim, Ho Young Hwang, Suk Ho Sohn, Jae Woong Choi, Kyung Hwan Kim; Acute Crit Care. 2021;36(3):242-248. Published online August 12, 2021; DOI: https://doi.org/10.4266/acc.2021.00094

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Abstract PDF

Background
Acute kidney injury (AKI) is a major complication after cardiac surgery and significantly affects postoperative mortality and morbidity. This study was conducted to evaluate the association between target pump flow to achieve adequate oxygen delivery (DO₂) and postoperative renal function after aortic valve replacement.
Methods
From January 2017 to May 2020, 281 patients (male:female, 160:121; mean age, 68±11 years) who underwent aortic valve replacement were retrospectively reviewed. Target pump flow was calculated based on DO₂ level of 280 mL/min/m². The primary endpoint was postoperative renal dysfunction, defined as the ratio of postoperative peak creatinine level to preoperative value. The ratio of the lowest actual pump flow to the ideal target pump flow, other hemodynamic variables related with cardiopulmonary bypass, intraoperative transfusion, and preoperative characteristics were analyzed to identify factors associated with the primary endpoint using a multivariable linear regression model.
Results
Preoperative and peak postoperative creatinine levels were 0.94±0.33 mg/dl and 1.15±0.56 mg/dl, respectively (ratio, 1.22±0.33). The ideal target pump flow was 4.70±0.59 L/min, whereas the lowest actual pump flow was 3.77±0.47 L/min (ratio, 0.81±0.13). The multivariable model showed that the ratio of the lowest pump flow to target pump flow (β±standard error, –0.405±0.162, P=0.013), as well as sex, stroke history, emergency operation, and transfusion of red blood cells were associated with the primary endpoint.
Conclusions
Low actual nadir pump flow compared to the ideal target pump flow based on DO₂ is associated with the risk of AKI after aortic valve replacement.

Citations

Citations to this article as recorded by

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks
Jakub Udzik, Jerzy Pacholewicz, Andrzej Biskupski, Paweł Walerowicz, Kornelia Januszkiewicz, Ewa Kwiatkowska
Journal of Clinical Medicine.2023; 12(21): 6894. CrossRef

Nephrology
The Association of Preoperative Body Mass Index with Acute Kidney Injury in Liver Transplantation Recipients: A Retrospective Study: Ju Yeon Park, Jung-Hyun Park, Su Sung Lee, Hyun-Su Ri, Hye-jin Kim, Yun Mi Choi, Yoon Ji Choi, Ji-Uk Yoon; Korean J Crit Care Med. 2017;32(3):265-274. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00178

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Abstract PDF

Background
Liver transplantation (LT) is a complicated procedure with a high incidence of postoperative acute kidney injury (AKI). Previous studies indicate that even transient or mild post-LT AKI can result in critical conditions, including prolonged stays in hospitals and intensive care units and increased morbidity and mortality. The aim of this study was to investigate the association between body mass index (BMI) and occurrence of AKI in LT recipients. Methods: Medical data from 203 patients who received LT surgery from January 2010 to August 2016 in a single university hospital setting were retrospectively collected and analyzed. Patients were classified as either underweight (BMI <20 kg/m²) or normal weight (20 ≤ BMI < 30 kg/m²). Demographic data, anesthetic methods, complications, and perioperative laboratory test values of each patient were assessed. Propensity analyses and logistic regression were performed to evaluate the association between BMI and post-LT AKI. Results: There was no significant difference in occurrence of post-LT AKI between underweight and normal weight patients. The underweight patient group had significantly longer hospital stay compared with the normal weight patient group (P = 0.023). Conclusions: BMI classification was neither a positive nor negative predictor of postoperative AKI occurrence. However, patients with lower BMI had significantly longer hospital stay compared with their counterparts. Although our study was limited by its retrospective design, our observations suggest that lower BMI might play a role in post-LT AKI.

Citations

Citations to this article as recorded by

Association of Body Mass Index and Acute Kidney Injury Incidence and Outcome: A Systematic Review and Meta-Analysis
Jiarong Lan, Guangxing Xu, Yongfu Zhu, Congze Lin, Ziyou Yan, Sisi Shao
Journal of Renal Nutrition.2023; 33(3): 397. CrossRef
Association of overweight with postoperative acute kidney injury among patients receiving orthotopic liver transplantation: an observational cohort study
Jian Zhou, Lin Lyu, Lin Zhu, Yongxin Liang, He Dong, Haichen Chu
BMC Nephrology.2020;[Epub] CrossRef

Case Reports

Neurology
Clozapine Induced Neuroleptic Malignant Syndrome: Yong Suk Jo, Hyung Ah Jo, Byung Chul Yu, Jung Hoon Shin, Kook-Hwan Oh; Korean J Crit Care Med. 2017;32(3):291-294. Published online December 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00052

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Abstract PDF

Neuroleptic malignant syndrome is a rare, but potentially life-threatening adverse event associated with the use of neuroleptic agents. We describe the case of a 47-year-old schizophrenic woman who was treated with clozapine for years. The patient developed acute renal failure with pulmonary edema, and underwent mechanical ventilation and hemodialysis.

Citations

Citations to this article as recorded by

Toxicity and Adverse Effects in Clozapine-Related Presentations to a Medical Toxicology Service in Western Sydney
Pramod Chandru, Naren Gunja
Journal of Medical Toxicology.2023; 19(4): 374. CrossRef

Neurology/Obstetric
A Critical Case of Wernicke's Encephalopathy Induced by Hyperemesis Gravidarum: Byung Ju Kang, Min Gu Kim, Jwa Hoon Kim, Mingee Lee, Sang-Beom Jeon, Ha Il Kim, Jin Won Huh; Korean J Crit Care Med. 2015;30(2):128-131. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.128

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Abstract PDF

Wernicke’s encephalopathy is a reversible but potentially critical disease caused by thiamine deficiency. Most patients complain of symptoms such as ophthalmoplegia, ataxia and confusion. Heavy alcohol drinking is commonly associated with the disease, but other clinical conditions also can provoke it. In pregnant women, hyperemesis gravidarum can lead to the depletion of body thiamine due to poor oral intake and a high metabolic demand. We report a case of Wernicke’s encephalopathy following hyperemesis gravidarum in a 36-year-old female at 20 weeks of pregnancy, who visited our hospital because of shock with vaginal bleeding. This case suggests that although the initial presentation may include atypical symptoms (e.g., shock or bleeding), Wernicke’s encephalopathy should be considered, and thiamine replacement should be performed in pregnant women with neurologic symptoms and poor oral intake.

Citations

Citations to this article as recorded by

Wernicke's Encephalopathy in Acute and Chronic Kidney Disease: A Systematic Review
Erik Oudman, Jan W. Wijnia, David Severs, Misha J. Oey, Mirjam van Dam, Maaike van Dorp, Albert Postma
Journal of Renal Nutrition.2024; 34(2): 105. CrossRef
Intrauterine Fetal Demise: A Rare Complication of Wernicke's Encephalopathy Secondary to Hyperemesis Gravidarum
Anthony Pham, Robin Okpara, Nancy Rollins, Roy Jacob
Cureus.2023;[Epub] CrossRef
Wernicke’s encephalopathy in hyperemesis gravidarum: A systematic review
Erik Oudman, Jan W. Wijnia, Misha Oey, Mirjam van Dam, Rebecca C. Painter, Albert Postma
European Journal of Obstetrics & Gynecology and Reproductive Biology.2019; 236: 84. CrossRef

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