Cardiorenal syndrome in sepsis: A narrative review

Kotecha, Aditya; Vallabhajosyula, Saraschandra; Coville, Hongchuan; Kashani, Kianoush

doi:10.1016/j.jcrc.2017.08.044

Cited by 61 publications

(54 citation statements)

References 71 publications

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“…It is possible that the higher occurrence of AKI over the years is related to greater recognition and improved coding practices. 17,18 The reasons for not obtaining cardiac and non-cardiac organ support therapies because of treatment-limiting decisions could not be assessed in this administrative database. no tubular injury).…”

Section: Discussionmentioning

confidence: 99%

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Sex disparities in acute kidney injury complicating acute myocardial infarction with cardiogenic shock

et al. 2019

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Aims To evaluate sex‐specific disparities in acute kidney injury (AKI) complicating acute myocardial infarction‐related cardiogenic shock (AMI‐CS) in the United States. Methods and results This was a retrospective cohort study from 2000 to 2014 from the National Inpatient Sample (20% sample of all hospitals in the United States). Patients >18 years admitted with a primary diagnosis of AMI and concomitant CS that developed AKI were included. The endpoints of interest were the prevalence, trends, and outcomes of men and women with AKI in AMI‐CS. Multivariable hierarchical logistic regression was used to control for confounding, and a two‐sided P < 0.05 was considered statistically significant. During this 15 year period, 440 257 admissions with AMI‐CS met the inclusion criteria, with AKI noted in 155 610 (35.3%). Women constituted 36.3% of the cohort and were older, of non‐White race, and with higher co‐morbidity compared with men. Women with AKI less often received coronary angiography (59% vs. 66%), percutaneous coronary intervention (39% vs. 43%), mechanical circulatory support (39% vs. 48%), mechanical ventilation (49% vs. 54%), and haemodialysis (9% vs. 10%) compared with men (all P < 0.001). Adjusted in‐hospital mortality was higher in women—odds ratio 1.16 (95% confidence interval 1.14–1.19); P < 0.001—compared with men. Women had shorter lengths of stay (12 ± 14 vs. 13 ± 14 days), lower hospital costs ($150 071 ± 180 796 vs. $181 260 ± 209 674), and were less often discharged to home (19% vs. 31%) (all P < 0.001). Conclusions Women with AKI in AMI‐CS received fewer cardiac and non‐cardiac interventions, had higher in‐hospital mortality, and were less often discharged to home compared with men.

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Section: Discussionmentioning

confidence: 99%

“…Knowing that AKI cases described in this paper are mostly patients with real AKI, we believe our results still provide valuable information. 17,18 The reasons for not obtaining cardiac and non-cardiac organ support therapies because of treatment-limiting decisions could not be assessed in this administrative database.…”

Section: Discussionmentioning

confidence: 99%

Sex disparities in acute kidney injury complicating acute myocardial infarction with cardiogenic shock

et al. 2019

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“…As the subset of sepsis, septic shock is defined in which underlying circulatory and cellular or metabolic abnormalities, and are profound enough to increase mortality substantially 2 . Generally, 40-60% sepsis patients have multiple organ dysfunction 3 . Among these, myocardial dysfunction is one of the main predictors of poor outcome in septic patients, with mortality rates next to 70% 4 .…”

Section: Introductionmentioning

confidence: 99%

The miR-15a affected the development of sepsis and septic shock by suppression BCL-2

Xie

Jiao

et al. 2019

Preprint

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Background: This study aimed to investigate the mechanism of microRNA-15a (miR-15a) in the development of sepsis and septic shock. Methods: Sepsis and septic shock rat models were constructed by intraperitoneal injection of E.coli endotoxin (LPS). The real-time polymerase chain reaction (RT-PCR), Enzyme-Linked ImmunoSorbent Assay (ELISA), ematoxylin-eosin (HE) and Masson staining, TdT-mediated dUTP Nick-End Labeling (TUNEL), as well as Western blot analysis were performed to reveal the expression of microRNA-15a and changes in sepsis/septic shock myocardial cells or tissue. The rat sepsis model (sepsis group and septic shock group) was successfully established. Results: The results of HE and Mason staining showed that myocardial tissue damage gradually deepened with the progression of sepsis. Moreover, the serum levels of creatinine kinase-mb (CK-MB) and cardiac troponin I (cTnI) in model groups were significantly increased than those in control group. In addition, the RT-PCR analysis showed that miR-15a was up-regulated in model groups. Furthermore, luciferase reporter gene assay showed that 3'-UTR was the binding site of BCL-2 to miR-15a. Finally, the TUNEL and Western blot showed the cardiomyocyte apoptosis in model group. Conclusions: The overexpression of miR-15a might take part in the progression of LPS-induced sepsis and septic shock via suppressing Bcl-2 expression. Furthermore, myocardial markers such as CK-MB and cTnI might be biomarkers for sepsis progression.

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“…Sepsis continues to be a leading cause of mortality and morbidity in intensive care units in the United States 6. Multiorgan dysfunction is observed in up to 45% of patients presenting with sepsis and is associated with worse short‐term outcomes and long‐term organ dysfunction 7, 8, 9. Cardiovascular dysfunction in sepsis can manifest as septic cardiomyopathy, TTC, refractory shock, and myocardial injury, resulting in worse mortality and morbidity 10, 11, 12, 13, 14.…”

Section: Introductionmentioning

confidence: 99%

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

Vallabhajosyula

Deshmukh

Kashani

et al. 2018

JAHA

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BackgroundThere are limited data on the presentation of Takotsubo cardiomyopathy (TTC) in severe sepsis.Methods and ResultsThis was a retrospective cohort study using the National Inpatient Sample database (2007–2013) of all adults with severe sepsis. TTC was identified in patients with severe sepsis using previously validated administrative codes. The primary outcome was in‐hospital mortality, and secondary outcomes included resource utilization and discharge disposition. Regression analysis was performed for the entire cohort and a propensity‐matched sample. An exploratory analysis was performed for predictors of TTC incidence and mortality in TTC. During this 7‐year period, in 7.1‐million hospitalizations for severe sepsis, TTC was diagnosed in 10 746 (0.15%) admissions. TTC was noted more commonly in whites, females, and among 65‐ to 79‐year‐old individuals. TTC was independently associated with lower in‐hospital mortality in severe sepsis (odds ratio, 0.58; 95% confidence interval, 0.51–0.65). This association was more prominent in females (odds ratio, 0.51; 95% confidence interval, 0.44–0.59]) compared with males (odds ratio, 0.69; 95% confidence interval, 0.55–0.85]). Presentation in later years of the study period, middle‐age, female sex, and white race were independent predictors for the diagnosis of TTC. Age ≥80 years, black race, greater comorbidity, and multiorgan dysfunction were independently associated with higher in‐hospital mortality among TTC admissions.Conclusions TTC is observed with increasing frequency in severe sepsis and was associated with a significantly lower in‐hospital mortality compared with patients without TTC. Presentation in later years of the study period, middle age, female sex, and white race were independent predictors for the diagnosis of TTC in severe sepsis.

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Cardiorenal syndrome in sepsis: A narrative review

Cited by 61 publications

References 71 publications

Sex disparities in acute kidney injury complicating acute myocardial infarction with cardiogenic shock

Sex disparities in acute kidney injury complicating acute myocardial infarction with cardiogenic shock

The miR-15a affected the development of sepsis and septic shock by suppression BCL-2

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

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