Influence of the trajectory of the urine output for 24 h on the occurrence of AKI in patients with sepsis in intensive care unit

Zhang, Luming; Xu, Fengshuo; Han, Didi; Li, Shaojin; Yin, Haiyan; Lyu, Jun

doi:10.1186/s12967-021-03190-w

Cited by 9 publications

(7 citation statements)

References 37 publications

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“…adopted RIFLE criteria. Recent research by Zhang and coworkers found that the incidence of AKI in sepsis was 41.1% in the mimic IV database ( 19 ), the results of this study support the findings of Luming Zhang and other colleges. The above studies indicate that patients with Sepsis AKI are still diseases that require urgent attention in critical care medicine.…”

Section: Discussionsupporting

confidence: 88%

The blood pressure targets in sepsis patients with acute kidney injury: An observational cohort study of multiple ICUs

et al. 2022

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BackgroundThe maintenance of blood pressure is pivotal in preventing sepsis with acute kidney injury (AKI). Especially in sepsis patients treated with vasopressors. The optimal the blood pressure has been controversial to maintain renal perfusion. This study aims to explore the blood pressure target in sepsis with AKI.MethodsWe retrieved patient data from the MIMIC IV and eICU databases. The Lasso regression model was used to identify the relationship between blood pressure and sepsis in patients with AKI and remove collinearity among variables. Generalized additive models were used to estimate the blood pressure range in patients with sepsis with AKI. Statistical methods such as multivariable logistic regression, propensity score analysis, inversion probability-weighting, and doubly robust model estimation were used to verify the target blood pressure for patients with sepsis and AKI.ResultsIn total, 17874 patients with sepsis were included in this study. the incidence of AKI may be related to the level of mean article pressure (MAP) and diastolic blood pressure (DBP) in sepsis patients. The range of MAPs and DBPs may be 65-73 mmHg and 50-60 mmHg in AKI patients without hypertension. The range of MAPs and DBPs may be 70-80 mmHg and 54-62 mmHg in AKI patients with hypertension. The prognosis of sepsis with AKI was unaffected by MAP or DBP. Systolic blood pressure is not associated with sepsis in patients with AKI.ConclusionsTo ensure renal perfusion, AKI patients with hypertension may require a higher MAP [70-80] versus (65-73), mmHg] and DBP [(54-62) vs (50-60), mmHg] than patients without hypertension.

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Section: Discussionsupporting

confidence: 88%

The blood pressure targets in sepsis patients with acute kidney injury: An observational cohort study of multiple ICUs

et al. 2022

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“…Treatment regimens for AKI have been unsuccessful over the years due to a lag in the clinical recognition of AKI with serum creatinine 17 . Some studies have also successively confirmed that oliguria is an early predictor of higher mortality in critically ill patients 18–20 . However, changes in urine output have shown high specificity only in oliguric AKI.…”

Section: Discussionmentioning

confidence: 99%

Construction and evaluation of a risk prediction model for pulmonary infection‐associated acute kidney injury in intensive care units

Cao

Liang

Feng

et al. 2023

Clinical Translational Sci

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Acute kidney injury (AKI) is one of the common complications of pulmonary infections. However, nomograms predicting the risk of early‐onset AKI in patients with pulmonary infections have not been comprehensively researched. In this study, 3278 patients with pulmonary infection were extracted from the Medical Information Mart for Intensive Care III (MIMIC‐III) database. These patients were randomly divided into training and validation cohorts, with the training cohort used for model building and the validation cohort used for validation. Independent risk factors for patients with pulmonary infection were determined using the least absolute shrinkage and selection operator (LASSO) method and forward stepwise logistic regression, which revealed that 11 independent risk factors for AKI in patients with pulmonary infections were congestive heart failure (CHF), hypertension, diabetes, transcutaneous oxygen saturation (SpO2), 24‐h urine output, white blood cells (WBC), serum creatinine (Scr), prothrombin time (PT), potential of hydrogen (PH), vasopressor use, and mechanical ventilation (MV) use. The nomogram was then constructed and validated. The area under the receiver operating characteristic curve (AUC) values of the nomogram were 0.770 (95% CI = 0.789–0.807) in the training cohort and 0.724 (95% CI = 0.754–0.784) in the validation cohort. High AUC values indicated the good discriminative ability of the nomogram, while the calibration curves and Hosmer–Lemeshow test results indicated that the nomogram was well‐calibrated. Improvements in net reclassification index (NRI) and integrated discrimination improvement (IDI) values indicate that our nomogram was superior to the Simplified Acute Physiology Score (SAPS) II scoring system, and the decision–curve analysis (DCA) curves indicate that the nomogram has good clinical application. We established a risk‐prediction model for AKI in patients with pulmonary infection, which has good discriminative power and is superior to the SAPS II scoring system. This model can provide clinical reference information for patients with this type of disease in the intensive care unit.

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“…and the Beth Israel Deaconess Medical Center (Boston, Mass. ), and consent was obtained for collection of the original data ( Zhang et al, 2021 ). The database also anonymizes patient information, and so informed consent did not need to be obtained.…”

Section: Methodsmentioning

confidence: 99%

The Association Between Bronchoscopy and the Prognoses of Patients With Ventilator-Associated Pneumonia in Intensive Care Units: A Retrospective Study Based on the MIMIC-IV Database

Zhang

Yuan

et al. 2022

Front. Pharmacol.

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Background: In intensive care units (ICUs), the morbidity and mortality of ventilator-associated pneumonia (VAP) are relatively high, and this condition also increases medical expenses for mechanically ventilated patients, which will seriously affect the prognoses of critically ill patients. The purpose of this study was to determine the impact of bronchoscopy on the prognosis of patients with VAP undergoing invasive mechanical ventilation (IMV).Methods: This was a retrospective study based on patients with VAP from the Medical Information Mart for Intensive Care IV database. The outcomes were ICU and in-hospital mortality. Patients were divided based on whether or not they had undergone bronchoscopy during IMV. Kaplan-Meier (KM) survival curves and Cox proportional-hazards regression models were used to analyze the association between groups and outcomes. Propensity score matching (PSM) and propensity score based inverse probability of treatment weighting (IPTW) were used to further verify the stability of the results. The effect of bronchoscopy on prognosis was further analyzed by causal mediation analysis (CMA).Results: This study enrolled 1,560 patients with VAP: 1,355 in the no-bronchoscopy group and 205 in the bronchoscopy group. The KM survival curve indicated a significant difference in survival probability between the two groups. The survival probabilities in both the ICU and hospital were significantly higher in the bronchoscopy group than in the no bronchoscopy group. After adjusting all covariates as confounding factors in the Cox model, the HRs (95% CI) for ICU and in-hospital mortality in the bronchoscopy group were 0.33 (0.20–0.55) and 0.40 (0.26–0.60), respectively, indicating that the risks of ICU and in-hospital mortality were 0.67 and 0.60 lower than in the no-bronchoscopy group. The same trend was obtained after using PSM and IPTW. CMA showed that delta-red blood cell distribution width (RDW) mediated 8 and 7% of the beneficial effects of bronchoscopy in ICU mortality and in-hospital mortality.Conclusion: Bronchoscopy during IMV was associated with reducing the risk of ICU and in-hospital mortality in patients with VAP in ICUs, and this beneficial effect was partially mediated by changes in RDW levels.

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Influence of the trajectory of the urine output for 24 h on the occurrence of AKI in patients with sepsis in intensive care unit

Cited by 9 publications

References 37 publications

The blood pressure targets in sepsis patients with acute kidney injury: An observational cohort study of multiple ICUs

The blood pressure targets in sepsis patients with acute kidney injury: An observational cohort study of multiple ICUs

Construction and evaluation of a risk prediction model for pulmonary infection‐associated acute kidney injury in intensive care units

The Association Between Bronchoscopy and the Prognoses of Patients With Ventilator-Associated Pneumonia in Intensive Care Units: A Retrospective Study Based on the MIMIC-IV Database

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