Critical Care Medicine最新文献

Objectives: The impact of acute kidney injury (AKI) on long-term outcomes of hospital survivors is controversial. We conducted a systematic review and meta-analysis of all studies reporting such outcomes in patients with AKI and including a control population.

Data sources: We included original studies published in peer-reviewed journals that compared long-term outcomes (survival, need for dialysis, chronic kidney disease [CKD]) among hospitalized patients with vs. without AKI.

Study selection: Pertinent articles enrolled patients who experienced and survived a defined episode of AKI, included a control group without AKI, and reported at least one long-term outcome (mortality, dialysis, or CKD), with a minimum follow-up of 1 year.

Data extraction: Two independent investigators extracted data on study characteristics, patient populations, follow-up duration, and long-term outcomes. Discrepancies were resolved by consensus.

Data synthesis: We identified 14 studies for a total of 1,058,109 overall matched patients with a median duration of follow-up of 3 years. Patients who experienced an episode of AKI and survived hospital discharge had a significant increase in long-term mortality at the longest follow-up available for each study (137,506/519,672 [26.4%] vs. 93,702/530,663 [17.6%]; relative risk [RR], 1.42; 95% CI, 1.13-1.78; p = 0.002), compared with controls. They also had a greater risk of receiving dialysis (1,928/42,529 [4.5%] vs. 854/42,529 [2.0%]; RR, 2.48; 95% CI, 1.79-3.43; p < 0.001), and of developing CKD (2,956/5,739 [51.5%] vs. 2,902/7,781 [37.3%]; RR, 1.71; 95% CI, 1.33-2.19; p < 0.001).

Conclusions: Compared with controls, patients who experienced an episode of AKI and survived to hospital discharge have an increased risk of death, dialysis, and CKD.

Objectives: Delays in emergency medical care (EMC) can increase sepsis mortality. Sepsis symptoms, however, are less known in the public compared with signs of stroke and myocardial infarction. Using case vignettes, we investigated the decision to seek EMC in sepsis-related compared with other emergencies.

Design: Cross-sectional survey.

Settings and subjects: A representative nationwide survey was conducted in December 2023 among 1013 persons in Germany.

Interventions: None.

Measurements and main results: A standardized questionnaire was administered via face-to-face interviews to assess perceived urgency, the tendency to seek EMC, sepsis knowledge, and barriers to EMC utilization. Multiple regression analyses were conducted to identify predictors for the perceived urgency and the tendency to seek EMC. Across ten case vignettes, the perceived urgency was lower for sepsis-related (mean = 3.93, sd = 0.64) than for nonsepsis-related emergencies (mean=4.15, sd = 0.67). In sepsis-related vignettes, the immediate EMC option ("Call emergency medical services or go to the emergency department [ED] immediately") was chosen by 18.3-43.2% of respondents, compared with 20.1-71.9% in nonsepsis-related vignettes. Even when situations were rated as very urgent, EMC use was less likely for sepsis-related emergencies (35%) than for nonsepsis-related emergencies (17%). In regression analyses, sepsis knowledge was the only predictor of perceived urgency, and perceived urgency was the strongest predictor of EMC use. The likelihood of EMC use in sepsis-related emergencies was 14.9 percentage points lower ( p < 0.01) than in nonsepsis-related emergencies; "long waiting times in the ED" was the only significant barrier for EMC use.

Conclusions: Compared with nonsepsis emergencies, sepsis-related emergencies are perceived as less urgent and less often lead to EMC use, even if the level of perceived urgency is the same. As the perceived urgency is associated with sepsis knowledge, this underlines the need to increase efforts to improve sepsis knowledge and the awareness that sepsis requires timely emergency care in the general public.