The American journal of the medical sciences最新文献

Background: This study aimed to investigate the potential impact of administering albumin and loop diuretics together on in-hospital mortality in septic shock patients.

Methods: Data from the MIMIC-IV database was used for a retrospective cohort study analyzing 3,298 adult septic shock patients. The Cox proportional hazards model and propensity score matching (PSM) were utilized to assess the relationship between loop diuretic administration and in-hospital mortality.

Results: The study found that septic shock patients who received albumin in combination with loop diuretic had a significantly lower in-hospital mortality rate compared to those who received albumin alone (19.4 % vs 33.1 %, p < 0.001). Administering diuretics after albumin infusion was associated with lower mortality rates. Optimal furosemide dosages of 10 to 40 mg daily were linked to the lowest mortality rates.

Conclusion: Co-administering albumin and loop diuretics in septic shock patients receiving high-dose crystalloids may be associated with reduced in-hospital mortality. Further investigation through a prospective randomized controlled trial is recommended to validate these findings.

To investigate the association between obesity and blood lead level (BLL) in the general population after controlled for menopause, blood pressure, calcium, and smoking; we assessed the relationship between BMI, WC (Waist Circumference), and blood lead levels in the non-smoking middle-aged subjects without hypertension among 2018 KNHANES. All data were recategorized into S1 (BMI<25 kg/m² & WC<90 cm), S2 (intermediate), and S3 (BMI>25 kg/m² & WC>90 cm). We made the log transformation of blood lead levels to bring them closer to a normal distribution. Logarithmic transformed BLL was closely related to BMI (p=.010) and WC (p=.020) after adjusting for sociodemographic, energy, working factors, and cardiometabolic variables. The prevalence of ratios of S3, S2, and S1 was comparable according to the quarterly group of BLL. Blood lead levels might increase oxidative stress on triglycerides and low high-density lipoprotein (HDL)-cholesterol; consequently, lead exposure might form peroxynitrite, a reactive oxygen substrate (ROS) susceptible to destroying lipids. Consequently, obesity was significantly correlated with logarithmic blood lead levels irrespective of sociodemographic, energy, working, and cardiometabolic factors in the non-smoking middle-aged population without hypertension. Further controlled clinical trials would be considered.

Background: As a life-threatening complication in patients undergoing surgery, acute kidney injury (AKI) is strongly associated with a worse prognosis. Urinary dickkopf-related protein 3 (DKK3) has been identified as a biomarker for predicting postoperative AKI in patients undergoing cardiac surgery.

Objective: To investigate the predictive value of urinary DKK3 on postoperative AKI and develop a clinical model based on the predictor for predicting the development of AKI within seven days for patients undergoing noncardiac surgery.

Methods: All patients who were admitted to the Intensive Care Unit (ICU) after noncardiac surgery from March 2023 to June 2023 were included in this study. The patients' baseline data on demographic characteristics, lifestyle risk factors, medical history, clinical features, and laboratory tests before surgery were collected at the time of admission. Besides, the blood samples for cystatin C and routine laboratory tests and the urine samples for DKK3 tests were simultaneously collected at the time of admission to the ICU. In addition, the independent predictors of postoperative AKI were identified by univariate, multivariate, and LASSO analyses. Moreover, a nomogram for predicting postoperative AKI was developed based on these independent predictors. Finally, the nomogram was evaluated through calibration and decision curve analyses.

Results: A total of 166 patients with a median age of 67 years old were included in this study, including 94 (56.63%) males. Among these patients, 47 patients (28.3%) developed postoperative AKI. Additionally, 7 independent risk factors, including preoperative serum creatinine, preoperative eGFR, preoperative serum albumin, preoperative serum potassium ion, cystatin C, uDKK3/uCr, and SOFA score, were selected by univariate and multivariate regression analyses. Eventually, 4 independent risk factors (including preoperative eGFR, cystatin C, uDKK3/uCr, and SOFA score) identified in this study by LASSO analyses were used to establish the nomogram. The area under the receiver operating characteristic (ROC) curve (AUC) for the prediction model was 0.868. The calibration curve and decision curve analysis results demonstrated that the nomogram had good prediction performance.

Conclusions: Urinary DKK3/creatinine was independently associated with postoperative AKI for patients in the ICU after noncardiac surgery. The nomogram constructed based on uDKK3/uCr, preoperative eGFR, cystatin C, and SOFA score showed a higher accuracy in predicting postoperative AKI.

Clinicians frequently evaluate patients who present with dyspnea. This term describes uncomfortable breathing during physical activity, and the intensity or degree of dyspnea can vary in an individual depending on circumstances and between individuals. In some cases, the level of dyspnea appears out of proportion to other information relevant to the cardiorespiratory system, and this situation has been described as dysfunctional breathing. The Bayesian brain hypothesis helps clinicians understand this symptom in these patients. This hypothesis suggests that prior experiences with dyspnea during physical activity or a respiratory disorder provide the background that is used to interpret current symptoms. This review outlines problems associated with the use of the term "dyspnea" and briefly describes how the Bayesian brain hypothesis might help clinicians understand this symptom better.

Objective: Retrospective study to examine the outcomes of acute kidney injury requiring dialysis (AKI-D) patients that received outpatient hemodialysis as part of continued AKI-D care and explore factors associated with recovery of kidney function and discontinuation of dialysis.

Methods: Records of all admissions to Emory Dialysis centers between January 2010 to December 2021 were reviewed to include patients with confirmed diagnosis of AKI-D. Basic demographics, comorbidities, duration of hospitalization and cause of AKI were extracted from hospital records and cross-referenced with the dialysis center electronic health record. Patients were followed starting from the day of the first outpatient hemodialysis up to 180 days. All hemodialysis sessions and laboratory data were analyzed. Logistic regression models were used to examine factors associated with recovery of kidney function, defined as survival free of dialysis.

Results: 132 patients were analyzed, corresponding to 12,662 patient-day of outpatient AKI-D care. Among those, 19 (14 %) patients died during the observation period. 54 % of patients were male and 70 % were Black race. Median Age was 64 years (IQR 49-79). 42 patients (32 %) recovered enough kidney function to discontinue dialysis. Median time to kidney recovery was 31 days (IQR: 19-75), and the cumulative probability of kidney recovery at 6 months was 39 %. Patients who discontinued dialysis were younger (58 vs 66 years), had higher estimated glomerular filtration rate (eGFR) at time of admission (69 vs 46 ml/min/1.73m²) to the hospital, and were less likely to have a history of hypertension (61 % vs 82 %). Intra-dialytic hypotension was more common in patients who did not recover kidney function.

Conclusions: 39 % of patients with AKI-D recovered kidney function within 180 days of outpatient HD start. The median time to recovery was 31 days. Younger age, higher e-GFR at time of hospital admission, and absence of hypertension were predictors of kidney recovery. Patients who recover kidney function experienced episodes of intradialytic hypotension less frequently.

Introduction: Acute-on-Chronic Liver Failure(ACLF) is a syndrome characterized by organ dysfunction and high mortality in cirrhotic patients. ACLF has multiple triggers but those precipitated by fungal infection have higher mortality. Early detection and treatment of candidemia have shown mortality benefits in ACLF. The sensitivity of blood cultures ranged from 21 % - 71 %. Given the increase in mortality, it is vital to have a quick yet reliable diagnostic test for the detection of candida. This study examines the risk of developing ACLF and its impact on survival in hospitalized cirrhotic patients with invasive fungal infection via a positive T2Candida Panel. We also examine the effects of earlier treatment on mortality in those with a positive T2Candida Panel.

Methods: We performed a retrospective study and included cirrhotic patients admitted from 2017 to 2021. Data collected includes baseline characteristics, labs, progression to ACLF, and mortality outcomes. The stages of ACLF were determined through the use of the CLIF-Consortium ACLF score.

Results: Of the 489 patients sampled, 95 patients developed ACLF during the time of the T2 panel collection, of which 60 (63.2 %) (p ≤ 0.001) patients had a positive T2Candida Panel. The data also demonstrates that patients who had earlier antifungal initiation had a decrease in mortality (6.15 ± 5.23 versus 13.53 ± 11.42)(p ≤ 001).

Conclusion: Our study shows that a positive T2 Panel leads to more frequent progression of ACLF and worsening survival outcomes. This study shows that earlier treatment of candidiasis via the T2 Panel leads to mortality benefits.

Background: The arterial to end-tidal carbon dioxide gradient (P [a-Et] CO₂) reveals the ventilation-perfusion (V/Q) status of critically ill patients. V/Q mismatch has several causes and affects the clinical outcomes of critically ill patients. We investigated the relationship between P (a-Et) CO₂ and the clinical outcomes in critically ill patients.

Methods: Critically ill patients (n = 1,978) on mechanical ventilation and capnography in the intensive care units of two institutions were enrolled and categorized into three groups: P (a-Et) CO₂ ≤10 mmHg (low group), 10 mmHg < P (a-Et) CO₂ ≤ 20 mmHg (medium group), and 20 mmHg < P (a-Et) CO₂ (high group).

Results: The Acute Physiology and Chronic Health Evaluation II score was 29.5 ± 8.1, 31.3 ± 8.2, and 33.3 ± 8.7 in the low, medium, and high groups, respectively (p < 0.001). Overall mortality rates were 25.5 %, 35.6 %, and 52.8 % in the low, medium, and high groups, respectively (p < 0.001). The odds ratio was 1.456 (95 % confidence interval [CI]: 1.117-1.897, p = 0.002) and 2.320 (95 % CI: 1.635-3.293, p < 0.001) for the medium and high groups, respectively, with the low group as a reference. The area under the receiver operating characteristic curve of P (a-Et) CO₂ for overall mortality was 0.604 (p < 0.001).

Conclusions: P (a-Et) CO₂ is a simple, easily accessible indicator that potentially impacts patient care and outcomes as an independent marker for assessing disease severity and predicting mortality, especially in non-respiratory critical care scenarios.