BACKGROUND:This study aims to evaluate the eff ect of continuous renal replacement therapy(CRRT)on inflammation-related anemia,iron metabolism,and the prognosis in sepsis patients with acute kidney injury(AKI).METHODS...BACKGROUND:This study aims to evaluate the eff ect of continuous renal replacement therapy(CRRT)on inflammation-related anemia,iron metabolism,and the prognosis in sepsis patients with acute kidney injury(AKI).METHODS:Sepsis patients with AKI were prospectively enrolled and randomized into the CRRT and control groups.The clinical and laboratory data on days 1,3 and 7 after intensive care unit(ICU)admission were collected.The serum interleukin(IL)-6,hepcidin,erythropoietin,ferritin,and soluble transferrin receptor(sTfR)were determined by enzyme-linked immunosorbent assay.The Sequential Organ Failure Assessment(SOFA)score and 28-day mortality were recorded.Data were analyzed using Pearson’s Chi-square test or Fisher’s exact test(categorical variables),and Mann-Whitney U-test or t-test(continuous variables).RESULTS:The hemoglobin and serum erythropoietin levels did not signifi cantly diff er between the CRRT and control groups though gradually decreased within the first week of ICU admission.On days 3 and 7,the serum IL-6,hepcidin,ferritin,and red blood cell distribution width significantly decreased in the CRRT group compared to the control group(all P<0.05).On day 7,the serum iron was significantly elevated in the CRRT group compared to the control group(P<0.05).However,the serum sTfR did not signifi cantly diff er between the groups over time.In addition,the SOFA scores were signifi cantly lower in the CRRT group compared to the control group on day 7.The 28-day mortality did not signifi cantly diff er between the control and CRRT groups(38.0%vs.28.2%,P=0.332).CONCLUSION:CRRT might have beneficial effects on the improvement in inflammationrelated iron metabolism and disease severity during the fi rst week of ICU admission but not anemia and 28-day mortality in sepsis patients with AKI.展开更多
Objective: To research the effectiveness of ulinastatin in combination with continuous renal replacement therapy in treating sepsis acute kidney injury and its effect on systemic inflammation, immune function and miRA...Objective: To research the effectiveness of ulinastatin in combination with continuous renal replacement therapy in treating sepsis acute kidney injury and its effect on systemic inflammation, immune function and miRAN expression. Methods: The 84 patients who were diagnosed with sepsis complicated by acute kidney injury in our hospital between May 2020 and June 2022 were chosen and randomly assigned to the study group (n = 42) and the control group (n = 42). Ulinastatin in combination with continuous renal replacement therapy was administered to the study group, whereas the control group was administered with continuous renal replacement therapy alone. Both groups’ clinical effects were observed. The levels of blood urea nitrogen (BUN), serum creatinine (SCr), tumor necrosis factor-α (TNF-α), high sensitivity Creactive protein (hs-CRP), vascular cell adhesion molecule-1 (VCAM-1), IgG, IgA, IgM, expression levels of miR-233 and miR-10a were compared among both the groups, pre-, and post-treatment. Results: The study group’s overall effectiveness rate was higher that is 95.24%, in comparison to the control group’s 78.57%, and this difference was statistically significant (P α, hs-CRP, VCAM-1, and miR-233 and miR-10a expression levels in both the study and control groups were decreased, however, the study group had reduced levels in comparison to the control group, with statistically significant differences (P P Conclusion: Ulinastatin in combination with continuous renal replacement therapy for treating sepsis acute kidney injury exhibits a positive effect and can significantly improve the systemic inflammation and immune function in patients.展开更多
BACKGROUND:Hospital mortality rates are higher among patients with sepsis-associated acute kidney injury(SA-AKI)than among patients with sepsis.However,the pathogenesis underlying SA-AKI remains unclear.We hypothesize...BACKGROUND:Hospital mortality rates are higher among patients with sepsis-associated acute kidney injury(SA-AKI)than among patients with sepsis.However,the pathogenesis underlying SA-AKI remains unclear.We hypothesized that the source of infection affects development of SA-AKI.We aim to explore the relationship between the anatomical source of infection and outcome in patients with SA-AKI.METHODS:Between January 2013 and January 2018,113 patients with SA-AKI admitted to our Emergency Center were identifi ed and divided into two groups:those with pulmonary infections and those with other sources of infection.For each patient,we collected data from admission until either discharge or death.We also recorded the clinical outcome after 90 days for the discharged patients.RESULTS:The most common source of infection was the lung(52/113 cases,46%),followed by gastrointestinal(GI)(25/113 cases,22.1%)and urinary(22/113,19.5%)sources.Our analysis showed that patients with SA-AKI had a significantly worse outcome(30/52 cases,P<0.001)and poorer kidney recovery(P=0.015)with pulmonary sources of infection than those infected by another source.Data also showed that patients not infected by a pulmonary source more likely experienced shock(28/61 cases,P=0.037).CONCLUSION:This study demonstrated that the source of infection infl uenced the outcome of SA-AKI patients in an independent manner.Lung injury may influence renal function in an asyet undetermined manner as the recovery of kidney function was poorer in SA-AKI patients with a pulmonary source of infection.展开更多
CD38 is known to play roles in various inflammatory pathways.However,whether it has a protective or detrimental effect during bacterial septicemia remains disputed.Herein,this study aimed to determine the potential ef...CD38 is known to play roles in various inflammatory pathways.However,whether it has a protective or detrimental effect during bacterial septicemia remains disputed.Herein,this study aimed to determine the potential effect of CD38 on renal injury in septicemia.Escherichia coli(E.coli)was used to induce sepsis-associated renal injury in mice.WT and CD38-/-mice were stimulated with E.coli.After three hours,the serum was collected to detect renal function.Function mRNA expressions inflammatory cytokines in kidneys were quantified by real-time PCR.Hematoxylin and eosin staining were used to observe the histomorphology of kidney.The expression of TLR4,NF-κB,MAPK and cytokines were detected by Western Blot.Our results demonstrated that 3×10^(8) cfu/mL E.coli is the appropriate dose to induce sepsis mice model.Compared to WT sepsis mice,CD38-/-mice showed aggravated kidney injuries with impaired renal function,increased inflammation and apoptosis after E.coli stimulation.Interestingly,CD38 deficiency also led to elevated expression of TLR4 and increased phosphorylation of NF-κB p65/p105 and ERK1/2.To sum up,our results suggested that CD38 deficiency could aggravate E.coli-induced renal injury through activating ERK1/2-NF-κB signaling pathway.展开更多
Objective:To investigate the effects of sustained low-efficiency dialysis (SLED) combined with hemoperfusion (HP) on inflammatory stress, hemodynamic parameters and renal function in septic patients with severe acute ...Objective:To investigate the effects of sustained low-efficiency dialysis (SLED) combined with hemoperfusion (HP) on inflammatory stress, hemodynamic parameters and renal function in septic patients with severe acute kidney injury.Methods: A total of 82 cases of sepsis with severe acute renal injury were divided into control group (n=41) and observation group (n=41) according to the random data table method. Two groups of patients were given conventional support treatment, on this basis, the control group was treated with Continuous renal replacement therapy (CRRT), and the observation group was treated with SLED plus HP. The levels of inflammatory factors, hemorheological parameters and renal function indexes of the two groups were compared before and after treatment.Results: There was no significant difference in the levels of CRP, WBC, PCT, MAP, OI, BUN and Scr between the control group and the observation group before the treatment. Compared with the level before treatment, the levels of CRP, WBC, PCT, BUN and Scr in the two groups were significantly decreased after treatment, while the levels of MAP and OI were significantly increased. Compared with the level of the control group after treatment, the levels of CRP, WBC, PCT, BUN and Scr in the observation group were significantly lower than those in the control group, the levels of MAP and OI were significantly increased, the difference was statistically significant.Conclusion:SLED combined with HP regimen in treatment of sepsis combined with severe acute kidney injury can effectively inhibit the release of inflammatory factors, improve hemodynamics and renal function, and has an important clinical value.展开更多
Renal cortical necrosis(RCN) is characterized by patchy or diffuse ischemic destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and mi...Renal cortical necrosis(RCN) is characterized by patchy or diffuse ischemic destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury. In addition, direct endothelial injury particularly in setting of sepsis, eclampsia, haemolytic uremic syndrome(HUS) and snake bite may lead to endovascular thrombosis with subsequent renal ischemia. Progression to end stage renal disease is a rule in diffuse cortical necrosis. It is a rare cause of acute kidney injury(AKI) in developed countries with frequency of 1.9%-2% of all patients with AKI. In contrast, RCN incidence is higher in developing countries ranging between 6%-7% of all causes of AKI. Obstetric complications(septic abortion, puerperal sepsis, abruptio placentae, postpartum haemorrhage and eclampsia) are the main(60%-70%) causes of RCN in developing countries. The remaining 30%-40% cases of RCN are caused by non-obstetrical causes, mostly due to sepsis and HUS. The incidence of RCN ranges from 10% to 30% of all cases of obstetric AKI compared with only 5% in non-gravid patients. In the developed countries, RCN accounts for 2% of all cases of AKI in adults and more than 20% of AKI during the third trimester of pregnancy. The reported incidence of RCN in obstetrical AKI varies between 18%-42.8% in different Indian studies. However, the overall incidence of RCN in pregnancy related AKI has decreased from 20%-30% to 5% in the past two decades in India. Currently RCN accounts for 3% of all causes of AKI. The incidence of RCN in obstetrical AKI was 1.44% in our recent study. HUS is most common cause of RCN in non-obstetrical group, while puerperal sepsis is leading cause of RCN in obstetric group. Because of the catastrophic sequelae of RCN, its prevention and aggressive management should always be important for the better renal outcome and prognosis of the patients.展开更多
Objective: To explore the correlation of insulin resistance (IR) extent with systemic inflammatory response and target organ damage in children with sepsis. Methods: A total of 70 patients with sepsis who were treated...Objective: To explore the correlation of insulin resistance (IR) extent with systemic inflammatory response and target organ damage in children with sepsis. Methods: A total of 70 patients with sepsis who were treated in our hospital between June 2013 and July 2016 were collected as observation group, 50 healthy children who received vaccination in our hospital during the same period were selected as normal control group, the insulin resistance index (HOMA-IR) of two groups of children were determined, the median of HOMA-IR of observation group was referred to further divide them into high HOMA-IR group and low HOMA-IR group, 35 cases in each group. The systemic inflammatory response and target organ damage extent were compared between sepsis children with different HOMA-IR levels. Results: HOMA-IR level in observation group was significantly higher than that in normal control group. Serum inflammatory factors PCT, IL-1β, IL-8 and IL-10 contents in high HOMA-IR group were significantly higher than those in low HOMA-IR group;serum myocardial injury indexes CK, CK-MB and LDH contents were significantly higher than those in low HOMA-IR group;serum liver injury indexes ALT, AST and TBIL contents were significantly higher than those in low HOMA-IR group while ALB content was lower than that in low HOMA-IR group;serum renal injury indexes Cr, BUN and CysC contents were significantly higher than those in low HOMA-IR group. Conclusion: HOMA-IR level in children with sepsis is higher than that in normal people, and HOMA-IR level is positively correlated with systemic inflammatory response and target organ injury.展开更多
Objective:To explore the correlation of insulin resistance (IR) extent with systemic inflammatory response and target organ damage in children with sepsis.Methods: A total of 70 patients with sepsis who were treated i...Objective:To explore the correlation of insulin resistance (IR) extent with systemic inflammatory response and target organ damage in children with sepsis.Methods: A total of 70 patients with sepsis who were treated in our hospital between June 2013 and July 2016 were collected as observation group, 50 healthy children who received vaccination in our hospital during the same period were selected as normal control group, the insulin resistance index (HOMA-IR) of two groups of children were determined, the median of HOMA-IR of observation group was referred to further divide them into high HOMA-IR group and low HOMA-IR group, 35 cases in each group. The systemic inflammatory response and target organ damage extent were compared between sepsis children with different HOMA-IR levels.Results: HOMA-IR level in observation group was significantly higher than that in normal control group. Serum inflammatory factors PCT, IL-1β, IL-8 and IL-10 contents in high HOMA-IR group were significantly higher than those in low HOMA-IR group;serum myocardial injury indexes CK, CK-MB and LDH contents were significantly higher than those in low HOMA-IR group;serum liver injury indexes ALT, AST and TBIL contents were significantly higher than those in low HOMA-IR group while ALB content was lower than that in low HOMA-IR group;serum renal injury indexes Cr, BUN and CysC contents were significantly higher than those in low HOMA-IR group.Conclusion: HOMA-IR level in children with sepsis is higher than that in normal people, and HOMA-IR level is positively correlated with systemic inflammatory response and target organ injury.展开更多
AIM: To determine renal dysfunction post liver transplantation, its incidence and risk factors in patients from a Belgian University Hospital.METHODS: Orthotopic liver transplantations performed from January 2006 unti...AIM: To determine renal dysfunction post liver transplantation, its incidence and risk factors in patients from a Belgian University Hospital.METHODS: Orthotopic liver transplantations performed from January 2006 until September 2012 were retrospectively reviewed(n = 187). Patients with no renal replacement therapy(RRT) before transplantation were classified into four groups according to their highest creatinine plasma level during the first postoperative week. The first group had a peak creatinine level below 12 mg/L, the second group between 12 and 20 mg/L, the third group between 20 and 35 mg/L, and the fourth above 35 mg/L. In addition, patients who needed RRT during the first week after transplantation were also classified into the fourth group. Perioperative parameters were recorded as risk factors, namely age, sex, bodymass index(BMI), length of preoperative hospital stay, prior bacterial infection within one month, preoperative ascites, preoperative treatment with β-blocker, angiotensin-converting enzyme inhibitor or non steroidal anti-inflammatory drugs, preoperative creatinine and bilirubin levels, donor status(cardiac death or brain death), postoperative lactate level, need for intraoperative vasopressive drugs, surgical revision, mechanical ventilation for more than 24 h, postoperative bilirubin and transaminase peak levels, postoperative hemoglobin level, amount of perioperative blood transfusions and type of immunosuppression. Univariate and multivariate analysis were performed using logistic ordinal regression method. Post hoc analysis of the hemostatic agent used was also done.RESULTS: There were 78 patients in group 1(41.7%), 46 in group 2(24.6%), 38 in group 3(20.3%) and 25 in group 4(13.4%). Twenty patients required RRT: 13(7%) during the first week after transplantation. Using univariate analysis, the severity of renal dysfunction was correlated with presence of ascites and prior bacterial infection, preoperative bilirubin, urea and creatinine level, need for surgical revision, use of vasopressor, postoperative mechanical ventilation, postoperative bilirubin and urea, aspartate aminotransferase(ASAT), and hemoglobin levels and the need for transfusion. The multivariate analysis showed that BMI(OR = 1.1, P = 0.004), preoperative creatinine level(OR = 11.1, P < 0.0001), use of vasopressor(OR = 3.31, P = 0.0002), maximal postoperative bilirubin level(OR = 1.44, P = 0.044) and minimal postoperative hemoglobin level(OR = 0.059, P = 0.0005) were independent predictors of early post-liver transplantation renal dysfunction. Neither donor status nor ASAT levels had significant impact on early postoperative renal dysfunction in multivariate analysis. Absence of renal dysfunction(group 1) was also predicted by the intraoperative hemostatic agent used, independently of the extent of bleeding and of the preoperative creatinine level.CONCLUSION: More than half of receivers experienced some degree of early renal dysfunction after liver transplantation. Main predictors were preoperative renal dysfunction, postoperative anemia and vasopressor requirement.展开更多
Background:Recent studies suggest that acute kidney injury(AKI)can be treated with renal replacement therapy(RRT).However,its benefits to patients with sepsis-associated AKI(SA-AKI),which is linked to high mortality a...Background:Recent studies suggest that acute kidney injury(AKI)can be treated with renal replacement therapy(RRT).However,its benefits to patients with sepsis-associated AKI(SA-AKI),which is linked to high mortality and morbidity rates,remain under debate.The aim of this study was to compare the outcomes of different RRT strategies for patients with SA-AKI.Methods:This retrospective study evaluated patients who were admitted to the hospital with sepsis and devel-oped SA-AKI during hospitalization from 1st January 2014 to 31st January 2019.Mortality,renal recovery,and systemic organ function at 90 days following admission were compared between the RRT group(RG)and non-RRT group(NRG),as well as the early-RRT group(EG)and delayed-RRT group(DG).The groups were defined according to the time from admission to RRT initiation(criterion 1,EG1 and DG1)and Kidney Disease Improving Global Outcomes(KDIGO)classification(criterion 2,EG2 and DG2).Categorical and continuous variables were compared using the chi-squared test or Fisher’s exact test and Student’s t-test or Wilcoxon test.Kaplan-Meier curves were constructed to determine the unadjusted survival rates for the different subgroups.Results:A total of 116 patients were included in this study;of those,38 received RRT and 46 expired within 90 days.Among different strategies of RRT,there were no significant differences found in 90-day mortality(RG vs.NRG:𝜒2=0.610,P=0.435;EG1 vs.DG1:𝜒2=0.835,P=0.360;EG2 vs.DG2:𝜒2=0.022,P=0.899)and renal recovery.However,the values of change in sequential organ failure assessment(ΔSOFA)max-min of patients in the EG and RG were significantly higher than those recorded in the NRG(ΔSOFA RG=7.0,ΔSOFA NRG=3.60,ΔSOFA EG1=9.00,ΔSOFA EG2=6.30;P<0.050).Also,the 90-day renal recovery in the EG was better than that noted in the DG with criterion 1(87.5%vs.38.5%,respectively,𝜒2=10.425,P=0.032),suggesting that RRT(especially timely RRT)may be beneficial to the restoration of systemic organ function in patients with SA-AKI.Conclusion:RRT did not reduce the 90-day mortality among patients with SA-AKI.However,timely RRT may benefit the restoration of systemic organ function,thereby improving the quality of life of patients.展开更多
基金funded by the Shenzhen Key Medical Discipline Construction Fund(S ZXK046)the National Nature Science Foundation of China(81571869).
文摘BACKGROUND:This study aims to evaluate the eff ect of continuous renal replacement therapy(CRRT)on inflammation-related anemia,iron metabolism,and the prognosis in sepsis patients with acute kidney injury(AKI).METHODS:Sepsis patients with AKI were prospectively enrolled and randomized into the CRRT and control groups.The clinical and laboratory data on days 1,3 and 7 after intensive care unit(ICU)admission were collected.The serum interleukin(IL)-6,hepcidin,erythropoietin,ferritin,and soluble transferrin receptor(sTfR)were determined by enzyme-linked immunosorbent assay.The Sequential Organ Failure Assessment(SOFA)score and 28-day mortality were recorded.Data were analyzed using Pearson’s Chi-square test or Fisher’s exact test(categorical variables),and Mann-Whitney U-test or t-test(continuous variables).RESULTS:The hemoglobin and serum erythropoietin levels did not signifi cantly diff er between the CRRT and control groups though gradually decreased within the first week of ICU admission.On days 3 and 7,the serum IL-6,hepcidin,ferritin,and red blood cell distribution width significantly decreased in the CRRT group compared to the control group(all P<0.05).On day 7,the serum iron was significantly elevated in the CRRT group compared to the control group(P<0.05).However,the serum sTfR did not signifi cantly diff er between the groups over time.In addition,the SOFA scores were signifi cantly lower in the CRRT group compared to the control group on day 7.The 28-day mortality did not signifi cantly diff er between the control and CRRT groups(38.0%vs.28.2%,P=0.332).CONCLUSION:CRRT might have beneficial effects on the improvement in inflammationrelated iron metabolism and disease severity during the fi rst week of ICU admission but not anemia and 28-day mortality in sepsis patients with AKI.
文摘Objective: To research the effectiveness of ulinastatin in combination with continuous renal replacement therapy in treating sepsis acute kidney injury and its effect on systemic inflammation, immune function and miRAN expression. Methods: The 84 patients who were diagnosed with sepsis complicated by acute kidney injury in our hospital between May 2020 and June 2022 were chosen and randomly assigned to the study group (n = 42) and the control group (n = 42). Ulinastatin in combination with continuous renal replacement therapy was administered to the study group, whereas the control group was administered with continuous renal replacement therapy alone. Both groups’ clinical effects were observed. The levels of blood urea nitrogen (BUN), serum creatinine (SCr), tumor necrosis factor-α (TNF-α), high sensitivity Creactive protein (hs-CRP), vascular cell adhesion molecule-1 (VCAM-1), IgG, IgA, IgM, expression levels of miR-233 and miR-10a were compared among both the groups, pre-, and post-treatment. Results: The study group’s overall effectiveness rate was higher that is 95.24%, in comparison to the control group’s 78.57%, and this difference was statistically significant (P α, hs-CRP, VCAM-1, and miR-233 and miR-10a expression levels in both the study and control groups were decreased, however, the study group had reduced levels in comparison to the control group, with statistically significant differences (P P Conclusion: Ulinastatin in combination with continuous renal replacement therapy for treating sepsis acute kidney injury exhibits a positive effect and can significantly improve the systemic inflammation and immune function in patients.
基金supported by the National Natural Science Foundation of China(81873947)Hospital Development center(SHDC120161)
文摘BACKGROUND:Hospital mortality rates are higher among patients with sepsis-associated acute kidney injury(SA-AKI)than among patients with sepsis.However,the pathogenesis underlying SA-AKI remains unclear.We hypothesized that the source of infection affects development of SA-AKI.We aim to explore the relationship between the anatomical source of infection and outcome in patients with SA-AKI.METHODS:Between January 2013 and January 2018,113 patients with SA-AKI admitted to our Emergency Center were identifi ed and divided into two groups:those with pulmonary infections and those with other sources of infection.For each patient,we collected data from admission until either discharge or death.We also recorded the clinical outcome after 90 days for the discharged patients.RESULTS:The most common source of infection was the lung(52/113 cases,46%),followed by gastrointestinal(GI)(25/113 cases,22.1%)and urinary(22/113,19.5%)sources.Our analysis showed that patients with SA-AKI had a significantly worse outcome(30/52 cases,P<0.001)and poorer kidney recovery(P=0.015)with pulmonary sources of infection than those infected by another source.Data also showed that patients not infected by a pulmonary source more likely experienced shock(28/61 cases,P=0.037).CONCLUSION:This study demonstrated that the source of infection infl uenced the outcome of SA-AKI patients in an independent manner.Lung injury may influence renal function in an asyet undetermined manner as the recovery of kidney function was poorer in SA-AKI patients with a pulmonary source of infection.
基金supported by the National Natural Sciences Foundation of China (NSFC) grant numbers [31960165&81760288]
文摘CD38 is known to play roles in various inflammatory pathways.However,whether it has a protective or detrimental effect during bacterial septicemia remains disputed.Herein,this study aimed to determine the potential effect of CD38 on renal injury in septicemia.Escherichia coli(E.coli)was used to induce sepsis-associated renal injury in mice.WT and CD38-/-mice were stimulated with E.coli.After three hours,the serum was collected to detect renal function.Function mRNA expressions inflammatory cytokines in kidneys were quantified by real-time PCR.Hematoxylin and eosin staining were used to observe the histomorphology of kidney.The expression of TLR4,NF-κB,MAPK and cytokines were detected by Western Blot.Our results demonstrated that 3×10^(8) cfu/mL E.coli is the appropriate dose to induce sepsis mice model.Compared to WT sepsis mice,CD38-/-mice showed aggravated kidney injuries with impaired renal function,increased inflammation and apoptosis after E.coli stimulation.Interestingly,CD38 deficiency also led to elevated expression of TLR4 and increased phosphorylation of NF-κB p65/p105 and ERK1/2.To sum up,our results suggested that CD38 deficiency could aggravate E.coli-induced renal injury through activating ERK1/2-NF-κB signaling pathway.
文摘Objective:To investigate the effects of sustained low-efficiency dialysis (SLED) combined with hemoperfusion (HP) on inflammatory stress, hemodynamic parameters and renal function in septic patients with severe acute kidney injury.Methods: A total of 82 cases of sepsis with severe acute renal injury were divided into control group (n=41) and observation group (n=41) according to the random data table method. Two groups of patients were given conventional support treatment, on this basis, the control group was treated with Continuous renal replacement therapy (CRRT), and the observation group was treated with SLED plus HP. The levels of inflammatory factors, hemorheological parameters and renal function indexes of the two groups were compared before and after treatment.Results: There was no significant difference in the levels of CRP, WBC, PCT, MAP, OI, BUN and Scr between the control group and the observation group before the treatment. Compared with the level before treatment, the levels of CRP, WBC, PCT, BUN and Scr in the two groups were significantly decreased after treatment, while the levels of MAP and OI were significantly increased. Compared with the level of the control group after treatment, the levels of CRP, WBC, PCT, BUN and Scr in the observation group were significantly lower than those in the control group, the levels of MAP and OI were significantly increased, the difference was statistically significant.Conclusion:SLED combined with HP regimen in treatment of sepsis combined with severe acute kidney injury can effectively inhibit the release of inflammatory factors, improve hemodynamics and renal function, and has an important clinical value.
文摘Renal cortical necrosis(RCN) is characterized by patchy or diffuse ischemic destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury. In addition, direct endothelial injury particularly in setting of sepsis, eclampsia, haemolytic uremic syndrome(HUS) and snake bite may lead to endovascular thrombosis with subsequent renal ischemia. Progression to end stage renal disease is a rule in diffuse cortical necrosis. It is a rare cause of acute kidney injury(AKI) in developed countries with frequency of 1.9%-2% of all patients with AKI. In contrast, RCN incidence is higher in developing countries ranging between 6%-7% of all causes of AKI. Obstetric complications(septic abortion, puerperal sepsis, abruptio placentae, postpartum haemorrhage and eclampsia) are the main(60%-70%) causes of RCN in developing countries. The remaining 30%-40% cases of RCN are caused by non-obstetrical causes, mostly due to sepsis and HUS. The incidence of RCN ranges from 10% to 30% of all cases of obstetric AKI compared with only 5% in non-gravid patients. In the developed countries, RCN accounts for 2% of all cases of AKI in adults and more than 20% of AKI during the third trimester of pregnancy. The reported incidence of RCN in obstetrical AKI varies between 18%-42.8% in different Indian studies. However, the overall incidence of RCN in pregnancy related AKI has decreased from 20%-30% to 5% in the past two decades in India. Currently RCN accounts for 3% of all causes of AKI. The incidence of RCN in obstetrical AKI was 1.44% in our recent study. HUS is most common cause of RCN in non-obstetrical group, while puerperal sepsis is leading cause of RCN in obstetric group. Because of the catastrophic sequelae of RCN, its prevention and aggressive management should always be important for the better renal outcome and prognosis of the patients.
文摘Objective: To explore the correlation of insulin resistance (IR) extent with systemic inflammatory response and target organ damage in children with sepsis. Methods: A total of 70 patients with sepsis who were treated in our hospital between June 2013 and July 2016 were collected as observation group, 50 healthy children who received vaccination in our hospital during the same period were selected as normal control group, the insulin resistance index (HOMA-IR) of two groups of children were determined, the median of HOMA-IR of observation group was referred to further divide them into high HOMA-IR group and low HOMA-IR group, 35 cases in each group. The systemic inflammatory response and target organ damage extent were compared between sepsis children with different HOMA-IR levels. Results: HOMA-IR level in observation group was significantly higher than that in normal control group. Serum inflammatory factors PCT, IL-1β, IL-8 and IL-10 contents in high HOMA-IR group were significantly higher than those in low HOMA-IR group;serum myocardial injury indexes CK, CK-MB and LDH contents were significantly higher than those in low HOMA-IR group;serum liver injury indexes ALT, AST and TBIL contents were significantly higher than those in low HOMA-IR group while ALB content was lower than that in low HOMA-IR group;serum renal injury indexes Cr, BUN and CysC contents were significantly higher than those in low HOMA-IR group. Conclusion: HOMA-IR level in children with sepsis is higher than that in normal people, and HOMA-IR level is positively correlated with systemic inflammatory response and target organ injury.
文摘Objective:To explore the correlation of insulin resistance (IR) extent with systemic inflammatory response and target organ damage in children with sepsis.Methods: A total of 70 patients with sepsis who were treated in our hospital between June 2013 and July 2016 were collected as observation group, 50 healthy children who received vaccination in our hospital during the same period were selected as normal control group, the insulin resistance index (HOMA-IR) of two groups of children were determined, the median of HOMA-IR of observation group was referred to further divide them into high HOMA-IR group and low HOMA-IR group, 35 cases in each group. The systemic inflammatory response and target organ damage extent were compared between sepsis children with different HOMA-IR levels.Results: HOMA-IR level in observation group was significantly higher than that in normal control group. Serum inflammatory factors PCT, IL-1β, IL-8 and IL-10 contents in high HOMA-IR group were significantly higher than those in low HOMA-IR group;serum myocardial injury indexes CK, CK-MB and LDH contents were significantly higher than those in low HOMA-IR group;serum liver injury indexes ALT, AST and TBIL contents were significantly higher than those in low HOMA-IR group while ALB content was lower than that in low HOMA-IR group;serum renal injury indexes Cr, BUN and CysC contents were significantly higher than those in low HOMA-IR group.Conclusion: HOMA-IR level in children with sepsis is higher than that in normal people, and HOMA-IR level is positively correlated with systemic inflammatory response and target organ injury.
文摘AIM: To determine renal dysfunction post liver transplantation, its incidence and risk factors in patients from a Belgian University Hospital.METHODS: Orthotopic liver transplantations performed from January 2006 until September 2012 were retrospectively reviewed(n = 187). Patients with no renal replacement therapy(RRT) before transplantation were classified into four groups according to their highest creatinine plasma level during the first postoperative week. The first group had a peak creatinine level below 12 mg/L, the second group between 12 and 20 mg/L, the third group between 20 and 35 mg/L, and the fourth above 35 mg/L. In addition, patients who needed RRT during the first week after transplantation were also classified into the fourth group. Perioperative parameters were recorded as risk factors, namely age, sex, bodymass index(BMI), length of preoperative hospital stay, prior bacterial infection within one month, preoperative ascites, preoperative treatment with β-blocker, angiotensin-converting enzyme inhibitor or non steroidal anti-inflammatory drugs, preoperative creatinine and bilirubin levels, donor status(cardiac death or brain death), postoperative lactate level, need for intraoperative vasopressive drugs, surgical revision, mechanical ventilation for more than 24 h, postoperative bilirubin and transaminase peak levels, postoperative hemoglobin level, amount of perioperative blood transfusions and type of immunosuppression. Univariate and multivariate analysis were performed using logistic ordinal regression method. Post hoc analysis of the hemostatic agent used was also done.RESULTS: There were 78 patients in group 1(41.7%), 46 in group 2(24.6%), 38 in group 3(20.3%) and 25 in group 4(13.4%). Twenty patients required RRT: 13(7%) during the first week after transplantation. Using univariate analysis, the severity of renal dysfunction was correlated with presence of ascites and prior bacterial infection, preoperative bilirubin, urea and creatinine level, need for surgical revision, use of vasopressor, postoperative mechanical ventilation, postoperative bilirubin and urea, aspartate aminotransferase(ASAT), and hemoglobin levels and the need for transfusion. The multivariate analysis showed that BMI(OR = 1.1, P = 0.004), preoperative creatinine level(OR = 11.1, P < 0.0001), use of vasopressor(OR = 3.31, P = 0.0002), maximal postoperative bilirubin level(OR = 1.44, P = 0.044) and minimal postoperative hemoglobin level(OR = 0.059, P = 0.0005) were independent predictors of early post-liver transplantation renal dysfunction. Neither donor status nor ASAT levels had significant impact on early postoperative renal dysfunction in multivariate analysis. Absence of renal dysfunction(group 1) was also predicted by the intraoperative hemostatic agent used, independently of the extent of bleeding and of the preoperative creatinine level.CONCLUSION: More than half of receivers experienced some degree of early renal dysfunction after liver transplantation. Main predictors were preoperative renal dysfunction, postoperative anemia and vasopressor requirement.
文摘Background:Recent studies suggest that acute kidney injury(AKI)can be treated with renal replacement therapy(RRT).However,its benefits to patients with sepsis-associated AKI(SA-AKI),which is linked to high mortality and morbidity rates,remain under debate.The aim of this study was to compare the outcomes of different RRT strategies for patients with SA-AKI.Methods:This retrospective study evaluated patients who were admitted to the hospital with sepsis and devel-oped SA-AKI during hospitalization from 1st January 2014 to 31st January 2019.Mortality,renal recovery,and systemic organ function at 90 days following admission were compared between the RRT group(RG)and non-RRT group(NRG),as well as the early-RRT group(EG)and delayed-RRT group(DG).The groups were defined according to the time from admission to RRT initiation(criterion 1,EG1 and DG1)and Kidney Disease Improving Global Outcomes(KDIGO)classification(criterion 2,EG2 and DG2).Categorical and continuous variables were compared using the chi-squared test or Fisher’s exact test and Student’s t-test or Wilcoxon test.Kaplan-Meier curves were constructed to determine the unadjusted survival rates for the different subgroups.Results:A total of 116 patients were included in this study;of those,38 received RRT and 46 expired within 90 days.Among different strategies of RRT,there were no significant differences found in 90-day mortality(RG vs.NRG:𝜒2=0.610,P=0.435;EG1 vs.DG1:𝜒2=0.835,P=0.360;EG2 vs.DG2:𝜒2=0.022,P=0.899)and renal recovery.However,the values of change in sequential organ failure assessment(ΔSOFA)max-min of patients in the EG and RG were significantly higher than those recorded in the NRG(ΔSOFA RG=7.0,ΔSOFA NRG=3.60,ΔSOFA EG1=9.00,ΔSOFA EG2=6.30;P<0.050).Also,the 90-day renal recovery in the EG was better than that noted in the DG with criterion 1(87.5%vs.38.5%,respectively,𝜒2=10.425,P=0.032),suggesting that RRT(especially timely RRT)may be beneficial to the restoration of systemic organ function in patients with SA-AKI.Conclusion:RRT did not reduce the 90-day mortality among patients with SA-AKI.However,timely RRT may benefit the restoration of systemic organ function,thereby improving the quality of life of patients.
