Abstract The relationship between albumin corrected anion gap (ACAG) and mortality in acute kidney injury (AKI) patients who received continuous renal replacement therapy (CRRT) has not been investigated in any previous studies. This study aimed to investigate the relationship between ACAG at CRRT initiation and all-cause mortality among these patients in the intensive care unit (ICU). Patients diagnosed with AKI and treated with CRRT in the ICU from the Medical Information Mart for Intensive Care-IV version 1.0 (MIMIC IV) database and Huzhou Central Hospital were retrospectively enrolled. Participants were divided into two groups: the normal ACAG group (12–20 mmol/L) and high ACAG group (&gt; 20 mmol/L). The Kaplan–Meier method and log-rank test were used to compare the survival rate between the two groups. Restricted cubic spine (RCS) and Cox proportional-hazards models were utilized to analyze the relationship between ACAG at CRRT initiation and ICU all-cause mortality of these patients. A total of 708 patients met the inclusion criteria in the study. The all-cause mortality of these patients during ICU hospitalization was 41.95%. Patients in the high ACAG group exhibited significantly higher ICU all-cause mortality rate than patients in the normal ACAG group (all P &lt; 0.001). The Kaplan–Meier survival curves showed that the normal ACAG group had a higher ICU cumulative survival rate than the high ACAG group (log-rank test, χ 1 2 = 13.620, χ 2 2 = 12.460, both P &lt; 0.001). In the multivariate COX regression analyses, patients with higher ACAG (&gt; 20 mmol/L) levels at the time of CRRT initiation in the MIMIC IV database and Huzhou Central Hospital were significantly correlated with ICU all-cause mortality after adjusting multiple potential confounding factors with hazard ratios of 2.852 (95% CI 1.718–4.734) and 2.637(95% CI 1.584–4.389), respectively. In critically AKI patients who undergo CRRT, higher ACAG (&gt; 20 mmol/L) level at the initiation of CRRT was significantly correlated with ICU all-cause mortality. Therefore, clinicians should pay more attention to those patients with a higher ACAG value. 

https://link.springer.com/content/pdf/10.1007/s11739-022-03093-8.pdf

The association between albumin corrected anion gap and ICU mortality in acute kidney injury patients requiring continuous renal replacement therapy

Purpose : Thyroid hormone is essential for development of the brain in early life. Thyroid dysfunction is more common in the first 2-4 postnatal weeks of life in premature infants than in term infants. This study aimed to identify the prevalence and clinical course of thyroid dysfunction in prematurity. Methods : Premature infants admitted to and given neonatal screenings at Dankook University Hospital between April 1999 and March 2008 were included in this study. We retrospectively reviewed medical records and categorized subjects into six groups: normal, hypothyroidism, hyperthyrotropinemia, hypothyroxinemia, delayed onset of hypothyroidism, and delayed onset of hyperthyrotropinemia. Results : Among 599 subjects, 136 (23%) had initially abnormal thyroid function test (TFT); transient hypothyroxinemia was the most frequent condition (118, 20%). In addition, 8 (17%) of 46 subjects with initially normal TFT levels showed delayed onset of hyperthyrotropinemia with or without low free thyroxine (fT4). Thyroxine was prescribed for 10 patients (1.7%) due to low fT4 levels but was discontinued in 9 patients during follow-up. Thyroid scan confirmed ectopic thyroid in one patient. Conclusion : Thyroid dysfunction was frequently seen in premature infants, but most of the conditions were transient. In addition, some infants showed delayed TSH elevation on routine follow-up. Therefore, a recheck of the thyroid function of premature infants at 3-4 weeks is recommended, even if normal thyroid function is initially seen, especially in prematurity of less than 33 weeks of gestational age or birth weight of less than 2,500 grams.

Thyroid dysfunction in premature infants

Abstract Background We hypothesized that a low mean arterial pressure (MAP) at CRRT initiation would influence the early death or withdrawal of CRRT and in-hospital mortality. Methods This prospective cohort study collected data for CRRT patients seen at the Third Affiliated Hospital from January 2016 to December 2020. We collected MAP data at the initiation of CRRT, reasons for CRRT termination, and in-hospital mortality data. We divided the patients into four groups based on quartiles of the initial MAP and analyzed its influence on early death/withdrawal of CRRT. Results A total of 2,346 patients with acute kidney injury (AKI) were included in this study. The median age of the participants was 68.0 (57.0–76.0) years, and 62.4% were male. CRRT was discontinued in 49.9% of our patients after renal recovery or HD transition; in 48.8%, CRRT was terminated by death (36.6%) or withdrawal (12.2%). An initial low MAP (Q1, MAP ≤ 69 mmHg and Q2, MAP ≤ 77.1 mmHg) was associated with a 1.3-fold greater risk of death/withdrawal during CRRT. Older age, a higher SOFA score, and oliguria at the time of CRRT initiation also predicted death/withdrawal during CRRT. Conclusions In patients on CRRT, a lower MAP at CRRT initiation was closely associated with a higher probability of terminating CRRT due to death/withdrawal, and it was associated with an increased risk of in-hospital mortality. 

/pdf/influence-of-mean-arterial-pressure-on-the-decision-to-16a0x3o9.pdf

Influence of mean arterial pressure on the decision to terminate CRRT and in-hospital mortality: A single-center prospective study

The review aimed to assess if hypoalbuminemia can predict mortality in patients undergoing continuous renal replacement therapy (CRRT). PubMed, Web of Science, Embase, and CENTRAL were searched for relevant articles published up to 24 July 2022. Adjusted data were pooled to calculate the odds ratio (OR). Sensitivity and meta-regression analysis was conducted. Five studies with 5254 patients were included. Meta-analysis of all five studies demonstrated that hypoalbuminemia was a significant predictor of mortality after CRRT (OR: 1.31 95% CI: 1.07, 1.60 I2 = 72% p = 0.01). The results did not change on sensitivity analysis. On meta-regression, we noted that variables like age, male gender, BMI, percentage of diabetics, and pre-CRRT SOFA score had no statistically significant influence on the outcome. Data from a limited number of studies suggest that hypoalbuminemia before initiation of CRRT is an independent predictor of early mortality. Based on current evidence, it may be suggested that patients with low albumin levels initiating CRRT should be prioritized and treated aggressively to reduce adverse outcomes.

Association between hypoalbuminemia and mortality in patients undergoing continuous renal replacement therapy: A systematic review and meta-analysis

/pdf/the-importance-of-early-detecting-high-risk-patients-with-j9jcbe35.pdf

The importance of early detecting high-risk patients with acute kidney injury requiring continuous kidney replacement therapy

Hypoalbuminemia at the initiation of continuous renal replacement therapy (CRRT) is a risk factor for poor patient outcomes. However, it is unknown whether the patterns of changes in serum albumin levels during CRRT can be used to predict patient outcomes.This retrospective study analyzed data that had been consecutively collected from January 2016 to December 2020 at the Third Affiliated Hospital. We included patients with acute kidney injury who received CRRT for ≥ 72 h. We divided the patients into four groups based on their serum albumin levels (albumin ≥ 3.0 g/dL or < 3.0 g/dL) at the initiation and termination of CRRT.The 793 patients in this study were categorized into the following albumin groups: persistently low, 299 patients (37.7%); increasing, 85 patients (10.4%); decreasing, 195 patients (24.6%); and persistently high, 214 patients (27.1%). In-hospital mortality rates were highest in the persistently low and decreasing groups, followed by the increasing and persistently high groups. The hazard ratio for in-hospital mortality was 0.481 (0.340-0.680) in the increasing group compared to the persistently low group; it was 1.911 (1.394-2.620) in the decreasing group compared to the persistently high group. The length of ICU stay was 3.55 days longer in the persistently low group than in the persistently high group.Serum albumin levels changed during CRRT, and monitoring of patterns of change in serum albumin levels is useful for predicting in-hospital mortality and the length of ICU stay. 

/pdf/worsening-or-improving-hypoalbuminemia-during-continuous-quzm6g6w.pdf

Worsening or improving hypoalbuminemia during continuous renal replacement therapy is predictive of patient outcome: a single-center retrospective study

Late Detection of Thyroid Dysfunction in NICU Patients

During the COVID-19 pandemic, maintenance of essential healthcare systems became very challenging. We describe the triage system of our institute, and assess the quality of care provided to critically ill non-COVID-19 patients requiring continuous renal replacement therapy (CRRT) during the pandemic.We introduced an emergency triage pathway early in the pandemic. We retrospectively reviewed the medical records of patients who received CRRT in our hospital from January 2016 to March 2021. We excluded end-stage kidney disease patients on maintenance dialysis. Patients were stratified as medical and surgical patients. The time from hospital arrival to intensive care unit (ICU) admission, the time from hospital arrival to intervention/operation, and the in-hospital mortality rate were compared before (January 2016 to December 2019) and during (January 2021 to March 2021) the pandemic.The mean number of critically ill patients who received CRRT annually in the surgical department significantly decreased during the pandemic in (2016-2019: 76.5 ± 3.1; 2020: 56; p < 0.010). Age, sex, and the severity of disease at admission did not change, whereas the proportions of medical patients with diabetes (before: 44.4%; after: 56.5; p < 0.005) and cancer (before: 19.4%; after: 32.3%; p < 0.001) increased during the pandemic. The time from hospital arrival to ICU admission and the time from hospital arrival to intervention/operation did not change. During the pandemic, 59.6% of surgical patients received interventions/operations within 6 hours of hospital arrival. In Cox's proportional hazard modeling, the hazard ratio associated with the pandemic was 1.002 (0.778-1.292) for medical patients and 1.178 (0.783-1.772) for surgical patients.Our triage system maintained the care required by critically ill non-COVID-19 patients undergoing CRRT at our institution. 

/pdf/maintenance-of-the-critical-care-system-during-the-pandemic-3p9tw5sy.pdf

Maintenance of the critical care system during the pandemic in non-COVID-19 patients requiring continuous renal replacement therapy: a single center experience

Hak Su Jeon

Papers

Worsening or improving hypoalbuminemia during continuous renal replacement therapy is predictive of patient outcome: a single-center retrospective study

Late Detection of Thyroid Dysfunction in NICU Patients

Maintenance of the critical care system during the pandemic in non-COVID-19 patients requiring continuous renal replacement therapy: a single center experience