Abstract:
INTRODUCTION:The pathophysiology of acute kidney injury (AKI) in sepsis is ill defined. We investigated parameters associated with low glomerular filtration, and their predictive value to discriminate transient from intrinsic septic AKI. METHODS:In 107 sepsis patients, AKI was defined by the Risk, Injury, Failure, Loss of Kidney Function, End-stage renal disease (RIFLE) urinary output or serum creatinine criterion, or both. Transient AKI (TAKI) versus intrinsic AKI was defined as RIFLE R, I, or F on the first day evolving to no AKI or not, respectively, over the following 5 days. Fractional excretion of sodium (FENa), urea (FEUrea), and NGAL (FENGAL) at admission (d0t0), 4 (d0t4), and 24 hours (d1) was determined. RESULTS:Including versus not including the urinary-output criterion of RIFLE increased AKI from 43% to 64.5%. Median uNGAL levels and FENGAL were lower in no AKI versus transient AKI when AKI was defined based on creatinine (P = 0.002 and P = 0.04, respectively), but not when based on urinary output (P = 0.9 and P = 0.49, respectively). FENa < 1% and FEUrea <35% was present in 77.3% and 63.2% of patients. Urinary NGAL was higher (P < 0.001) in those with high versus low fractional sodium excretion, but this was only in patients with transient or intrinsic AKI (P < 0.001 in subgroups), and not in patients without AKI. The negative predictive value for either intrinsic AKI or not restoring diuresis in patients with FENa > 0.36% and FEUrea > 31.5% was 92% and 94.5% respectively. CONCLUSIONS:A low FENa and FEUrea is highly prevalent in the first hours of sepsis. In sepsis, oliguria is an earlier sign of impending AKI than increase in serum creatinine. A combination of a high FENa and a low FEUrea is associated with intrinsic AKI, whereas a combined high FENa and FEUrea is strongly predictive of transient AKI.
journal_name
Crit Carejournal_title
Critical care (London, England)authors
Vanmassenhove J,Glorieux G,Hoste E,Dhondt A,Vanholder R,Van Biesen Wdoi
10.1186/cc13057subject
Has Abstractpub_date
2013-10-13 00:00:00pages
R234issue
5eissn
1364-8535issn
1466-609Xpii
cc13057journal_volume
17pub_type
杂志文章相关文献
CRITICAL CARE文献大全abstract::The present review introduces the notion of statistical power and the hazard of under-powered studies. The problem of how to calculate an ideal sample size is also discussed within the context of factors that affect power, and specific methods for the calculation of sample size are presented for two common scenarios, ...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc1521
更新日期:2002-08-01 00:00:00
abstract::Urgent cardiac ultrasound examination in the critical care setting is clinically useful. Application of goal-directed echocardiography in this setting is quite distinct from typical exploratory diagnostic comprehensive echocardiography, because the urgent critical care setting mandates a goal-directed approach. Goal-d...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-014-0681-z
更新日期:2014-12-01 00:00:00
abstract::Drug acquisition costs are only a proportion of the total costs associated with drug therapy. The relevance of these costs are often not appreciated. However, they impact on the Intensive Care Unit via resources and quality of care. Increased indirect care by medical and nursing staff has the potential to adversely af...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc2403
更新日期:2003-12-01 00:00:00
abstract::A crucial determinant for the success of intensive insulin therapy in critically ill patients is the frequent and accurate measurement of blood glucose values with immediate feedback of results. In general, therefore, this is achieved by point-of-care testing, raising the question of the best way of monitoring blood g...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc5110
更新日期:2006-01-01 00:00:00
abstract::Acute pancreatitis results from a sequence of events that involve the systemic inflammatory response. Activated C has multiple anti-inflammatory activities and may attenuate the degree of pancreatic injury and systemic organ dysfunction when infused early in pancreatitis. ...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc3515
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:Hypernatraemia is common in inpatients and is associated with substantial morbidity. Its differential diagnosis is challenging, and delayed treatment may have devastating consequences. The most important hormone for the regulation of water homeostasis is arginine vasopressin, and copeptin, the C-terminal por...
journal_title:Critical care (London, England)
pub_type: 杂志文章,多中心研究
doi:10.1186/s13054-018-1955-7
更新日期:2018-02-09 00:00:00
abstract:INTRODUCTION:Prevalence of iron deficiency (ID) at intensive care (ICU) admission is around 25 to 40%. Blood losses are important during ICU stay, leading to iron losses, but prevalence of ID at ICU discharge is unknown. ID has been associated with fatigue and muscular weakness, and may thus impair post-ICU rehabilitat...
journal_title:Critical care (London, England)
pub_type: 杂志文章,多中心研究
doi:10.1186/s13054-014-0542-9
更新日期:2014-09-30 00:00:00
abstract::Bacterial sepsis and septic shock are complex inflammatory disorders associated with a systemic inflammatory response syndrome. In the most severe cases of infection, an overzealous release of pro-inflammatory cytokines and inflammatory mediators by activated leukocytes, epithelial cells and endothelial cells, known a...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc12700
更新日期:2013-08-27 00:00:00
abstract:BACKGROUND:We sought to determine the effects of alternative resuscitation strategies on microcirculatory perfusion and examine any association between microcirculatory perfusion and mortality in sepsis. METHODS:This was a prospective, formally designed substudy of participants in the Protocolized Care in Early Septic...
journal_title:Critical care (London, England)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/s13054-018-2240-5
更新日期:2018-11-20 00:00:00
abstract:INTRODUCTION:Control of blood glucose (BG) in critically ill patients is considered important, but is difficult to achieve, and often associated with increased risk of hypoglycemia. We examined the use of a computerized insulin dosing algorithm to manage hyperglycemia with particular attention to frequency and conditio...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc8129
更新日期:2009-01-01 00:00:00
abstract:INTRODUCTION:Following trauma, patients may suffer an overwhelming pro-inflammatory response and immune paralysis resulting in infection and multiple organ failure (MOF). Various potentially immunomodulative interventions have been tested. The objective of this study is to systematically review the randomized controlle...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc9218
更新日期:2010-01-01 00:00:00
abstract:INTRODUCTION:Prognosis in patients suffering out-of-hospital cardiac arrest is poor. Higher survival rates have been observed only in patients with ventricular fibrillation who were fortunate enough to have basic and advanced life support initiated soon after cardiac arrest. An ability to predict cardiac arrest outcome...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc7009
更新日期:2008-01-01 00:00:00
abstract:INTRODUCTION:Expanding the criteria for deceased organ donors increases the risk of delayed graft function (DGF) and complicates kidney transplant outcome. We studied whether donor neutrophil gelatinase-associated lipocalin (NGAL), a novel biomarker for acute kidney injury, could predict DGF after transplantation. MET...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc10220
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Critical illness myopathy is an acquired skeletal muscle disorder with severe myosin loss and muscle weakness frequently seen in intensive care unit (ICU) patients. It is unknown if impaired excitation-contraction coupling contributes to the muscle weakness. METHODS:We used a unique ICU model where rats wer...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-016-1417-z
更新日期:2016-08-10 00:00:00
abstract:BACKGROUND:Acute kidney injury and hyperchloremia are commonly present in critically ill septic patients. Our study goal was to evaluate the association of hyperchloremia and acute kidney injury in severe sepsis and septic shock patients. METHODS:In this retrospective cohort study in a provincial tertiary care hospita...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-016-1499-7
更新日期:2016-10-06 00:00:00
abstract::Vasopressin (antidiuretic hormone) is emerging as a potentially major advance in the treatment of septic shock. Terlipressin (tricyl-lysine-vasopressin) is the synthetic, long-acting analogue of vasopressin, and has comparable pharmacodynamic but different pharmacokinetic properties. Vasopressin mediates vasoconstrict...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc2945
更新日期:2005-04-01 00:00:00
abstract:INTRODUCTION:Frequency-dependent acceleration of relaxation (FDAR) ensures appropriate ventricular filling at high heart rates and results from accelerated sarcoplasmic/endoplasmic reticulum calcium ATPase (SERCA) activity independent of calcium removal from the cell. Because lipopolysaccharide (LPS) challenge may indu...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc7712
更新日期:2009-01-01 00:00:00
abstract:INTRODUCTION:Critically ill patients and families rely upon physicians to provide estimates of prognosis and recommendations for care. Little is known about patient and clinician factors which influence these predictions. The association between these predictions and recommendations for continued aggressive care is als...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc7926
更新日期:2009-01-01 00:00:00
abstract::Assessment of vasomotor tone is essential in defining appropriate resuscitation strategies for the hypotensive patient. Although changes in mean arterial pressure to cardiac output define arterial resistance, resistance is only one component of vasomotor tone. Compliance is the other component. The reciprocal of compl...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc9986
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Several choices of inotropic therapy are available and used in relation to cardiac surgery. Comparisons are necessary to select optimal therapy. In Denmark, dobutamine and milrinone are the two inotropic agents most commonly used to treat post-bypass low cardiac output syndrome. This study compares all-cause...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-018-1969-1
更新日期:2018-02-26 00:00:00
abstract:INTRODUCTION:Glutamine supplementation has beneficial effects on morbidity and mortality in critically ill patients, possibly in part through an attenuation of the proinflammatory cytokine response and a stimulation of heat shock protein (HSP)70. We infused either alanine-glutamine or saline during endotoxin challenge ...
journal_title:Critical care (London, England)
pub_type: 杂志文章,随机对照试验
doi:10.1186/cc7696
更新日期:2009-01-01 00:00:00
abstract::Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support, in case the natural lungs are failing and are not able to maintain a sufficient oxygenation of the body's organ systems. ECMO technique was an adaptation of conventional cardiopulmonary bypass techniques and introduced into treatment...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc689
更新日期:2000-01-01 00:00:00
abstract:INTRODUCTION:Patients with sepsis often demonstrate severely impaired immune responses. The hallmark of this state of immunoparalysis is monocytic deactivation characterized by decreased human leukocyte antigen (HLA)-DR expression and reduced production of proinflammatory cytokines. Recently, diminished numbers of dend...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc7969
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Kidney congestion is a common pathophysiologic pathway of acute kidney injury (AKI) in sepsis and heart failure. There is no noninvasive tool to measure kidney intracapsular pressure (KIP) directly. METHODS:We evaluated the correlation of KIP with kidney elasticity measured by ultrasound surface wave elasto...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-017-1847-2
更新日期:2017-10-19 00:00:00
abstract:INTRODUCTION:The mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma. METHODS:Th...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc11375
更新日期:2012-06-11 00:00:00
abstract:INTRODUCTION:The FloTrac/Vigileo (Edwards Lifesciences, Irvine, CA, USA) allows pulse pressure-derived cardiac output measurement without external calibration. Software modifications were performed in order to eliminate initially observed deficits. The aim of this study was to assess changes in cardiac output determine...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc7739
更新日期:2009-01-01 00:00:00
abstract:INTRODUCTION:Delirium occurs in most ventilated patients and is independently associated with more deaths, longer stay, and higher cost. Guidelines recommend monitoring of delirium in all intensive care unit (ICU) patients, though few data exist in non-ventilated patients. The study objective was to determine the relat...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc3729
更新日期:2005-08-01 00:00:00
abstract:INTRODUCTION:Fever is frequently observed in critically ill patients. An independent association of fever with increased mortality has been observed in non-neurological critically ill patients with mixed febrile etiology. The association of fever and antipyretics with mortality, however, may be different between infect...
journal_title:Critical care (London, England)
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1186/cc11211
更新日期:2012-02-28 00:00:00
abstract:INTRODUCTION:Activation of the sympathetic nervous system has beneficial cardiovascular effects in sepsis, but there is also evidence that sympatholytics have beneficial actions in sepsis. We therefore determined the effect of selective β1-adrenoceptor blockade on cardiac and renal function and cytokine release in ovin...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-014-0610-1
更新日期:2014-11-21 00:00:00
abstract:BACKGROUND:The purpose of this study was to determine whether the provision of corticosteroids improves time to shock reversal and outcomes in patients with post-cardiac arrest shock. METHODS:We conducted a randomized, double-blind trial of post-cardiac arrest patients in shock, defined as vasopressor support for a mi...
journal_title:Critical care (London, England)
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13054-016-1257-x
更新日期:2016-04-03 00:00:00