Siaki Collection 76725 Porcelain Dinnerware Set, White, 18 Pieces, Polyester

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Mandelbaum, T. et al. Outcome of critically ill patients with acute kidney injury using the Acute Kidney Injury Network criteria. Crit. Care Med. 39(12), 2659–2664 (2011).

Oh, H. J. et al. Can early initiation of continuous renal replacement therapy improve patient survival with septic acute kidney injury when enrolled in early goal-directed therapy?. J. Crit. Care 35, 51–56 (2016). Karlsson S, Heikkinen M, Pettila V, Alila S, Vaisanen S, Pulkki K, et al. Predictive value of procalcitonin decrease in patients with severe sepsis: a prospective observational study. Crit Care. 2010; 14: R205. pmid:21078153 Kim, I. Y. et al. Fluid overload and survival in critically ill patients with acute kidney injury receiving continuous renal replacement therapy. PLoS ONE 12(2), e0172137 (2017).Kellum, J. A., Lameire, N., KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: A KDIGO summary (Part 1). Critical care 17, 1–15 (2013). For all the participants (n = 649), the best cut-off value of % PCT decrease for predicting survival was > 31%, with an associated sensitivity of 64.8% and specificity of 83.6% (AUC: 0.802, 95% CI: 0.769–0.832, P< 0.001, Youden index: 0.48). In the survivors (n = 332), the best cut-off of % PCT decrease for predicting the recovery from dialysis was > 69%, with an associated sensitivity of 73.5% and specificity of 80.5% (AUC: 0.825, 95% CI: 0.780–0.864, P< 0.001, Youden index: 0.54). AKI, acute kidney injury; AUC, area under the curve; CI, confidence interval; CRRT, continuous renal replacement therapy; PCT, procalcitonin; SIAKI, sepsis-induced acute kidney injury. Hall, A. et al. Fluid removal associates with better outcomes in critically ill patients receiving continuous renal replacement therapy: a cohort study. Crit. Care 24(1), 279 (2020). One of the strengths of our study is the inclusion of time from AKI diagnosis to CRRT initiation in the multivariable analysis. We found that a 1-day increase in the time between AKI diagnosis and CRRT initiation was associated with an 11% increased risk of the 28-day mortality in our study population. Whether early initiation of CRRT improves mortality in critically ill patients with SIAKI remains controversial, and previous studies have reported inconsistent results. Several retrospective studies have shown that early initiation of CRRT has survival benefits in critically ill patients with SIAKI 35, 36, 37, 38. However, two randomized clinical trials reported that early application of CRRT is deleterious 39 or there was no difference in mortality between early and late RRT initiation in these patients 40. This discrepancy between the results of previous studies might be owing to an unstandardized definition for early and late initiation of CRRT. Furthermore, the optimal timing to initiate CRRT remains undefined in patients with SIAKI. In the present study, we found that the best cutoff value for the time from AKI diagnosis to CRRT initiation for predicting the 28-day mortality was > 1.5 day, with a sensitivity of 71.3% and specificity of 75.6% (AUC, 0.808; P< 0.001). The Kaplan–Meier curve also showed a significant difference in the 28-day mortality between the late CRRT group (> 1.5 days) and early CRRT group (≤ 1.5 days) (Supplementary Fig. S3). Despite the retrospective design of our study, this observation suggests that CRRT initiation within 1.5 days from AKI diagnosis, if possible, should be encouraged to improve the survival of critically ill patients with SIAKI. In the current retrospective study, we found that dynamic changes in the PCT levels over 72 hours after CRRT initiation predicted survival and recovery from dialysis at 28 days in patients with SIAKI receiving CRRT. This finding was independent of the initial disease severity assessed by commonly used clinical risk scores, including SOFA or APACHE II. The predictive value of a single PCT level at CRRT initiation is poor. We demonstrated the best cut-off value of % PCT decrease for predicting survival and recovery from dialysis, which suggested that a decrease in % PCT could be a promising biomarker for predicting the prognosis in these patients.

Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992; 101: 1644–55. pmid:1303622Sutherland, S. M. et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: The prospective pediatric continuous renal replacement therapy registry. Am. J. Kidney Dis. 55(2), 316–325 (2010). Tolwani, A. Continuous renal-replacement therapy for acute kidney injury. N. Engl. J. Med. 367(26), 2505–2514 (2012). Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004; 66: 1613–21. pmid:15458458 Despite advances in medical interventions, including CRRT, SIAKI has been reported to be associated with a high mortality rate of 50–60% 3, 32. Until now, most studies on the effect of CRRT on mortality in patients with SIAKI have focused on the timing and dose of CRRT 32 and little research has been conducted on the association between survival and fluid overload in patients with SIAKI receiving CRRT. In this study, we investigated the association between fluid overload and survival in patients receiving CRRT considering the important role of fluid balance in patients with SIAKI.

Early-Stage AKI in CLP Mice Recapitulates the Clinical and Renal Pathological Features of Early-Stage AKI Patients The cut-off value of the % PCT decrease for predicting prognosis is of interest currently. Previous studies have demonstrated that % PCT decreases within a range of 30–70% within 2–7 days after the initial PCT measurement predicted survival in patients with sepsis [ 14]. The present study showed that the best cut-off value of % PCT decrease over 72 hours after CRRT initiation for predicting survival in patients with SIAKI receiving CRRT was > 31% (AUC: 0.802, P< 0.001), with an associated sensitivity of 64.8% and specificity of 83.6%. Patients with a % PCT decrease > 31% showed a significant increase in survival compared to those with a % PCT decrease ≤ 31% (28-day survival: 80.5 vs. 30.6%, P< 0.001). Furthermore, for the first time, to the best of our knowledge, the present study showed that the best cut-off of % PCT decrease for predicting recovery from dialysis in survivors was > 69% (AUC: 0.825, 95% CI: 0.780–0.864, P< 0.001) with an associated sensitivity of 73.5% and specificity of 80.5%. Survivors with a % PCT decrease > 69% showed a significantly higher rate of recovery from dialysis than those with a % PCT decrease ≤ 69% (28-day recovery rate from dialysis: 58.5% vs. 25.7%, P< 0.001). From these findings, we suggest that the serial monitoring of PCT concentration over 72 hours after CRRT initiation could help guide physicians to identify patients who are at risk of death and are dialysis-dependent in patients with SIAKI receiving CRRT, and prompt physicians to evaluate the appropriateness and adequacy of early management in these patients.Heilmann E, Gregoriano C, Schuetz P. Biomarkers of Infection: Are They Useful in the ICU? Semin Respir Crit Care Med. 2019; 40: 465–75. pmid:31585473 Despite its strengths, our study had some limitations. First, owing to its retrospective design, it is not possible to discern whether fluid overload is solely a marker of more severe illness or a causal contributor to mortality in our study subjects. However, as discussed above in the present study, we attempted to adjust for the disease severity indices, such as the SOFA score, APACHE II score, vasopressor use, and ventilator dependency, and found that fluid overload during CRRT was independently associated with the 28-day mortality, suggesting that fluid overload is a potentially modifiable risk factor for mortality in patients with SIAKI receiving CRRT. Second, we included a specific subset of critically ill patients, namely those with SIAKI who received CRRT. Thus, selection bias could not be avoided, and the results of our study might not be generalizable to other populations of critically ill patients with AKI. Third, fluid management using CRRT was implemented through discussion and consultation with the attending nephrologist without a standardized protocol. Thus, variations in fluid management might have affected the effect of fluid overload on survival in the present study.