Impact of Diabetes on the Recurrence and Prognosis of Acute Kidney Injury in Older Male Patients: A 10-Year Retrospective Cohort Study

Development and validation of a Multi-Causal investigation and discovery framework for knowledge harmonization (MINDMerge): A case study with acute kidney injury risk factor discovery using electronic medical records

OBJECTIVE

Accurate diagnoses and personalized treatments in medicine rely on identifying causality. However, existing causal discovery algorithms often yield inconsistent results due to distinct learning mechanisms. To address this challenge, we introduce MINDMerge, a multi-causal investigation and discovery framework designed to synthesize causal graphs from various algorithms.

METHODS

MINDMerge integrates five causal models to reconcile inconsistencies arising from different algorithms. Employing credibility weighting and a novel cycle-breaking mechanism in causal networks, we initially developed and tested MINDMerge using three synthetic networks. Subsequently, we validated its effectiveness in discovering risk factors and predicting acute kidney injury (AKI) using two electronic medical records (EMR) datasets, eICU Collaborative Research Database and MIMIC-III Database. Causal reasoning was employed to analyze the relationships between risk factors and AKI. The identified causal risk factors of AKI were used in building a prediction model, and the prediction model was evaluated using the area under the receiver operating characteristics curve (AUC) and recall.

RESULTS

Synthetic data experiments demonstrated that our model outperformed significantly in capturing ground-truth network structure compared to other causal models. Application of MINDMerge on real-world data revealed direct connections of pulmonary disease, hypertension, diabetes, x-ray assessment, and BUN with AKI. With the identified variables, AKI risk can be inferred at the individual level based on established BNs and prior information. Compared against existing benchmark models, MINDMerge maintained a higher AUC for AKI prediction in both internal (AUC: 0.832) and external network validations (AUC: 0.861).

CONCLUSION

MINDMerge can identify causal risk factors of AKI, serving as a valuable diagnostic tool for clinical decision-making and facilitating effective intervention.

Association between lactate dehydrogenase to albumin ratio and acute kidney injury in patients with sepsis: a retrospective cohort study

BACKGROUND

Serum lactate dehydrogenase to albumin ratio (LAR) is associated with poor outcomes in malignancy and pneumonia. However, there are few studies suggesting that LAR is associated with the occurrence of acute kidney injury (AKI) in patients with sepsis, which was investigated in this study.

METHODS

We conducted a retrospective cohort study based on the Medical Information Mart for Intensive Care (MIMIC)-IV database. The primary outcome was the occurrence of AKI within 2 days and 7 days. Multivariable logistic regression models were used to calculate odds ratios to validate the association between LAR and AKI, in-hospital mortality, RRT use, and recovery of renal function, respectively.

RESULTS

A total of 4010 participants were included in this study. The median age of the participants was 63.5 years and the median LAR was 10.5. After adjusting for confounding variables, patients in the highest LAR quartile had a higher risk of AKI than those in the lowest LAR quartile within 2 days and 7 days, with odds ratios of 1.37 (95% confidence interval [CI]: 1.23-1.52) and 1.95 (95% CI: 1.72-2.22), respectively. The adjusted odds of AKI within 2 and 7 days were 1.16 (95% CI: 1.12-1.20) and 1.29 (95% CI: 1.24-1.35) for each 1 unit increase in LAR(log2), respectively.

CONCLUSION

This study demonstrated that elevated LAR was associated with poor prognosis in patients with sepsis. The risk of AKI and in-hospital mortality increased, the need for RRT increased, and the chance of recovery of renal function decreased with the increase of LAR.

Antibiotic Treatment Practices and Microbial Profile in Diabetic Foot Ulcers: A Retrospective Cohort Study

Aim and objective Diabetic foot ulcers (DFUs) are a frequent complication of diabetes mellitus, impacting more than one in 10 diabetic patients, with roughly half of these ulcers progressing to infection. Existing literature indicates that these infections are predominantly polymicrobial, with gram-positive isolates being the most common. This microbial profile informs the empiric antibiotic strategies employed in first-world countries, often including highly potent nephrotoxic antibiotics. This retrospective cohort study aims to assess the microbial profile and antibiotic treatment practices in patients with infected DFUs at Ochsner LSU Health Shreveport Academic Medical Center in Shreveport, Louisiana, United States. Materials and methods A total of 115 patients diagnosed with infected DFUs were included in the study. Patient records were reviewed to identify bacterial pathogens cultured from foot wounds, antibiotic treatment regimens administered, and the prevalence of acute kidney injury (AKI). Results The study found a predominance of gram-negative isolates (199; 59.4%), facultative anaerobes (246; 73.4%), and polymicrobial infections (67; 78.8%) in infected DFUs. Vancomycin was administered to 95 patients (82.6%), with only a small number subsequently testing positive for methicillin-resistant Staphylococcus aureus (MRSA). Combination therapy with vancomycin and Zosyn was given to 71 patients (61.7%), which increased the potential risk of antibiotic-induced nephrotoxicity. AKI was prevalent, affecting 58 patients (50.4%). Conclusions This study highlights a discrepancy between the microbial profile of infected DFUs and empiric antibiotic treatment practices at Ochsner LSU Health Shreveport Academic Medical Center. The predominance of gram-negative bacteria underscores the need for a polymicrobial, gram-negative-focused empiric treatment approach. Alternative antibiotics with broad-spectrum coverage and minimal nephrotoxicity, such as ceftriaxone, clindamycin, metronidazole, amoxicillin-clavulanate, and linezolid, should be considered. Tailored antibiotic strategies, guided by local microbial profiles and patient-specific factors, are essential to optimize treatment outcomes in this high-risk population.

Value of Hcy combined with Framingham score for predicting macrovascular disease in elderly patients with type 2 diabetes

To analyze the predictive value of homocysteine (Hcy) combined with the Framingham risk score for cardio- and cerebrovascular disease in elderly patients with type 2 diabetes mellitus (T2DM) to provide a reference for clinical treatment. We retrospectively reviewed the clinical data of 1036 elderly patients with T2DM admitted to our hospital between July 2017 and July 2022. The patients were divided into occurrence (n = 438) and control (n = 598) groups based on the incidence of cardio- or cerebrovascular disease. Univariate and multivariate logistic analyses were used to analyze the factors associated with cardio-cerebral small-vessel disease in the elderly patients with T2DM. The predictive value of Hcy combined with the Framingham score for cardio- and cerebrovascular diseases in elderly patients with T2DM was determined using receiver operating characteristic curves. Univariate analysis showed that the occurrence group had significantly higher Framingham score, systolic blood pressure (SBP), total cholesterol (TC), fasting blood glucose (FBG), 2-hour postprandial plasma glucose, Hcy, glycated hemoglobin, smoking history, and disease duration than the control group (all P < .05). Food preferences, sleep duration, physical exercise, high density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol levels were significantly lower in the occurrence group than in the control group (all P < .05). Multivariate logistic analysis showed that smoking history, duration of diabetes, Framingham score, SBP, TC, FBG, HDL-C, 2h postprandial plasma glucose, and Hcy levels were risk factors for cardio- and cerebrovascular disease in elderly patients with T2DM. The area under the curve for Hcy and Framingham scores was 0.741 (95% confidence interval [CI]: 0.635-1.871) and 0.717 (95% CI: 0.601-0.856), respectively. Hcy combined with the Framingham score demonstrated a significantly higher predictive value (0.852, 95% CI: 0.741-0.979). Long smoking history, long diabetes duration, high Framingham score, high SBP, high TC, high FBG, low HDL-C, and high Hcy levels are risk factors for cardio-cerebrovascular disease in elderly patients with T2DM. In addition, Hcy level combined with the Framingham score demonstrated superior predictive power for cardio- and cerebrovascular disease in elderly patients with T2DM.

Acute kidney injury in diabetic patients: A narrative review

Diabetes mellitus (DM) is the most common cause of chronic kidney disease, which leads to end-stage renal failure worldwide. Glomerular damage, renal arteriosclerosis, and atherosclerosis are the contributing factors in diabetic patients, leading to the progression of kidney damage. Diabetes is a distinct risk factor for acute kidney injury (AKI) and AKI is associated with faster advancement of renal disease in patients with diabetes. The long-term consequences of AKI include the development of end-stage renal disease, higher cardiovascular and cerebral events, poor quality of life, and high morbidity and mortality. In general, not many studies discussed extensively "AKI in DM." Moreover, articles addressing this topic are scarce. It is also important to know the cause of AKI in diabetic patients so that timely intervention and preventive strategies can be implemented to decrease kidney injury. Aim of this review article is to address the epidemiology of AKI, its risk factors, different pathophysiological mechanisms, how AKI differs between diabetic and nondiabetic patients and its preventive and therapeutic implications in diabetics. The increasing occurrence and prevalence of AKI and DM, as well as other pertinent issues, motivated us to address this topic.