ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients

BACKGROUND

Transient and persistent acute kidney injury (AKI) could share similar physiopathological mechanisms. The objective of our study was to assess prognostic impact of AKI duration on ICU mortality.

DESIGN

Retrospective analysis of a prospective database via cause-specific model, with 28-day ICU mortality as primary end point, considering discharge alive as a competing event and taking into account time-dependent nature of renal recovery. Renal recovery was defined as a decrease of at least one KDIGO class compared to the previous day.

SETTING

23 French ICUs.

PATIENTS

Patients of a French multicentric observational cohort were included if they suffered from AKI at ICU admission between 1996 and 2015.

INTERVENTION

None.

RESULTS

A total of 5242 patients were included. Initial severity according to KDIGO creatinine definition was AKI stage 1 for 2458 patients (46.89%), AKI stage 2 for 1181 (22.53%) and AKI stage 3 for 1603 (30.58%). Crude 28-day ICU mortality according to AKI severity was 22.74% (n = 559), 27.69% (n = 327) and 26.26% (n = 421), respectively. Renal recovery was experienced by 3085 patients (58.85%), and its rate was significantly different between AKI severity stages (P < 0.01). Twenty-eight-day ICU mortality was independently lower in patients experiencing renal recovery [CSHR 0.54 (95% CI 0.46-0.63), P < 0.01]. Lastly, RRT requirement was strongly associated with persistent AKI whichever threshold was chosen between day 2 and 7 to delineate transient from persistent AKI.

CONCLUSIONS

Short-term renal recovery, according to several definitions, was independently associated with higher mortality and RRT requirement. Moreover, distinction between transient and persistent AKI is consequently a clinically relevant surrogate outcome variable for diagnostic testing in critically ill patients.

The epidemiology and outcome of acute septic arthritis: a hospital based study

BACKGROUND

Septic arthritis is an acute bacterial infection affecting synovial joints. It is an orthopaedic emergency with potential high morbidity and mortality. This study determined the epidemiological pattern and outcome of acute septic arthritis and analyzed factors affecting morbidity and mortality Methods:This is a 5 year (2007-2012) retrospective study conducted at NKST rehabilitation hospital Mkar, North -Central Nigeria. All patients with septic arthritis upon presentation were consecutively selected. Patients with clear, non-purulent or haemorrhagic joint aspirate and those with incomplete data were excluded from the study. Data was analysed using SPSS version 21.

RESULTS

A total of 30 patients with 35septic joints were studied. Eighteen (60%) were males and 12(40%) were female with a male to female ratio of 1.5:1. Age range was 3months and 75years. The knee was the commonest 16(45.7 %) joint involved followed by the hip joint 11(31.4%). Staphylococcus aureus was the commonest organism cultured in joint aspirate in 19 (54.3%) patients and postoperative complications include joint stiffness 2(5.7%), painand stiffness 3(8.6%), bony ankylosis2(5.7%) and limb shortening 1(2.9%).

CONCLUSION

Early accurate diagnosis and prompt interventionare crucial for a successful outcome. Appropriate drainage of septic joints and antibiotic treatment can result in prompt recovery with minimum or no long term morbidity. Close follow-up is needed to monitor the growth of the affected limbs until skeletal maturity. There is a need to maintain a high index of suspicion and to educate patients about early presentation, early referral, avoidance of improper use of antibiotics and regular follow-up after the acute pathology.