Acute kidney injury (AKI) and sepsis are critical clinical conditions associated with high morbidity and mortality. Despite growing research interest, there remains a need for a comprehensive analysis of global research trends in this field. Bibliometric analysis offers a quantitative approach to assessing the evolution of scientific knowledge, collaborative networks, and emerging research areas over time.

This study aims to map the global landscape of research on AKI and sepsis over the last two decades (2004-2024), identify major contributors, collaboration networks, key research trends, and highlight gaps in the literature.

We conducted a bibliometric analysis of research articles from leading databases. The study utilized network visualization techniques to assess co-authorship, citation patterns, and keyword co-occurrence, focusing on the most influential countries, institutions, and research collaborations.

Results reveal China leads in publication volume, yet countries like the United States and Australia show higher international collaboration rates and citation impact. Additionally, thematic analyses highlight critical research areas, including biomarkers, bioenergetics, inflammation, and machine learning, marking significant advancements in the understanding and management of AKI.

This bibliometric analysis offers valuable insights into the evolving landscape of AKI and sepsis research, emphasizing the importance of collaborative efforts to address knowledge gaps and ensure evidence-based care across diverse healthcare settings. Future research should prioritize the development of biomarkers and the integration of AI-driven technologies to enhance early diagnosis and personalize treatment strategies for AKI patients.

The risk of developing a persistent reduction in renal function after postoperative acute kidney injury (pAKI) is not well established. The goal of this investigation was to evaluate whether patients who develop pAKI have a greater decline in long-term renal function than patients who do not.

In this multicentre retrospective propensity-matched study, anaesthesia data warehouses at three tertiary care hospitals were queried. Adult patients undergoing surgery with available preoperative and postoperative creatinine results and without baseline haemodialysis requirements were included. Patients were stratified by occurrence of pAKI as defined by the Acute Kidney Injury Network classification. The primary outcome was a decline in follow-up glomerular filtration rate (GFR) of 40% relative to baseline, based on follow-up outpatient visits from 0 to 36 months after hospital discharge. A propensity score-matched sample was used in Kaplan-Meier analysis and a piecewise Cox model to compare the time to reach a 40% decline in GFR for patients with and without pAKI.

In 95 213 patients, the rate of pAKI ranged from 9.9% to 13.7%. In the piecewise Cox model, pAKI was associated with a significantly increased hazard of a 40% decline in GFR. The common-effect hazard ratio was 13.35 (95% confidence interval [CI] 10.79-16.51, P<0.001) for 0-6 months, 7.07 (5.52-9.05, P<0.001) for 6-12 months, 6.02 (4.69-7.74, P<0.001) for 12-24 months, and 4.32 (2.65-7.05, P<0.001) for 24-36 months.

pAKI is associated with a significantly increased hazard of a 40% decline in GFR up to 36 months after surgery across three institutions.

Sepsis and septic shock are associated with microcirculatory dysfunction, significantly impacting patient outcomes. This study aimed to evaluate the effects of a 20 % albumin bolus on microcirculation compared to crystalloid resuscitation in fluid-responsive patients (ClinicalTrials.govID:NCT05357339).

We conducted a single-centre randomised controlled trial, enrolling 103 patients (Albumin n = 52, Control n = 51). Fluid responsiveness was assessed, and fluid was administered in boluses of 100 ml to clinical effect. Microcirculation was measured using the Side stream Dark Field camera and AVA 4.3 software. Baseline characteristics, macrohaemodynamics, and microcirculation parameters were recorded. Three patients were excluded from analysis.

The final cohort comprised 100 patients, 35 (35 %) females with a mean age of 58 years (range: 18-86). The mean APACHE score was 28 (range: 7-45), and the mean SOFA score was 9.4 (range: 1-17). No significant differences in APACHE (26.24 vs. 29.4, p = 0.069) or SOFA (9.08 vs. 9.78, p = 0.32) scores were found for albumin and control group respectively. The albumin group had worse microcirculation at baseline but demonstrated significant improvements in microvascular density and activity at 15 min and 60 min (p < 0.005), while the control group exhibited no significant changes. Additionally, both groups were fluid responsive, with a mean pulse pressure variability of 17 % at admission. There were no significant differences in overall fluid balances, vasopressor days, length of ICU stay, or mortality between groups.

This study demonstrates that a 20 % albumin bolus significantly enhances microcirculation in fluid-responsive patients with septic shock. These findings underscore the potential benefits of targeted microcirculation therapy in critically ill patients.

To evaluate the efficacy and safety of empagliflozin in patients with type 2 diabetes mellitus (T2DM) undergoing elective on-pump coronary artery bypass grafting (CABG).

Investigator-initiated, pragmatic, single-center, randomized, open-label trial with blinded outcome adjudication conducted in Brazil. A total of 145 patients with T2DM scheduled for elective on-pump CABG were randomized to receive empagliflozin 25 mg daily plus standard care (n = 71) for at least 3 months, which was discontinued 72 h before surgery, or to received standard care alone (n = 74). The primary outcome was postoperative acute kidney injury (AKI) within 7 days of surgery, defined by creatinine-based criteria (namely, Acute Kidney Injury Network; Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Kidney Disease; or Kidney Disease: Improving Global Outcomes). Secondary outcomes included 30-day postoperative atrial fibrillation and type 5 myocardial infarction (MI). Safety outcomes were ketoacidosis, urinary tract infection, hospital-acquired pneumonia, and wound infection within 30 days after CABG.

AKI occurred in 22.5% of the empagliflozin group vs. 39.1% in the control group (relative risk [RR] 0.57 [95% CI 0.34-0.96]; P = 0.03). Rates of atrial fibrillation (15.4% vs. 13.5%; RR 1.15 [95% CI 0.52-2.53]; P = 0.73) and type 5 MI (1.4% vs. 4.1%; RR 0.35 [95% CI 0.04-3.26]; P = 0.62) were similar between groups. No statistically significant differences between groups were observed for safety events. Three deaths occurred, all in the control group.

Empagliflozin use before on-pump CABG in patients with T2DM was associated with a reduced incidence of postoperative AKI without an increase in safety events. These findings warrant confirmation in larger clinical trials.

Despite the fact that chemotherapy for bone sarcomas (e.g. Ewing sarcoma, osteosarcoma) has well-reported toxicities and that surgical intervention is frequently life altering, follow-up care to monitor for late and long-term effects beyond that of oncological surveillance in former patients is variable. Anecdotal evidence suggests that inconsistent follow-up means some former bone sarcoma patients are left to cope with post-treatment late and long-term effects with limited support. Here, we performed a scoping review to provide a more empirical identification of the knowledge gaps and to provide an overview of the peer reviewed academic literature reporting the late and long-term effects of treatment for bone sarcoma. JBI Scoping Review Network guidelines for charting, analysis and data extraction were followed. Literature searches were conducted in Medline (Ovid), Cochrane CENTRAL, EMBASE (Ovid), CINAHL, PsycINFO, Proquest and Web of Science (Clarivate Analytics) from March 2024 to September 2024. Paper titles and abstracts were screened by two independent reviewers followed by full text analysis by the lead researcher. Seventy-four peer reviewed articles were included in the analysis. Most studies were of a retrospective study design, some up to 20 years of follow-up and included chemotherapy, surgery and sometimes radiotherapy as the treatment modality. Our analysis identified secondary malignancies, cardio- and nephrotoxicity, lower bone mineral density and microarchitectural deterioration, cancer related fatigue and motor neuropathies as the major physical late and long-term effects requiring dedicated follow-up. In some cases, follow-up may need to span decades, especially given the increasing population of former patients. Our results form the evidence-based foundations for future work that might include late and long-term effect follow-up service mapping exercises and expanded clinical recommendations.

Transcatheter tricuspid valve repair (TTVR) might be an alternative option to reduce tricuspid regurgitation (TR) in patients with sarcopenia. Psoas muscle area (PMA) measured using computed tomography (CT) is known as a marker of sarcopenia. We investigated the association of PMA with procedural and clinical outcomes following TTVR. We retrospectively measured left and right PMA using pre-procedural CT in patients undergoing TTVR. Low PMA was defined as the total PMA < 20.3 cm2 for men and < 11.8 cm2 for women. The primary outcome was a composite of all-cause mortality and heart failure hospitalization within one year after TTVR. Of 163 patients, 47 (29%) were considered as having low PMA. Procedural success, defined as residual TR of ≤ 2 + at discharge, and in-hospital mortality were comparable between patients with low and high PMA. Patients with low PMA had a higher incidence of the composite outcome than those with high PMA (49% vs. 21%; p = 0.001) This association was consistent after adjusting for baseline characteristics (adjusted hazard ratio 0.43; 95% confidence interval: 0.23-0.80; p = 0.008). In contrast, the New York Heart Association functional class improved from baseline to three-month follow-up, regardless of PMA. Approximately 30% of patients undergoing TTVR were found to have low PMA. Although TTVR may be a safe therapeutic option to reduce TR and improve heart failure symptoms in patients with sarcopenia, the prognosis after TTVR remains poor in this population. Pre-procedural CT-based assessment of PMA may enhance risk stratification and support better clinical decision-making for TTVR.

This systematic review and meta-analysis evaluate Acute Kidney Injury (AKI) differences between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) and how surgical risk stratification and diagnostic criteria influence outcomes. Following the PRISMA guidelines, we included both non-randomized studies and randomized clinical trials that reported AKI criteria and patients' surgical risk in patients with aortic stenosis by searching PubMed, Scopus, and Web of Science until late September. We executed a random-effects model in Review Manager to pool effect estimates of AKI incidence or the need for dialysis as an odds ratio (OR) and I2 heterogeneity, and we utilized R for meta-regression to address any heterogeneity with subgroup analysis for surgical risk, AKI criteria, and study design. We used the Newcastle Ottawa Scale (NOS) and the Cochrane Risk of Bias Tool (RoB-1) for risk of bias assessment and GRADE for certainty assessment. Involving 17 studies and a total of 13,777 patients, we found that the AKI incidence was significantly lower in TAVR compared to SAVR (OR = 0.36; 95% CI: [0.30, 0.44], I2 = 55%, P = 0.003), along with the need for dialysis (OR = 0.35; 95% CI: [0.19, 0.63], I2 = 0%, P = 0.92). The study also found that intermediate and low-risk patients had more favorable outcomes. However, the retrospective study design and VARC-2 criteria were associated with unfavorable outcomes. TAVR effectively reduced the risk of AKI in all surgical risk categories and the need for dialysis compared to SAVR in patients with AS.

The condition of sepsis, defined by the misregulation of the body's defensive mechanisms against infection, culminates in the potential for catastrophic organ damage and stands as a primary driver of mortality in Intensive Care Units (ICU) settings. Among patients in a critical condition, sepsis is a predominant factor in the development of acute kidney injury (AKI), and the death rate among those with both sepsis and AKI is considerably higher, underscoring the importance of addressing this health crisis. Sepsis-associated acute kidney injury (S-AKI) is a complex process involving inflammation, microcirculatory issues, and metabolic disorders. Among these, the inflammatory response has become a focal point of interest. Bridging the innate and adaptive immunity, natural killer T (NKT) cells can be rapidly activated in sepsis, contributing to sepsis-associated injury and downstream activation of inflammatory cells through the emission of Th1 or Th2 cytokines. They also contribute to S-AKI through the TNF-α/FasL and perforin pathways. Alpha-Galactosylceramide (α-GalCer), acting as a powerful activator for type I NKT (iNKT) cells, is able to regulate the secretory profile of iNKT cells, responding to the pro-inflammatory response and immunosuppressive profiles of sepsis. This review examines the part played by NKT cells in S-AKI and whether α-Galcer could function as a significant regulator in sepsis, based on studies of regression-related mechanisms.

Intraoperative hypotension (IOH) is associated with morbidity and mortality. The Hypotension Prediction Index (HPI), a machine learning-based tool, offers the opportunity for a proactive approach by predicting hypotensive events. This single center, single blind randomized clinical trial aimed to evaluate the hypothesis that an HPI software-guided approach to IOH management during prone position spine surgery could reduce its incidence compared to our standard care practices. 85 adult patients undergoing spine fusion surgery in the prone position were enrolled. Patients were randomized with a 1:1 allocation ratio. Participants were blinded to their group allocation. In the intervention group, the HPI software was actively used to guide IOH management. In the control group, HPI software readings were blinded, and standard care was administered. The primary outcome was the comparison of time-weighted average (TWA) of IOH between the two groups. Secondary outcomes included a comparison of the incidence of postoperative in-hospital events related to IOH between groups. 77 patients were included in the final analysis (39 in the intervention group), as 8 patients were excluded due to technical issues. No statistically significant difference was found between the intervention and control groups in the TWA of IOH (0.10 mmHg [0.05, 0.23] vs. 0.15 mmHg [0.09, 0.37], p-value 0.088). However, the total duration of hypotensive events per patient was significantly lower in the intervention group (4 min [0.5, 12.2] vs. 11.2 min [2.6, 20.1]; p-value 0.019). Postoperative complication rates did not differ significantly between the two groups. HPI-guided management did not significantly reduce the TWA of IOH compared to standard care in patients undergoing prone-position spine surgery. Complication rates were similar between the two groups.Clinical Trial Registration: This trial was registered with ClinicalTrials.gov (registration number: NCT05341167).

Acute pancreatitis (AP) is a severe but insufficiently recognized adverse effect of tigecycline in kidney transplant (KT) recipients. This study aimed to identify the clinical characteristics and risk factors associated with tigecycline-induced AP in this population.

A single-center retrospective study was conducted in KT recipients treated with tigecycline. The clinical characteristics of patients who developed AP were analyzed, and risk factors for tigecycline-induced AP were assessed using univariate analysis and multivariate logistic regression.

80 KT recipients were enrolled, of whom nine developed AP (incidence: 11.25%), and four died. The mean time from tigecycline administration to AP onset was 7.00 days, to symptomatic relief after discontinuation was 4.87 days, and to normalisation of pancreatic enzymes after discontinuation was 8.75 days. The analysis revealed that tacrolimus trough concentration (C0 Tac) and post-transplant acute kidney injury (AKI) were independent risk factors for tigecycline-induced AP in KT recipients. Logistic regression analysis produced a combined predictive expression: Ycombined = AKI + 0.064C0 Tac-2.789. Receiver operating characteristic curve analysis determined that the C0  Tac cut-off was 13.9 ng/mL. The area under the curve for C0  Tac and combined predictor were 0.802 and 0.853, respectively.

The incidence of AP following tigecycline treatment was significantly higher in KT recipients than in non-transplant patients. Post-transplant AKI and elevated C0 Tac concentrations were identified as independent risk factors for the development of AP. Close monitoring of renal function and ensuring therapeutic monitoring of C0 Tac levels may help prevent AP.

This systematic review and meta-analysis aimed to identify and quantify the risk factors associated with acute kidney injury (AKI) in patients with traumatic brain injury (TBI).

PubMed, Embase, and Web of Science were systematically searched for articles published up to October 2024. Observational studies published in English that reported on risk factors for AKI in TBI patients were included. Data on AKI incidence and risk factors were extracted. A meta-analysis was conducted using a random-effects model when heterogeneity I2 > 50 % and a fixed-effects model when I2 < 50 %. Risk of bias for studies was assessed using the Newcastle-Ottawa Scale (NOS). Certainty of evidence was evaluated using the GRADE approach.

Twenty studies involving 13,115 TBI patients were included in the meta-analysis. The pooled incidence of AKI after TBI was 19 % (95 % CI 16-23). Male gender (odds ratio (OR) 1.43, 95 % CI 1.21-1.70; I2 0 %), diabetes (OR 3.59, 95 % CI 1.74-7.42; I2 0 %), Glasgow Coma Scale (GCS) (mean difference (MD) -0.48, 95 % CI -0.74,-0.23; I2 38 %), GCS ≤ 8 at admission (OR 1.56, 95 % CI 1.28-1.90; I2 0 %), Simplified Acute Physiology Score II (SAPS II) score (MD 4.65, 2.69-6.61; I2 56 %), serum creatinine level at admission (MD 18.17, 95 % CI 1.82-34.51; I2 93 %), hemoglobin (MD -6.82, 95 % CI -12.72, -0.92; I2 79 %), glucose (MD 1.42, 95 % CI 0.64-2.20; I2 0 %), the use of mannitol (OR 2.14, 95 % CI 1.08-4.25; I2 74 %), vancomycin (OR 1.75, 95 % CI 1.35-2.27; I2 0 %) and red blood cell transfusion (OR 3.35, 95 % CI 1.86-6.04; I2 59 %) increased the risk for AKI.

These findings highlighted the critical need for proactive surveillance of these risk factors in clinical practice, enabling the development of prediction models to identify TBI patients at high risk of AKI.

Acute kidney injury (AKI) is a critical yet frequently under diagnosed condition in hospitalized patients, impacting morbidity and mortality. Electronic alerts for AKI aimed to assist physicians in early diagnosis and intervention, though evidence for their effectiveness is inconsistent.

A systematic search was conducted in PubMed, the Cochrane Central Register of Controlled Trials, Cochrane Library, and Web of Science from inception to November 2024. Eligible studies included randomized controlled trials (RCTs), before-and-after analyses, and stepped-wedge designs involving hospitalized patients. The primary outcomes were mortality and renal replacement therapy (RRT) rates, Secondary outcomes included hospital length of stay (LoS), AKI progression and recovery. Care-centered outcomes encompassed nephrologist consultation, nephrotoxic medication discontinuation and medication review. Subgroup analysis examined the impact of response intensity, hospital type and geographic region on these outcomes.

Twenty-two studies involving 170,696 participants were included: 8 RCTs (n = 21,710) and 14 non-RCTs or observational studies (n = 148,986). RCTs showed no effect on mortality (RR 1.02; 95% CI 0.97-1.07) or LoS (mean difference 0.04; 95% CI - 0.13 to 0.22) but a significant increase in RRT use (RR 1.13; 95% CI 1.02-1.26) with AKI alert systems. Non-RCTs, however, reported reduced mortality (RR 0.92; 95% CI 0.88-0.96), less AKI progression (RR 0.85; 95% CI 0.77-0.94), enhanced kidney recovery (RR 1.65; 95% CI 1.56-1.75), increased nephrotoxic drug discontinuation (RR 1.20; 95% CI 1.13-1.28), and higher drug review rates (RR 1.19; 95% CI 1.17-1.21), with no impact on RRT use (RR 1.08; 95% CI 0.87-1.36). Subgroup analysis revealed an increased in-hospital mortality in low response intensity (RR 1.15; 95% CI 1.00-1.32), reduced mortality in moderate response intensity (RR 0.93; 95% CI 0.89-0.97), and unclear effects in high response intensity (RR 0.88; 95% CI 0.70-1.09). AKI alert was also favored in teaching hospitals and in several regions (Europe, North America and South America).

The efficacy of AKI alerts remains inconclusive. Current evidence do not support or refute their effectiveness. Variability in response intensity, hospital type and geographic region may help explaining discrepancies, underscoring the need for further research to optimize AKI alert systems with more effective action in clinical practice.

Background/Objectives: Voriconazole (VRCZ) use requires accurate monitoring to avoid suboptimal drug levels and adverse effects. In addition, the appearance of resistant fungal strains is a problem that needs attention. Blood concentration measurement is the monitoring technique of choice; however, it is slow, limiting its clinical application. This study aimed to evaluate the clinical utility of rapid therapeutic drug monitoring (TDM) for VRCZ using high-performance liquid chromatography with ultraviolet detection (HPLC-UV) compared to conventional outsourced liquid chromatography-tandem mass spectrometry (LC-MS/MS) testing in outpatient care. Methods: VRCZ blood concentrations were measured using HPLC-UV and LC-MS/MS. Reporting times, accuracy, and clinical outcomes were assessed for outpatients receiving VRCZ treatment. Safety was monitored for renal, hepatic, and visual toxicities. Results: HPLC-UV significantly reduced reporting times (0.433 h vs. 74.3 h, p < 0.001), and Deming's regression analyses showed a strong correlation with LC-MS/MS results (Pearson's r = 0.988). Bland-Altman analysis showed an average difference of 0.025 μg/mL between HPLC-UV and LC-MS/MS. Prospective monitoring of three outpatients revealed no adverse events, enabling safe and effective VRCZ dosing. Conclusions: Rapid VRCZ TDM using HPLC-UV is a cost-effective and feasible approach for outpatient care, significantly improving reporting times and patient safety. Further studies and cross-facility collaboration are needed to expand its application.

The 2020 vancomycin consensus guidelines recommend AUC-guided dosing over trough-based dosing to decrease nephrotoxicity. This study was performed to add data comparing these dosing methods in the outpatient setting.

This retrospective cohort study compared trough-guided versus AUC-guided dosing in patients receiving vancomycin through two home infusion pharmacies (HIPs). Multivariate analysis was performed to report adjusted relative risks, adjusting for patient demographics and clinical characteristics. Eligible patients were ≥18 years old, had an absolute neutrophil count of ≥1000 cells/mm3, a baseline serum creatinine of <2.0 mg/dL at HIP intake, and ≥7 days of IV vancomycin at home. Primary outcome was rate of acute kidney injury (AKI) events, defined as the number of AKI events per treatment days. Secondary outcomes were rate of 30 day hospital readmission and number of HIP interventions (vancomycin dose changes).

Six hundred and sixty patients were included (303 trough, 357 AUC). The mean number of AKI events was 0.84 per treatment day for trough-guided versus 0.63 for AUC-guided dosing (P = 0.11). In adjusted models, there were no significant associations between the exposure and AKI events [relative risk (RR) = 0.8, 95% CI 0.5-1.2, P = 0.26], 30 day hospital readmissions (RR 1.0, 95% CI 0.8-1.3, P = 0.71) or number of pharmacy interventions (RR = 1.0, 95% CI 0.9-1.2, P = 0.67).

There was no significant difference in AKI rates among patients receiving vancomycin via trough- or AUC-guided monitoring and dosing through a HIP. Further evaluation is needed to determine how to improve AKI rates using AUC-guided monitoring and dosing among patients receiving vancomycin therapy at home.

The aim of this study was to investigate the influence of prolonged aerobic exercise on cardiac, muscular and renal inflammatory markers in a group of trained obese men.

Seventeen men (aged 40 ± 6 years; body mass index [BMI] 31.3 ± 2.8 kg m-2, maximal oxygen uptake [V'O2max] 41.5 ± 5.6 ml kg-1 min-1) ran a half, 30 km, or full marathon. Troponin I (cTnI), the n-terminal creatine kinase-myocardial band (CK-MB), pro b-type natriuretic peptide (NT-proBNP), lactate dehydrogenase (LDH), myoglobin, creatinine (CREA) and the estimated glomerular filtration rate (eGFR) were measured before (T0), immediately after (T1) and 3 days after the race (T2).

The concentrations of cTnI, myoglobin, LDH, CK-MB and CREA significantly increased (P < 0.05), whereas eGRF decreased at T1 (P < 0.05). All the above parameters returned to baseline at T2, except for eGFR, which remained lower than that at T0 (P < 0.05). A positive association was observed between ΔCK-MB (%) and the time spent in Zone 3 during the race (R = 0.686, P = 0.014). The Δmyoglobin (%) was positively correlated with race time, race mean speed and time in Zone 3 (R = 0.574-0.862, P < 0.05). The ∆CREA values were moderately correlated with the race mean HRMAX (%) and time spent in Zone 3 (%) (R = 0.514-0.610; P = 0.05). The ∆eGRF values were moderately inversely correlated with the time spent in Zone 3 (%) (R =  - 0.627; P < 0.05).

Changes in cardiac, muscular and renal inflammatory markers in trained men with obesity are consistent with those described in the literature in normal-weight individuals. Finally, running parameters, such as running time, average running intensity and time in Zone 3 appear to be responsible for the changes in cardiac, muscular and renal function markers after long-distance running.

Acute Kidney Injury (AKI) is a common complication after cardiac surgery affecting up to 40% leading to increased morbidity and mortality. To date, there is no specific treatment for AKI, thus, clinical research efforts are focused on preventive measures. The only pharmacological preventive intervention that has demonstrated a beneficial effect on AKI in a high-quality, double-blind, randomized controlled trial is a short perioperative infusion of a balanced mixture of amino acid solution. Amino acid infusion reduced the incidence of AKI by recruiting renal functional reserve and, therefore, increasing the glomerular filtration rate. The beneficial effect of amino acids was further confirmed for severe AKI and applied to patients with chronic kidney disease. Among non-pharmacological interventions, international guidelines on AKI suggest the implementation of a bundle of good clinical practice measures to reduce the incidence of perioperative AKI or to improve renal function whenever AKI occurs. The Kidney Disease Improving Global Outcomes (KDIGO) bundle includes the discontinuation of nephrotoxic agents, volume status and perfusion pressure assessment, renal functional hemodynamic monitoring, serum creatine, and urine output monitoring, and the avoidance of hyperglycemia and radiocontrast procedures. However, pooled data from a meta-analysis did not find a significant reduction in AKI. The aim of this review is to delineate the most appropriate evidence-based approach to prevent AKI in cardiac surgery patients.

Although cytomegalovirus (CMV) is a common complication after pediatric liver transplantation (PLT), the optimal method for CMV prevention is uncertain and lacks multicentered investigation. We compared the effectiveness of short (<120 days) vs long (>180 days) CMV primary antiviral prophylaxis to prevent CMV disease in PLT, through a prospective cohort study of primary PLT (aged <18 years) recipients enrolled in the Society of Pediatric Liver Transplantation registry from 2015 to 2019 with either donor or recipient CMV seropositivity. Participants were grouped into short or long prophylaxis based on their center's practice and intended duration. In total, 199 PLT recipients were enrolled including 112 (56.3%) short and 87 (43.7%) long prophylaxis. End-organ disease was rare and similar between groups (2.7% and 1.1%; P = .45). CMV DNAemia and syndrome were more common in the short compared with those in long prophylaxis (26.8% vs 13.8%; P = .03; 18.8% vs 6.9%; P = .02). Neutropenia occurred more commonly with long prophylaxis (55.2% vs 16.1%; P < .001). Graft and patient survival were similar. Consideration of a short prophylaxis must weigh increased risk of CMV syndrome/DNAemia against medication burden and neutropenia of longer prophylaxis.

Endovascular aneurysm repair (EVAR) for large infrarenal abdominal aortic aneurysms (AAAs) has been associated with worse outcomes compared with EVAR for smaller AAAs. Whether these findings apply to complex AAAs (cAAA) remains uncertain.

We identified all intact complex EVAR (cEVAR) from 2012 to 2024 in the Vascular Quality Initiative. cEVAR was defined as having a proximal extent between zones 6 and 9 and at least one side branch/fenestration/chimney/parallel grafting. Aneurysm size was defined as follows: large: >65 mm (males), >60 mm (females); medium: 55 to 65 mm (males), 50 to 60 mm (females); and small: <55 mm (males), <50 mm (females). We assessed perioperative death, any complication, and in-hospital reintervention using logistic regression and midterm mortality using adjusted Kaplan-Meier methods and Cox regression analyses. Medium-sized aneurysms were compared with large and small aneurysms.

Of the 3426 patients, 22.6% had large, 60.4% medium, and 17.0% had small aneurysms. As compared with medium and small aneurysms, large aneurysms demonstrated higher rates of perioperative death (4.8% vs 2.6% vs 0.5%), any complication (33.3% vs 23.6% vs 19.4%), and in-hospital reintervention (6.2% vs 4.0% vs 2.6%) (all P < .05). The median follow-up was 445 days. One-year mortality rates were higher in large aneurysms (12.3% vs 7.8% vs 3.8%; P < .001). After adjustment, when compared with medium-sized aneurysms, large aneurysms were associated with a significantly higher risk of perioperative death (adjusted odds ratio [aOR], 1.73; 95% confidence interval [CI], 1.09-2.72), any complication (aOR, 1.44; 95% CI, 1.18-1.76), and midterm mortality (adjusted hazard ratio, 1.50; 95% CI, 1.19-1.88), but not in-hospital reintervention (aOR, 1.46; 95% CI, 0.99-2.13). Although small aneurysms, as compared with medium-sized aneurysms, did not demonstrate a difference in any complication (aOR, 0.87; 95% CI, 0.68-1.10), in-hospital reintervention (aOR, 0.77; 95% CI, 0.42-1.33), and midterm mortality (adjusted hazard ratio, 0.78; 95% CI, 0.57-1.08], they did demonstrate a lower risk of perioperative death (aOR, 0.26; 95% CI, 0.06-0.71).

In cEVAR for cAAA, large aneurysms, compared with medium-sized aneurysms, were associated with higher rates of perioperative death, any complication, and midterm mortality, with in-hospital reinterventions trending toward a statistically significant higher risk. Although these results align with expectations, they emphasize the importance of effectively managing patients with large cAAAs and highlight the need for future research to determine whether patients might benefit more from medical therapy or open repair.

The ability to predict progression to severe acute kidney injury (AKI) remains an unmet challenge. Contributing to the inability to predict the course of AKI is a void of understanding of the pathophysiological mechanisms of AKI. The identification of novel prognostic biomarkers could both predict patient outcomes and unravel the molecular mechanisms of AKI. We performed a multicenter retrospective observational study from a cohort of patients following cardiac surgery. We identified novel urinary prognostic biomarkers of severe AKI among subjects with early AKI. Of 2,065 proteins identified in the discovery cohort, insulin-like growth factor binding protein 1 (IGFBP-1) was the most promising. We validated IGFBP-1 as a prognostic biomarker of AKI in 213 patients. In addition, we investigated its role in the pathophysiology of AKI using a murine model of cisplatin-induced AKI (CIAKI). Urinary IGFBP-1 concentration in samples collected from patients with stage 1 AKI following cardiothoracic surgery was significantly higher in patients who progressed to severe AKI compared with patients who did not progress beyond stage 1 AKI (40.28 ng/ml vs. 2.8 ng/ml, P < 0.0001) and predicted the progression to the composite outcome (area under the curve: 0.85, P < 0.0001). IGFBP-1 knockout mice showed less renal injury, cell death, and apoptosis following CIAKI, possibly through increased activation of the insulin growth factor receptor 1. IGFBP-1 is a clinical prognostic biomarker of AKI and a direct mediator of the pathophysiology of AKI. Therapies that target the IGFBP-1 pathways may help alleviate the severity of AKI.NEW & NOTEWORTHY The ability to predict progression to severe AKI remains an unmet challenge. Early prognostic biomarkers of AKI hold promise to improve patient outcomes by early implementation of clinical therapy, as well as unravel the pathophysiological mechanisms of AKI. Here, we present a novel urinary biomarker, IGFBP-1, that predicts the progression to severe AKI following cardiac surgery. In addition, we show that IGFBP-1 mice are protected against CIAKI, suggesting a mechanistic role for IGFBP-1 in AKI.

IntroductionThe ultimate answer to the question whether minimal invasive extracorporeal circulation (MiECC) represents the optimal perfusion technique in contemporary clinical practice remains elusive. The present study is a real-world study that focuses on specific perfusion-related clinical outcomes after cardiac surgery that could potentially be favourably affected by MiECC and thereby influence the future clinical practice.MethodsThe MiECS study is an international, multi-centre, two-arm randomized controlled trial. Patients undergoing elective or urgent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or combined procedure (CABG + AVR) using extracorporeal circulation will be randomized to MiECC or contemporary conventional cardiopulmonary bypass (cCPB). Use of optimized conventional circuits as controls is acceptable. The study design includes a range of features to prevent bias and is registered at clinicaltrials.gov (NCT05487612).ResultsThe primary outcome is a composite of postoperative serious adverse events that could be related to perfusion technique occurring up to 30 days postoperatively. Secondary outcomes include use of blood products, ICU and hospital length of stay (30 days) as well as health-related quality of life (30 and 90 days).ConclusionsThe MiECS trial has been designed to overcome perceived limitation of previous trials of MiECC. Results of the proposed study could affect current perfusion practice towards advancement of patient care.

Alkaline phosphatase (ALP) has been associated with an increased risk of cardiovascular events and is strongly correlated with adverse cerebrovascular outcomes. However, the relationship between ALP and neurological outcomes post-cardiac arrest (CA) remains underexplored. This study aims to investigate the association between serum ALP levels and 3-month neurological outcomes in patients who have experienced CA.

A retrospective review of 354 CA patients was conducted. Data for the study population were sourced from the DRYAD Digital Repository. Participants were categorized into three groups based on ALP level tertiles. Neurological outcomes were assessed at 3 months, with unfavorable neurological outcomes defined as a Cerebral Performance Categories (CPC) score of 3 to 5.

After adjusting for covariates, elevated ALP levels were independently associated with an increased risk of unfavorable neurological outcomes post-CA (odds ratio = 1.095, 95%confidence interval: 1.021-1.174; P = 0.011). Compared to the low ALP tertile, the high ALP tertile exhibited a 1.54-fold increased risk of unfavorable neurological outcomes.

Elevated serum ALP levels were correlated with a higher risk of suboptimal neurological outcomes within 3 months following CA.

Total aortic arch replacement surgery (TARS) for Acute type A aortic dissection is associated with high incidence of postoperative acute kidney injury (AKI), at least partly due to the lower body ischemia during circulatory arrest. This study aimed to evaluate whether retrograde inferior vena cava perfusion (RIVP) reduces the risk of AKI by providing oxygenated blood to the lower body.

This retrospective study utilized a medical recording system to screen patients who underwent TARS from January 1 to December 31, 2019. Patients were assigned to receive antegrade cerebral perfusion (ACP) only or ACP + RIVP during circulatory arrest. The primary outcome was postoperative AKI. Oxygen delivery, consumption, and extraction ratio during RIVP were also determined.

Of all included 87 patients, postoperative AKI occurred in 35 (40%), of whom 23 (53.5%) were in the ACP, and 12 (27.3%) were in the ACP + RIVP (P = 0.013). In regression analysis, ACP + RIVP was associated with lower risk of AKI than ACP alone (adjusted OR 0.229; 95% CI 0.071-0.746). RIVP at a pressure of 22.5 ± 3.8 mmHg delivered 0.98 ± 0.34 ml/min/kg of oxygen to the lower body, and the partial oxygen pressure decreased from 359 ± 57 mmHg in RIVP blood to 64 ± 30 mmHg in returning blood. Oxygen extraction ratio was 44 ± 16%, which correlated negatively with peak postoperative creatinine levels (r = -0.58, P = 0.01) and creatinine increase (r = -0.61, P = 0.009). No correlations were found between oxygen delivery and postoperative creatinine or creatinine increase.

RIVP may reduce the risk of postoperative AKI in a manner that depends on the tissue oxygen extraction ratio.

Cardiac surgery-associated acute kidney injury (CSA-AKI) significantly increases postoperative mortality and healthcare costs. Despite the growing volume of CSA-AKI research, the field remains fragmented, with challenges in identifying high-impact studies, collaborative networks, and emerging trends. Bibliometric analysis addresses these gaps by systematically mapping knowledge structures, revealing research priorities, and guiding resource allocation for both researchers and clinicians.

We analyzed 4,474 CSA-AKI-related publications (2014-2023) from the Web of Science Core Collection (WoSCC) using VOSviewer, CiteSpace, the Bibliometrix Package in R, and the bibliometric online analysis platform.

Annual publications increased steadily, with the USA and China leading productivity. The Journal of Cardiothoracic and Vascular Anesthesia serves as the foremost preferred journal within this domain. Critical Care (IF = 15.1) has the highest impact factor. Yunjie Li published the most papers. John A Kellum has the highest H-index. The definition, pathogenesis or etiology, diagnosis, prediction, prevention and treatment, which are the research basis in CSA-AKI. Machine learning (ML) and prediction models emerged as dominant frontiers (2021-2023), reflecting a shift toward personalized risk stratification and real-time perioperative decision-making. These advancements align with clinical demands for early AKI detection and precision prevention.

This study not only maps the evolution of CSA-AKI research but also identifies priority areas for innovation: multicenter validation of predictive models to strengthen generalizability, preventive nephrology frameworks for long-term AKI survivor monitoring, and randomized controlled trials to confirm efficacy of machine learning-based CSA-AKI prediction tools.

Acute kidney injury (AKI) is a key clinical condition that has puzzled clinicians for many years since there is currently no efficient drug therapy. Vitamin E is found to exert a vital antioxidant role and can protect the kidney. However, clinical studies that analyze the correlation between vitamin E and AKI are scarce, and no consistent conclusions are reported from current studies. Therefore, this study was performed to evaluate the impact of vitamin E on treating AKI.

The PubMed, Embase, and Cochrane Library databases were comprehensively searched on 27 December 2023. Qualified studies were selected following the eligibility criteria. The incidence of AKI, serum creatinine, and urea nitrogen levels after vitamin E treatment were evaluated. Then, the data were combined with a fixed- or random-effects model, depending on the heterogeneity test results.

Six eligible randomized controlled trials that used vitamin E for the prevention of kidney injury were included. According to our pooled analysis, vitamin E elevated eGFR levels [MD: 0.36; 95% CI (0.19, 0.53), p = 0.000], reduced serum creatinine levels [MD: -0.32; 95% CI (-0.48, 0.16), p = 0.000], and effectively inhibited the occurrence of AKI [RR: 0.69; 95% CI (0.49, 0.98), p = 0.036].

Vitamin E elevates eGFR levels, reduces serum creatinine levels, and efficiently suppresses AKI occurrence. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024499597, identifier CRD42024499597.

Intravascular imaging (IVI) improves the outcomes of percutaneous coronary intervention (PCI). However, the benefit of a systematic approach versus an already higher usage rate remains unclear. This study investigates the short-term impact of systematic IVI utilization during PCI in a complex higher-risk interventional PCI (CHIP-PCI) center.

This retrospective study analyzed all patients undergoing PCI at a single center between April 2018 and March 2024. Participants were divided into groups based on IVI usage (systematic IVI: ≥80 % of procedures; non-systematic IVI: <80 %). Study endpoints included procedural metrics and in-hospital outcomes.

We analyzed 5547 PCI procedures: 2529 in the non-systematic IVI group (2018-2020) and 3018 in the systematic IVI group (2021-2024). PCI was performed for multivessel disease in 835 patients (15.1 %), left main disease in 957 (17.3 %), and chronic total occlusion in 2040 (36.8 %). Mechanical circulatory support was used in 385 (6.9 %). Atherectomy and intravascular lithotripsy were performed in 1409 (25.4 %) and 249 (4.5 %), respectively. After propensity score matching, -2,305 pairs were evaluated. Procedural and fluoroscopy time were similar between groups, while air kerma (577 vs. 688 mGy, p < 0.001) and contrast volume (96 ± 45 vs. 100 ± 47 ml, p = 0.005) were lower in the systematic IVI group. Systematic IVI was also associated with reduced cardiac tamponade rates (0.8 % vs. 1.6 %, p = 0.015) without differences in other cardiac-related complications.

In this large cohort of CHIP-PCI procedures performed at a highly specialized center, systematic IVI implementation was associated with lower radiation dose and contrast volume, as well as lower incidence of cardiac tamponade, at the expense of a slightly prolonged procedural time.

Non-tuberculosis mycobacteria (NTM) are extensively drug-resistant organisms that require long-term therapy. The study purpose was to quantify the incidence of and risk factors for antimycobacterial-associated adverse drug events (ADEs) in persons with NTM infections receiving outpatient therapy. A multicenter, retrospective cohort was performed of persons with NTM infections who received antimycobacterial treatment from 2013 to 2024. Inclusion criteria were age ≥18 years, ≥1 month of outpatient treatment, and ≥1 follow-up outpatient visit within 3 months of index encounter. Mycobacterium avium complex and Mycobacterium tuberculosis complex were excluded. The primary outcome was development of pre-specified treatment-related ADE or acute kidney injury (AKI), thrombocytopenia, and/or Clostridioides difficile infection (CDI) through 12 months of therapy. Secondary outcomes included therapy discontinuation due to any treatment-related ADEs. Two hundred patients were included: 14% developed a pre-specified ADE. Mycobacterium abscessus (29%) was the most common pathogen; most initial regimens included a macrolide (54%), systemic aminoglycoside (24%), β-lactam (24%), or tetracycline derivative (22%). The most common pre-specified ADEs were thrombocytopenia (9%), AKI (8%), and CDI (<1%). The median (IQR) time-to-ADE was 25 (18-38) days from initial outpatient regimen; patients who received aminoglycoside- or oxazolidinone-based therapies were more likely to develop a pre-specified ADE (adjOR, 3.9; 95% CI, 1.7-9.2). Therapy discontinuation due to any ADE occurred in 35% of patients; the median (IQR) time-to-any ADE was 32 (21-58) days. ADEs in persons with NTM infections are common and occur near the first month of outpatient treatment. Intensified monitoring and/or use of more tolerable antimycobacterial regimens early in treatment may be an appropriate approach to avoid harms.Treatment of non-tuberculosis mycobacteria is complicated by adverse drug events (ADEs). This work quantified the incidence and time course of pre-determined, clinically relevant ADEs (acute kidney injury, thrombocytopenia, and C. difficile infection), which occurred in 14% of patients within 30 days of outpatient treatment.

Acute kidney injury (AKI) is a common and serious complication following cardiac surgery. Dexmedetomidine, a highly selective α2-adrenergic agonist, has shown potential renoprotective effects, but previous studies have yielded conflicting results.

This meta-analysis aimed to evaluate the efficacy and safety of dexmedetomidine in preventing AKI and reducing postoperative serum creatinine levels in adult patients undergoing cardiac surgery.

We comprehensively searched 5 databases for randomized controlled trials comparing dexmedetomidine with control groups in adult cardiac surgery patients. The main outcomes were the incidence of AKI and change in postoperative serum creatinine levels. Meta-analyses were conducted using RevMan 5.4 models, and subgroup analyses were performed based on dexmedetomidine dosing and timing of administration. Continuous outcomes were combined and analyzed using either mean difference (M.D.), while dichotomous outcomes were analyzed using risk ratio (RR) with 95% confidence intervals (CI).

Our study included a total of 14 trials involving 2744 patients. Dexmedetomidine administration significantly reduced the incidence of AKI compared to control groups (RR = 0.54, 95% CI: 0.41-0.70, P < 0.00001). Postoperative serum creatinine levels were also lower with dexmedetomidine (MD = -0.14 mg/dL, 95% CI: -0.28 to -0.001, P =0.04). Subgroup analyses revealed that higher initial doses (>0.5 μg/kg) and administration during intraoperative and postoperative periods were associated with more pronounced renoprotective effects. Dexmedetomidine did not significantly affect mortality but reduced the duration of the length of hospital stay and mechanical ventilation.

This meta-analysis demonstrates that dexmedetomidine administration, particularly at higher doses and during both intraoperative and postoperative periods, reduces the risk of AKI in adults undergoing cardiac surgery. These findings support the use of dexmedetomidine as a preventive strategy to enhance renal outcomes in this population.

Given our desire to reduce kidney transplant waiting times by utilizing more difficult-to-place ("higher-risk") DD kidneys, we wanted to better understand post-transplant renal function among 1119 adult DD recipients consecutively transplanted during 2016-2019. Stepwise linear regression of eGFR (CKD-EPI formula) at 3-, 6-, and 12-months post-transplant (considered as biomarkers for longer-term outcomes), respectively, was performed to determine the significant multivariable baseline predictors, using a type I error ≤ 0.01 to avoid spurious/weak associations. Three unfavorable characteristics were selected as highly significant in all three models: Older DonorAge (yr) (p < 0.000001), Longer StaticColdStorage Time (hr) (p < 0.000001), and Higher RecipientBMI (p ≤ 0.00003). Other significantly unfavorable characteristics included: Shorter DonorHeight (cm) (p ≤ 0.00001), Higher Natural Logarithm {Initial DonorCreatinine} (p ≤ 0.001), Longer MachinePerfusion Time (p ≤ 0.003), Greater DR Mismatches (p = 0.01), DonorHypertension (p ≤ 0.004), Recipient HIV+ (p ≤ 0.006), DCD Kidney (p = 0.002), Cerebrovascular DonorDeath (p = 0.01), and DonorDiabetes (p = 0.01). Variables not selected into any model included DonorAKI Stage (p ≥ 0.24), Any DonorAKI (p ≥ 0.04), and five KDRI components: two DonorAge splines at 18 years (p ≥ 0.52) and 50 years (p ≥ 0.28), BlackDonor (p ≥ 0.08), DonorHCV+ (p ≥ 0.06), and DonorWeight spline at 80 kg (p ≥ 0.03), indicating that DonorAKI and the weaker KDRI components have little, if any, prognostic impact on renal function during the first 12 months post-transplant. Additionally, biochemical determinations with skewed distributions such as DonorCreatinine are more accurately represented by natural logarithmic transformed values. In conclusion, one practical takeaway is that donor AKI may be ignored when evaluating DD risk.

Total hip arthroplasty and total knee arthroplasty are among the most successful orthopedic procedures, with increasing numbers performed annually in the United States. However, adverse perioperative complications like acute kidney injury (AKI) can adversely affect patient outcomes and increase health care costs. The incidence of AKI post-total joint arthroplasty varies widely, with large-scale studies reporting less than 2% and smaller studies indicating rates as high as 21.9%. Holding angiotensin converting enzyme inhibitors, aldosterone receptor blockers, NSAIDs, diuretics, and avoiding nephrotoxic antibiotics can help mitigate the risk.

Transplant-associated thrombotic microangiopathy (TA-TMA) is an increasingly recognized complication in hematopoietic cell transplantation (HCT). Given the rarity of prospective pediatric studies on TA-TMA, this study aimed to evaluate the incidence, survival outcomes, and risk factors for predicting early the development of TA-TMA in a pediatric population following allogeneic HCT. We conducted a prospective analysis of 173 pediatric patients to evaluate the incidence, survival outcome, and risk factors of TA-TMA. The cumulative incidence of TA-TMA at one-year post-HCT was 4.7% (95% CI, 2.2-8.6%). Patients with TA-TMA showed significantly poorer 1-year overall survival (OS) rate, 50.0% ± 17.7% compared to 85.4% ± 2.8% in those without TA-TMA (p = 0.008). Additionally, the non-relapse mortality (NRM) rate was higher in the TA-TMA group at 12.5% (95% CI, 3.7-55.8%) versus 7.0% (95% CI, 2.8-10.1%) (p = 0.598). A urine protein/creatinine ratio ≥ 1 mg/mg on day 30 post-HCT was significantly associated with TA-TMA occurrence (adjusted HR, 9.5; [95% CI], 1.28-70.39; p = 0.028). This study showed the significantly unfavorable clinical outcomes associated with TA-TMA in pediatric patients and emphasized the importance of early identification of patients at risk. Further research is needed to explore additional strategies for early detection and intervention to improve outcomes.

BackgroundHigh output is a common cause for readmission after new ileostomy creation. The loss of sodium leads to compensatory activation of the renin-angiotensin-aldosterone system (RAAS). Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are first-line therapy for hypertension in the United States. We hypothesized that concurrent use of ACEI/ARB increases the risk of readmission following new ileostomy creation due to the loss of this compensatory mechanism.MethodsPatients undergoing ileostomy creation between 2009-2022 at an integrated managed health care system were included in this retrospective study. Primary outcomes were hospital readmission and ED visit within 30-days. Additional variables included ACEI/ARB use, ileostomy type, Charlson Comorbidity Index, additional antihypertensives at discharge (furosemide, hydrochlorothiazide, spironolactone, amlodipine, nifedipine, and diltiazem), and readmission diagnosis. Descriptive and advanced statistical analysis was completed with SPSS.ResultsOf 540 patients, 41.9% were readmitted or visited an ED within 30 days. There was no difference in readmission or ED visit based on age, gender, or ileostomy type. Patients discharged with ACEI/ARB (37.4% vs 25.5%, P = .005) and additional antihypertensives (37.2% vs 17.3%, P = .006) were at a higher risk for readmission.ConclusionsInhibition of RAAS is associated with increased risk for hospital readmission. In patients with hypertension undergoing ileostomy creation, individualized care plans are needed with earlier antimotility agent use or intravenous rehydration plans.

IntroductionIntraoperative ultrafiltration (UF) is a procedure used during cardiopulmonary bypass (CPB) to reduce haemodilution and prevent excessive blood transfusion. However, the effect of UF volume on acute kidney injury (AKI) is not well established, and the results are conflicting. Additionally, there are no set indications for applying UF during CPB.MethodsThis retrospective study analysed 641 patients who underwent coronary artery bypass graft (CABG) surgery with CPB. Perioperative parameters were extracted from the patients' records, and the UF volume was recorded. Acute Kidney Injury Network classification was used to define AKI. Univariable and multivariable logistic regression models were used to predict AKI while controlling for confounding factors.ResultsThe study enrolled patients with a mean age of 58.8 ± 11.1 years, 39.2% of whom were female. AKI occurred in 22.5% of patients, with 16.1% (103) experiencing stage I and 6.4% (41) experiencing stage II. The results showed a significant association between UF volume and the risk of developing AKI, with higher UF volumes associated with a higher risk of AKI. In the multivariable analysis, the other predictors of AKI included age, lowest mean arterial pressure (MAP), and red blood cell (RBC) transfusion during CPB.ConclusionThe predictors of postoperative AKI in coronary CABG patients were the volume of UF, age, MAP, and blood transfusion during CPB.

Hypoalbuminemia is a risk factor for mortality in patients with end-stage liver disease (ESLD) and in those undergoing orthotopic liver transplantation (OLT), since it represents a biomarker of post-operative delayed functional recovery of the graft. Despite albumin infusion during and after OLT is frequently adopted in recipients with hypoalbuminemia, it remains unclear whether this procedure could improve post OLT clinical outcomes. Observational studies indicated that treatment with albumin after OLT might be beneficial in reducing ascites and acute kidney injury (AKI) development. However, considering potential complications and the cost of albumin therapy, the decision to use albumin after OLT should be based on careful consideration of patient's individual needs and risks. In addition, the threshold plasma value of albumin below which it could be clinically useful to infuse albumin has not been clearly defined. This systematic review, prepared in accordance with the PRISMA 2020 guidelines, aimed to assess the efficacy of albumin infusion in patients undergoing OLT, in the prevention or treatment of ascites, AKI, and ischemia reperfusion syndrome, as well as its potential impact on patient survival. Furthermore, this review aimed to illustrate the pathophysiological bases justifying the use of albumin infusion in a subset of patients receiving OLT.

Despite the overall safety of metabolic and bariatric surgery (MBS), the potential for postoperative complications such as acute kidney injury (AKI) remains a critical concern. Decade-old studies from our institution reported rates of AKI following MBS between 5.8% and 8.6%, with factors such as higher body mass index (BMI), diabetes, and hypertension identified as potential contributors. However, the incidence and factors associated with AKI following MBS have remained underexplored in contemporary literature.

To investigate the incidence and risk factors associated with postoperative AKI, as well as the potential for progression to CKD and renal failure.

Quaternary academic medical center with a high-volume MBS practice.

A retrospective review of adult patients undergoing primary laparoscopic MBS between 2008 and 2022 to identify patients who developed AKI, defined as postoperative increase in serum creatinine (sCr) by .3 mg/dL within 72 hours. A multivariable logistic regression was constructed to identify potential AKI risk factors.

Among 1697 patients, the incidence of AKI was 3.0% (n = 51). The distribution of AKI was not significantly different between procedure types. There was no significant correlation between anesthesia medications given and the occurrence of AKI. Male gender was the most significant predictor of AKI (adjusted odds ratio [aOR] = 3.87, 95% confidence interval {CI} [2.14-6.99]), followed by hypertension (aOR = 2.12, 95% CI [1.03-4.83]) and longer surgical duration (aOR = 1.19, 95% CI [1.05-1.35]) per 30 minutes. Of those who developed AKI, 7 (13.7%) required dialysis acutely for management, while 3 patients (5.9%) progressed to chronic renal failure and required transplant.

AKI is a rare but serious complication following MBS that occurs in approximately 3% of cases. AKI incidence is higher in male patients, those with hypertension, insulin-requiring diabetes, renal insufficiency, and longer procedure durations. Heightened awareness of the identified risk factors should help guide patient selection, and additional efforts should be directed towards refining postoperative follow-up.

IntroductionThe trial hypothesized that minimally invasive extra-corporeal circulation (MiECC) reduces the risk of serious adverse events (SAEs) after cardiac surgery operations requiring extra-corporeal circulation without circulatory arrest.MethodsThis is a multicentre, international randomized controlled trial across fourteen cardiac surgery centres including patients aged ≥18 and <85 years undergoing elective or urgent isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR) surgery, or CABG + AVR surgery. Participants were randomized to MiECC or conventional extra-corporeal circulation (CECC), stratified by centre and operation. The primary outcome was a composite of 12 post-operative SAEs up to 30 days after surgery, the risk of which MiECC was hypothesized to reduce. Secondary outcomes comprised: other SAEs; all-cause mortality; transfusion of blood products; time to discharge from intensive care and hospital; health-related quality-of-life. Analyses were performed on a modified intention-to-treat basis.ResultsThe trial terminated early due to the COVID-19 pandemic; 1071 participants (896 isolated CABG, 97 isolated AVR, 69 CABG + AVR) with median age 66 years and median EuroSCORE II 1.24 were randomized (535 to MiECC, 536 to CECC). Twenty-six participants withdrew after randomization, 22 before and four after intervention. Fifty of 517 (9.7%) randomized to MiECC and 69/522 (13.2%) randomized to CECC group experienced the primary outcome (risk ratio = 0.732, 95% confidence interval (95% CI) = 0.556 to 0.962, p = 0.025). The risk of any SAE not contributing to the primary outcome was similarly reduced (risk ratio = 0.791, 95% CI 0.530 to 1.179, p = 0.250).ConclusionsMiECC reduces the relative risk of primary outcome events by about 25%. The risk of other SAEs was similarly reduced. Because the trial terminated early without achieving the target sample size, these potential benefits of MiECC are uncertain.

Increased monitoring of health-related data for ICU patients holds great potential for the early prediction of medical outcomes. Research on whether the use of clinical notes and concepts from knowledge bases can improve the performance of prediction models is limited. We investigated the effects of combining clinical variables, clinical notes, and clinical concepts. We focus on the early prediction of Acute Kidney Injury (AKI) in the intensive care unit (ICU). AKI is a sudden reduction in kidney function measured by increased serum creatinine (SCr) or decreased urine output. AKI may occur in up to 30% of ICU stays. We developed three models based on convolutional neural networks using data from the Medical Information Mart for Intensive Care (MIMIC) database. The models used clinical variables, free-text notes, and concepts from the Elsevier H-Graph. Our models achieved good predictive performance (AUROC 0.73-0.90). These models were assessed both when using Scr and urine output as predictors and when omitting them. When Scr and urine output were used as predictors, models that included clinical notes and concepts together with clinical variables performed on par with models that only used clinical variables. When excluding SCr and urine output, predictive performance improved by combining multiple modalities. The models that used only clinical variables were externally validated on the eICU dataset and transported fairly to the new population (AUROC 0.68-0.77). Our in-depth comparison of modalities and text representations may further guide researchers and practitioners in applying multimodal models for predicting AKI and inspire them to investigate multimodality and contextualized embeddings for other tasks. Our models can support clinicians to promptly recognize and treat deteriorating AKI patients and may improve patient outcomes in the ICU.