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Lin Y, Zhang S, Chen Z, Lin X, Wang X, Shen X, Huang L, Deng Y, Chen C. Stress hyperglycemia ratio as a predictor of acute kidney injury and its outcomes in critically ill patients. Ren Fail 2025; 47:2499228. [PMID: 40321025 PMCID: PMC12054585 DOI: 10.1080/0886022x.2025.2499228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Revised: 04/10/2025] [Accepted: 04/20/2025] [Indexed: 05/08/2025] Open
Abstract
This study investigated stress hyperglycemia ratio (SHR) for acute kidney injury (AKI) and clinical outcomes in intensive care unit (ICU). Key outcomes were AKI within 48 h after ICU admission, acute kidney disease (AKD), ICU mortality, 28-day mortality, 90-day mortality and 1-year mortality. The associations between SHR and outcomes was estimated via logistic regression, Cox proportional hazards regression, and restricted cubic spline (RCS) analyses. Subgroup analyses assessed the consistency of these associations. Totally 3,714 patients were included from the Medical Information Mart for Intensive Care IV. SHR was associated with an increased risk of AKI (ORadjusted 1.29 95%CI 1.05-1.59). Among AKI patients, SHR was associated with increased risks of AKD (ORadjusted 1.94 95%CI 1.57-2.39), ICU mortality (ORadjusted 2.31 95%CI 1.60-3.32), 28-day mortality (HRadjusted 1.39 95%CI 1.29-1.50), 90-day mortality (HRadjusted 1.37 95%CI 1.26-1.48), and 1-year mortality (HRadjusted 1.37 95%CI 1.27-1.47). RCS analysis revealed a linear relationship with AKI, a J-shaped relationship with AKD, and a U-shaped relationship with mortality. Subgroup analysis confirmed the consistency of relationship between SHR and AKI. SHR demonstrates significant associations with AKI incidence, and correlates with AKD progression/mortality in critically ill adult ICU patients, suggesting its potential as a risk stratification and prognostic tool for AKI management, though further prospective validation is required.
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Affiliation(s)
- Yingxin Lin
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, China
| | - Sheng Zhang
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zeling Chen
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xuwei Lin
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xueqing Wang
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaojun Shen
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lei Huang
- Department of Intensive Care Unit, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yiyu Deng
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Chunbo Chen
- Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Critical Care Medicine, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
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Liu D, Zhao J, Xia H, Dong S, Yan S, Zhuang Y, Chen Y, Peng H. Nafamostat mesylate versus regional citrate anticoagulation for continuous renal replacement therapy in patients at high risk of bleeding: a retrospective single-center study. Eur J Med Res 2024; 29:72. [PMID: 38245802 PMCID: PMC10799389 DOI: 10.1186/s40001-024-01660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
PURPOSE The choice of continuous renal replacement therapy (CRRT) anticoagulation program for patients at high risk of bleeding has always been a complex problem in clinical practice. Clinical regimens include regional citrate anticoagulation (RCA) and nafamostat mesylate (NM). This study aimed to evaluate the efficacy and safety of these two anticoagulants for CRRT in patients at high risk of bleeding to guide their clinical use better. PATIENTS AND METHODS Between January 2021 and December 2022, 307 patients were screened for this study. Forty-six patients were finally enrolled: 22 in the regional citrate anticoagulation group and 24 in the nafamostat mesylate group. We collected patients' baseline characteristics, laboratory indicators before CRRT, and CRRT-related data. We then performed a statistical analysis of the data from both groups of patients. RESULTS In our study, the baseline characteristics did not differ significantly between the two groups; the baseline laboratory indicators before CRRT of patients in the two groups were not significantly different. The duration of CRRT was 600 min in the regional citrate anticoagulation (RCA) group, 615 min in the nafamostat mesylate (NM) group; the success rate was 90.7% in the RCA group, and 85.6% in the NM group, the anticoagulant efficacy between the two groups was comparable. There was no significant difference in the safety of anticoagulation between the two groups. We used Generalized Estimating Equations (GEE) to test whether different anticoagulation methods significantly affected the success rate of CRRT and found no statistical difference between RCA and NM. CONCLUSION Our study suggests that nafamostat mesylate's anticoagulant efficacy and safety are not inferior to regional citrate anticoagulation for continuous renal replacement therapy in patients at high risk of bleeding.
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Affiliation(s)
- Dan Liu
- Department of Emergency, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Yanchang Middle Road, Jingan District, Shanghai, People's Republic of China
| | - Jian Zhao
- Department of Emergency, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Yanchang Middle Road, Jingan District, Shanghai, People's Republic of China
| | - Hui Xia
- Department of Emergency, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Yanchang Middle Road, Jingan District, Shanghai, People's Republic of China
| | - Shi Dong
- Department of Emergency, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Yanchang Middle Road, Jingan District, Shanghai, People's Republic of China
| | - Songjuan Yan
- Department of Emergency, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Yanchang Middle Road, Jingan District, Shanghai, People's Republic of China
| | - Yugang Zhuang
- Department of Emergency, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Yanchang Middle Road, Jingan District, Shanghai, People's Republic of China
| | - Yuanzhuo Chen
- Department of Emergency, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Yanchang Middle Road, Jingan District, Shanghai, People's Republic of China.
| | - Hu Peng
- Department of Emergency, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Yanchang Middle Road, Jingan District, Shanghai, People's Republic of China.
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Wang L, Wang Y, Zhang RY, Wang Y, Liang W, Li TG. Management of acute carbamazepine poisoning: A narrative review. World J Psychiatry 2023; 13:816-830. [DOI: 10.5498/wjp.v13.i11.816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/23/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023] Open
Abstract
Standard management protocols are lacking and specific antidotes are unavailable for acute carbamazepine (CBZ) poisoning. The objective of this review is to provide currently available information on acute CBZ poisoning, including its management, by describing and summarizing various therapeutic methods for its treatment according to previously published studies. Several treatment methods for CBZ poisoning will be briefly introduced, their advantages and disadvantages will be analyzed and compared, and suggestions for the clinical treatment of CBZ poisoning will be provided. A literature search was performed in various English and Chinese databases. In addition, the reference lists of identified articles were screened for additional relevant studies, including non-indexed reports. Non-peer-reviewed sources were also included. In the present review, 154 articles met the inclusion criteria including case reports, case series, descriptive cohorts, pharmacokinetic studies, and in vitro studies. Data on 67 patients, including 4 fatalities, were reviewed. Based on the summary of cases reported in the included articles, the cure rate of CBZ poisoning after symptomatic treatment was 82% and the efficiency of hemoperfusion was 58.2%. Based on the literature review, CBZ is moderately dialyzable and the recommendation for CBZ poisoning is supportive management and gastric lavage. In severe cases, extracorporeal treatment is recommended, with hemodialysis as the first choice.
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Affiliation(s)
- Luan Wang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yang Wang
- Department of General Surgery, The 4th Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, China
| | - Ruo-Ying Zhang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yao Wang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Wei Liang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Tie-Gang Li
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Wu Z, Huang W, Ding Y, Jiang L, Zhao Y, Zhu X, Huang J. Construction of an evaluation index system of core competencies for critical care blood purification nurses in China: A Delphi study. Nurse Educ Pract 2023; 72:103751. [PMID: 37633075 DOI: 10.1016/j.nepr.2023.103751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/01/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
AIM The purpose of this study was to construct a core competencies evaluation index system for critical care blood purification nurses in China. BACKGROUND While nursing is an integral part of critical care blood purification treatment, there are no established indicators to evaluate the core competencies of critical care blood purification nurses. DESIGN A Delphi study. METHODS An initial draft of the competencies evaluation index system for critical care blood purification nurses was developed through a literature review and semi-structured interviews. From February 2023 to March 2023, a two-round Delphi survey was conducted to consult with 18 experts in the field of critical care blood purification from eight provinces in China to rate the importance of each item and propose modifications to the evaluation index system. RESULTS The effective questionnaire recovery rates in two rounds of expert consultation were 94.4 % and 94.1 % and the average expert authority coefficients were 0.88 in both rounds. The core competencies evaluation index system of critical care blood purification nurses consisted of 39 items in five domains, namely theoretical knowledge, practical skills, professional development capability, critical thinking ability and personal qualities and attributes. The Kendall's W coefficients for the first- and second-level indicators were.21 and.20 in the first round and.23 and.25, respectively, in the second round of consultations (p < .01). CONCLUSION The core competencies evaluation index system of critical care blood purification nurses is scientific and reliable and can provide references for the recruitment, training and management of critical care blood purification nurses.
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Affiliation(s)
- Zhishan Wu
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Huang
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuefeng Ding
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liping Jiang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Zhao
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoye Zhu
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Huang
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Tan Z, Liu Q, Chen H, Zhang Z, Wang Q, Mu Y, Li Y, Hu T, Yang Y, Yan X. Pectolinarigenin alleviated septic acute kidney injury via inhibiting Jak2/Stat3 signaling and mitochondria dysfunction. Biomed Pharmacother 2023; 159:114286. [PMID: 36706631 DOI: 10.1016/j.biopha.2023.114286] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023] Open
Abstract
Sepsis is a systemic inflammatory response to infection, where sepsis-associated acute kidney injury (AKI) is a common morbid disease with a high morbidity and mortality, and however at present no effective therapy exists. Increasing evidence have shown that mitochondrial damage and inflammatory response are important initiating factors in pathogenesis of septic AKI. Natural flavonoid pectolinarigenin exerted anti-inflammatory properties in previous studies, while its role in septic AKI remains unknown. In the study, pectolinarigenin administration significantly ameliorated the dramatic rise of serum creatinine and blood urea nitrogen in lipopolysaccharide (LPS)- and cecal ligation/puncture (CLP)-induced septic mice, respectively. Consistently, LPS/CLP-induced renal damage as implied by histopathological score and the increased injury markers NGAL and KIM-1, which was attenuated by pectolinarigenin. Meanwhile, LPS/CLP triggered proinflammatory cytokine production and inflammation related proteins in the kidneys. However, pectolinarigenin inhibited renal expression of IL-6, IL-1β, TNF-α, and MCP-1 to improve inflammatory response. Furthermore, pectolinarigenin upregulated Bcl-2 protein expression and suppressed apoptotic protein of BAX and cleaved caspase-3 in the kidneys of CLP-induced septic AKI. Mechanistically, LPS could induce the high expression of IL-6 and trigger the phosphorylation of Jak2 and Stat3, while pectolinarigenin remarkably reduced their corresponding levels. Notably, CLP-induced kidney injury of mice significantly reduced the expression of PGC-1α, OPA1 and increased the expression of Drp1, Cyt-C, where pectolinarigenin pretreatment significantly restored their corresponding expression in mice. In summary, pectolinarigenin improved septic AKI via inhibiting JAK2/STAT3 signaling and mitochondria dysfunction.
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Affiliation(s)
- Zhouke Tan
- Department of Nephrology, Affiliated Hospital of ZunYi Medical University, ZunYi 563003, China; Organ Transplant Center, Affiliated Hospital of ZunYi Medical University, ZunYi 563000, China.
| | - Qianqian Liu
- Department of Nephrology, Affiliated Hospital of ZunYi Medical University, ZunYi 563003, China
| | - Hongjun Chen
- Department of Critical Care Medicine, Affiliated Hospital of ZunYi Medical University, ZunYi 563003, China
| | - Ziyang Zhang
- Department of Nephrology, Affiliated Hospital of ZunYi Medical University, ZunYi 563003, China
| | - Qin Wang
- Department of Nephrology, Affiliated Hospital of ZunYi Medical University, ZunYi 563003, China
| | - Yingsong Mu
- Department of Nephrology, Affiliated Hospital of ZunYi Medical University, ZunYi 563003, China
| | - Yiman Li
- Department of Nephrology, Affiliated Hospital of ZunYi Medical University, ZunYi 563003, China
| | - TingTing Hu
- Department of Nephrology, Affiliated Hospital of ZunYi Medical University, ZunYi 563003, China
| | - Yibin Yang
- Department of Nephrology, Affiliated Hospital of ZunYi Medical University, ZunYi 563003, China.
| | - Xiaoyong Yan
- Department of Nephrology, Affiliated Hospital of ZunYi Medical University, ZunYi 563003, China.
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Wang Y, Chen J, Du J, Lei L, Zhao B, Bai Y, Chen D, Wang X, Chen C. The Determination of Polymyxin B in Critically Ill Patients by the HPLC-MS/MS Method. Int J Anal Chem 2023; 2023:6674009. [PMID: 37063108 PMCID: PMC10104742 DOI: 10.1155/2023/6674009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 04/18/2023] Open
Abstract
Polymyxin B (PB) is a dose-dependent drug used to treat multidrug-resistantgram-negative bacteria, for which a suitable method is needed to determine clinical samples. A simple, economical, and efficient high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS) method was developed and validated for polymyxin B1 (PB1), polymyxin B1-Ile (PB1-I), polymyxin B2 (PB2), and polymyxin B3 (PB3) in human plasma. Chromatographic column was Waters BEH C18 column (2.1 × 50 mm, 1.7 μm). Phase A was water with 0.2% formic acid (FA), and phase B was acetonitrile containing 0.2% FA. The elution method is gradient elutio. The total analysis time was 5 min. The pretreatment method involved protein precipitation using acetonitrile containing 0.2% trifluoroacetic acid and 0.1% FA as the precipitant. The recovery rate was 92-99%. The total quantity of PB1 and PB1-I was measured in the linear range of 100-8000 ng/mL. Simultaneously, the total amounts of PB2 and PB3 were measured in the linear range of 11.9-948.5 ng/mL. This validated method was successfully applied to the pharmacokinetics of PB in critically ill patients.
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Affiliation(s)
- Yirong Wang
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, Guangdong, China
| | - Jingchun Chen
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, Guangdong, China
| | - Jinpan Du
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, Guangdong, China
| | - Liming Lei
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Boxin Zhao
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yunpeng Bai
- Center of Scientific Research, Maoming People's Hospital, Maoming 525000, China
| | - Dong Chen
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Xipei Wang
- Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Chunbo Chen
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, Guangdong, China
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Critical Care Medicine, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of South University of Science and Technology, Shenzhen 518020, China
- Department of Emergency, Maoming People's Hospital, Maoming 525000, China
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