Background Hemodynamic management is of paramount importance in patients with acute kidney injury (AKI). Central venous pressure (CVP) has been used to assess volume status. We intended to identify the optimal time window in which to obtain CVP to avoid the incidence of adverse outcomes in patients with AKI. Methods The study was based on the Medical Information Mart for Intensive Care (MIMIC) IV database. The primary outcome was in-hospital mortality. Secondary outcomes included the number of ICU-free days and norepinephrine-free days at 28 days after ICU admission, and total fluid input and fluid balance during the first and second day. A time–dose–response relationship between wait time of CVP measurement and in-hospital mortality was implemented to find an inflection point for grouping, followed by propensity-score matching (PSM), which was used to compare the outcomes between the two groups. Results Twenty Nine Thousand and Three Hundred Thirty Six patients with AKI were enrolled, and the risk of in-hospital mortality increased when the CVP acquisition time was >9 h in the Cox proportional hazards regression model. Compared with 8,071 patients (27.5%) who underwent CVP measurement within 9 h and were assigned to the early group, 21,265 patients (72.5%) who delayed or did not monitor CVP had a significantly higher in-hospital mortality in univariate and multivariate Cox regression analyses. After adjusting for potential confounders by PSM and adjusting for propensity score, pairwise algorithmic, overlap weight, and doubly robust analysis, the results were still stable. The HRs were 0.58–0.72, all p < 0.001. E-value analysis suggested robustness to unmeasured confounding. Conclusions Among adults with AKI in ICU, increased CVP wait time was associated with a greater risk of in-hospital mortality. In addition, early CVP monitoring perhaps contributed to shortening the length of ICU stays and days of norepinephrine use, as well as better fluid management.

/pdf/association-between-wait-time-of-central-venous-pressure-kk5t35qa.pdf

Association Between Wait Time of Central Venous Pressure Measurement and Outcomes in Critical Patients With Acute Kidney Injury: A Retrospective Cohort Study

The aim: To conduct the analysis of medical records with the diagnosis of traumatic brain injury for the deceased within 24 hours following admission to Clinical Emergency Hospital. Materials and methods: The study was aimed at a retrospective analysis of 102 cases of the lethality of the deceased within 24 hours following admission to Clinical Emergency Hospital for 2012-2019 in cases of traumatic brain injury. Medical histories of the deceased and data from the forensic autopsy had been analyzed. Results: There were 62 cases (60.8%) of isolated traumatic brain injury, and 40 cases (39.2%) of combined traumatic brain injury. The following defects were identified in the diagnosis: absence of a complete description of the local status with external injuries on the head, absence of a complete and qualitative assess¬ment and objectification of hemodynamics and the function of external breathing using laboratory indicators and electrocardiography, absence of neuroimaging. Conclusions: The percentage of diagnostic defects prevailed among traumatic brain injury patients who died from acute blood loss. The maximum number of diagnostic defects for the patients with traumatic brain injury was observed in the polytrauma department, and the minimum - in the neurological department. The maximum number of defects of a diagnostic nature as a whole fall on those patients who were admitted to the hospital in the interval I - 6:00 a.m. – 9:59 a.m. and in the interval IV - 6:00 p.m. – 9:59 p.m. 

Analysis of defects in the diagnosis of traumatic brain injury for the deceased within 24 hours following admission

OBJECTIVE
The aim: To conduct the analysis of medical records with the diagnosis of traumatic brain injury for the deceased within 24 hours following admission to Clinical Emergency Hospital.


PATIENTS AND METHODS
Materials and methods: The study was aimed at a retrospective analysis of 102 cases of the lethality of the deceased within 24 hours following admission to Clinical Emergency Hospital for 2012-2019 in cases of traumatic brain injury. Medical histories of the deceased and data from the forensic autopsy had been analyzed.


RESULTS
Results: There were 62 cases (60.8%) of isolated traumatic brain injury, and 40 cases (39.2%) of combined traumatic brain injury. The following defects were identified in the diagnosis: absence of a complete description of the local status with external injuries on the head, absence of a complete and qualitative assess¬ment and objectification of hemodynamics and the function of external breathing using laboratory indicators and electrocardiography, absence of neuroimaging.


CONCLUSION
Conclusions: The percentage of diagnostic defects prevailed among traumatic brain injury patients who died from acute blood loss. The maximum number of diagnostic defects for the patients with traumatic brain injury was observed in the polytrauma department, and the minimum - in the neurological department. The maximum number of defects of a diagnostic nature as a whole fall on those patients who were admitted to the hospital in the interval I - 6:00 a.m. - 9:59 a.m. and in the interval IV - 6:00 p.m. - 9:59 p.m.

Analysis of defects in the diagnosis of traumatic brain injury for the deceased within 24 hours following admission.

Additional file 1: Correlation analysis of AKI patients with furosemide administration. 

Additional file 1 of Hospitalized patients received furosemide undergoing acute kidney injury: the risk and prediction tool

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Dear editor, We are interested in the recent published article about the association between central venous pressure (CVP) monitoring and mortality for ICU patients with sepsis [1]. The study provides new insights into this traditional monitoring. However, an important factor might make the study more convincing if it had been taken into account. The clinical experience tells us that ICU admissions after surgeries (surgical patients in the ICU) are more likely to have central venous catheters than those from the medical system (medical patients in the ICU). Besides, as has been proven by many studies, medical patients have worse prognosis than surgical patients in the ICU [2–4]. Chen and his colleagues collected tens of important covariates to adjust the results, but the admission resource (from surgical or medical systems, which can be identified with the official codes [5]) was neglected [1]. To validate our supposition, we conducted an analysis in the same database. According to the inclusion and exclusion criteria of Chen’s study, we extracted a very similar (10,131) but not identical (10,275) cohort (because we didn’t get the authors’ original codes). The CVP monitoring group has 4,505 patients (vs. 4516 in Chen’s study), while the non-CVP monitoring group has 5626 ones (vs. 5759 in Chen’s study). As shown in the mosaic plot (Fig. 1a), CVP monitoring is positively associated with ICU admissions after surgery (1574/4505 [35%] for CVP group vs 835/5626 [15%] for non-CVP group, Phi coefficient = 0.235, p < 0.001). And the 28-day mortality is significantly lower among surgical patients (12% for surgical patients vs 21% for medical patients, relative risk [95% confidence interval]: 0.60 [0.53–0.67], p < 0.001). Briefly, the CVP monitoring group has a larger proportion (more than twice the non-CVP monitoring group) of surgical patients, which has a lower 28-day mortality rate (nearly a half ) than medical patients. Not considering the admission resources may bring bias to Chen’s study. Service units of patients in the MIMIC database (MICU, SICU/TSICU and CCU/CSRU in Chen’s study) were collected as a covariate. Except for MICU, the other two units were balanced in the numbers of surgical and medical patients (Fig. 1b). As a result, the proportions of surgical and medical patients could not be adjusted between CVP monitoring and non-CVP monitoring groups, which means that the effect of admission resources could not be replaced by service units. We would be very interested in the results if the effect of admission resources were considered.

/pdf/central-venous-pressure-monitoring-and-mortality-what-was-26g697iiqk.pdf

Central venous pressure monitoring and mortality: What was neglected?

We are interested in the recently published article about the effect of furosemide on the outcomes of patients with acute renal injury (AKI) [1], because the result seems against to the current guidelines [2]. AKI is commonly faced by the intensivists and its effects on mortality have drawn great attention recently. Zhao and his colleagues explored the effect of furosemide on the outcomes of critically ill patients with AKI in a real-word dataset, the MIMIC III database. They found the furosemide administration was associated with better short-term survival, especially in the AKI stages 2–3. However, the dataset they used in the analysis is single-center. We notice that another real-world database, the eICU database, which has larger size of data (200,859 patients) and more contributing centers (335 units at 208 hospitals), has been available to the world [3]. We reproduced the main analysis of Zhao’s study in the eICU database to give more evidence for the real-world research. The main results for outcomes are presented in Table 1. Some results are similar with Zhao’s study [1]: the furosemide group has a higher recovery rate and longer hospital and ICU stay. However, a reduction in inhospital mortality for the furosemide group only exists in the dataset after propensity score matching (PSM) and under the method of Cox regression (HR 0.92; 95% CI 0.85–0.99; p = 0.03). For subgroup analysis, furosemide reduces mortality only in AKI stages 2 and 3, but not in any of AKI or AKI stages. Up to now, the main viewpoint is that diuretics including furosemide do not improve survival of AKI patients. The protective effect by improved renal function observed in some studies [1, 4] (include Zhao’s and ours) may be covered by the adverse events, such as electrolyte abnormalities [5]. Our study supports no benefit for furosemide on in-hospital mortality of AKI patients, despite a significant p value in the post-PSM dataset under the method of Cox regression (Table 1). Most of the studies use logistic regression to evaluate in-hospital mortality, because longer hospital stay for acute condition is not like longer follow-up time in chronic condition and may implicate bad outcomes. However, since the in-hospital mortality nearly doubles in the non-diuretic group comparing to the furosemide group in Zhao’s study (21.7% vs 12.7%), the debate of this issue still exists and needs more well-designed research.

/pdf/do-critically-ill-patients-with-aki-benefit-from-furosemide-2p73enmqtd.pdf

Do critically ill patients with AKI benefit from furosemide? Further real-word evidence from a large multi-center database

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Central venous pressure monitoring and mortality: What was neglected?

Do critically ill patients with AKI benefit from furosemide? Further real-word evidence from a large multi-center database