Association between hyperglycemia at ICU admission and postoperative acute kidney injury in patients undergoing cardiac surgery:Analysis of the MIMIC-IV database

Background:This study aimed to explore the correlation between hyperglycemia at intensive care unit(ICU)admission and the incidence of acute kidney injury(AKI)in patients after cardiac surgery.Methods:We conducted a retrospective cohort study,in which clinical data were extracted from the Medical Information Mart for Intensive Care(MIMIC)-IV database.Adults(≥18 years)in the database who were admitted to the cardiovascular intensive care unit after cardiac surgery were enrolled.The primary outcome was the incidence of AKI within 7 days following ICU admission.Secondary outcomes included ICU mortality,hospital mortality,ICU length of stay,and the 28-day and 90-day mortality.Multivariable Cox regression analysis was used to assess the association between ICU-admission hyperglycemia and AKI incidence within 7 days of ICU admission.Different adjustment strategies were used to adjust for potential confounders.Patients were divided into three groups according to their highest blood glucose levels recorded within 24 h of ICU admission:no hyperglycemia(<140 mg/dL),mild hyperglycemia(140-200 mg/dL),and severe hyperglycemia(≥200 mg/dL).Results:Of the 6905 included patients,2201(31.9%)were female,and the median(IQR)age was 68.2(60.1-75.9)years.In all,1836(26.6%)patients had severe hyperglycemia.The incidence of AKI within 7 days of ICU admission,ICU mortality,and hospital mortality was significantly higher in patients with severe admission hyperglycemia than those with mild hyperglycemia or no hyperglycemia(80.3%vs.73.6% and 61.2%,respec-tively;2.8%vs.0.9% and 1.9%,respectively;and 3.4%vs.1.2% and 2.5%,respectively;all P<0.001).Severe hyperglycemia was a risk factor for 7-day AKI(Model 1:hazard ratio[HR]=1.4809,95%confidence interval[CI]:1.3126 to 1.6707;Model 2:HR=1.1639,95%CI:1.0176 to 1.3313;Model 3:HR=1.2014,95%CI:1.0490 to 1.3760;all P<0.050).Patients with normal glucose levels(glucose levels<140 mg/dL)had a higher 28-day mortality rate than those with severe hyperglycemia(glucose levels≥200 mg/dL)(4.0%vs.3.8%,P<0.001).Conclusions:In post-cardiac surgery patients,severe hyperglycemia within 24 h of ICU admission increases the risk of 7-day AKI,ICU mortality,and hospital mortality.Clinicians should be extra cautious regarding AKI among patients with hyperglycemia at ICU admission after cardiac surgery.

Assessment of respiratory support decision and the outcome of invasive mechanical ventilation in severe COVID-19 with ARDS

Background:The coronavirus disease 2019(COVID-19)is an ongoing pandemic.Invasive mechanical ventilation(IMV)is essential for the management of COVID-19 with acute respiratory distress syndrome(ARDS).We aimed to assess the impact of compliance with a respiratory decision support system on the outcomes of patients with COVID-19-associated ARDS who required IMV.Methods:In this retrospective,single-center,case series study,patients with COVID-19-associated ARDS who required IMV at Zhongnan Hospital of Wuhan University,China,from January 8th,2020,to March 24th,2020,with the final follow-up date of April 20th,2020,were included.Demographic,clinical,laboratory,imaging,and management information were collected and analyzed.Compliance with the respiratory support decision system was documented,and its relationship with 28-day mortality was evaluated.Results:The study included 46 COVID-19-associated ARDS patients who required IMV.The median age of the 46 patients was 68.5 years,and 31 were men.The partial pressure of arterial oxygen(PaO_(2))/fraction of inspired oxygen(FiO_(2))ratio at intensive care unit(ICU)admission was 104 mmHg.The median total length of IMV was 12.0(interquartile range[IQR]:6.0–27.3)days,and the median respiratory support decision score was 11.0(IQR:7.8–16.0).To 28 days after ICU admission,18(39.1%)patients died.Survivors had a significantly higher respiratory support decision score than non-survivors(15.0[10.3–17.0]vs.8.5(6.0–10.3),P=0.001).Using receiver operating characteristic(ROC)curve to assess the discrimination of respiratory support decision score to 28-day mortality,the area under the curve(AUC)was 0.796(95%confidence interval[CI]:0.657–0.934,P=0.001)and the cut-offwas 11.5(sensitivity=0.679,specificity=0.889).Patients with a higher score(>11.5)were more likely to survive at 28 days after ICU admission(log-rank test,P<0.001).Conclusions:For severe COVID-19-associated ARDS with IMV,following the respiratory support decision and assessing completion would improve the progress of ventilation.With a decision score of>11.5,the mortality at 28 days after ICU admission showed an obvious decrease.