Serum magnesium level as a predictor of acute kidney injury in patients with acute pancreatitis

BACKGROUND Decreased serum magnesium(Mg2+)is commonly seen in critically ill patients.Hypomagnesemia is significantly more frequent in patients with severe acute pancreatitis.Acute kidney injury(AKI)in patients with acute pancreatitis(AP)is associated with an extremely high mortality.The association underlying serum Mg2+and AKI in AP has not been elucidated.AIM To explore the association between serum Mg2+on admission and AKI in patients with AP.METHODS A retrospective observational study was conducted in a cohort of patients(n=233)with AP without any renal injury before admission to our center from August 2015 to February 2019.Demographic characteristics on admission,severity score,laboratory values and in-hospital mortality were compared between patients with and without AKI.RESULTS A total of 233 patients were included for analysis,including 85 with AKI.Compared to patients without AKI,serum Mg2+level was significantly lower in patients with AKI at admission[OR=6.070,95%CI:3.374-10.921,P<0.001].Multivariate logistic analysis showed that lower serum Mg2+was an independent risk factor for AKI[OR=8.47,95%CI:3.02-23.72,P<0.001].CONCLUSION Our analysis indicates that serum Mg2+level at admission is independently associated with the development of AKI in patients with AP and may be a potential prognostic factor.

Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen:a randomized controlled trial

Background:Fluid overload(FO)after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen(OA)patients.Bioelectrical impedance analysis(BIA)is a promising tool for monitoring fluid status and FO.Therefore,we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA patients.Methods:A pragmatic,prospective,randomized,observer-blind,single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center.A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation(defined as BIA)protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level(HL)measured by BIA or a traditional fluid resuscitation(TRD)in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 d of intensive care unit(ICU)management.The primary outcome was the 30-day primary fascial closure(PFC)rate.The secondary outcomes included the time to PFC,postoperative 7-day cumulative fluid balance(CFB)and adverse events within 30 d after OA.The Kaplan–Meier method and the log-rank test were utilized for PFC after OA.A generalized linear regression model for the time to PFC and CFB was built.Results:A total of 134 patients completed the trial(BIA,n=66;TRD,n=68).The BIA patients were significantly more likely to achieve PFC than the TRD patients(83.33%vs.55.88%,P<0.001).In the BIA group,the time to PFC occurred earlier than that of the TRD group by an average of 3.66 d(P<0.001).Additionally,the BIA group showed a lower postoperative 7-day CFB by an average of 6632.80 ml(P<0.001)and fewer complications.Conclusions:Among postinjury OA patients in the ICU,the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complications than the traditional fluid resuscitation strategy.