Background：As a major complication after orthotopic liver transplantation （OLT）,the occurrence of acute kidney injury （AKI） is frequently defined by serum creatinine （Cr）;however,the accuracy of commonly used b...Background：As a major complication after orthotopic liver transplantation （OLT）,the occurrence of acute kidney injury （AKI） is frequently defined by serum creatinine （Cr）;however,the accuracy of commonly used blood urea nitrogen （BUN）,uric acid （UA）,and β2-microglobulin （β2-MG） remains to be explored.This retrospective study compared the accuracy of these parameters for post-OLT AKI evaluation.Methods：Patients who underwent OLT in three centers between July 2003 and December 2013 were enrolled.The postoperative AKI group was diagnosed by the Kidney Disease Improving Global Outcomes （KDIGO） criteria and classified by stage.Measurement data were analyzed using the t-test or Wilcoxon rank-sum test;enumerated data were analyzed using the Chi-square test or Fisher＇s exact test.Diagnostic reliability and predictive accuracy were evaluated using receiver operating characteristic （ROC） curve analysis.Results：This study excluded 976 cases and analyzed 697 patients （578 men and 1 1 9 women）;the post-OLT AKI incidence was 0.409.Compared with the no-AKI group,the AKI group showed very significant differences in Model for End-stage Liver Disease score （14.74 ± 9.91 vs.11.07 ± 9.54,Z =5.404;P ＜ 0.001）,hepatic encephalopathy （45 [15.8％] vs.30 [7.3％],x2 =12.699;P ＜ 0.001）,hemofiltration （28 [9.8％] vs.0 [0.0％],x2 =42.171;P ＜ 0.001）,and 28-day mortality （23 [8.1％] vs.9 [2.2％],x2 13.323;P ＜0.001）.Moreover,mean values of Cr,BUN,UA,and β2-MG in the AKI group differed significantly at postoperative days 1,3,and 7 （all P ＜0.001）.ROC curve area was 0.847 of Cr for the detection of AKI Stage 1 （sensitivity 80.1％,specificity 75.7％,cutoffvalue 88.23 μmol/L）,0.916 for Stage 2 （sensitivity 87.6％,specificity 82.6％,cutoff value 99.9 μmol/L）,and 0.972 for Stage 3 （sensitivity 94.1％,specificity 88.2％,cutoff value 122.90 μmol/L）.Conclusion：The sensitivity and specificity of serum Cr might be a high-value indicator for the diagnosis and grading of post-OLT AKI.展开更多
Serum uric acid level is associated with some chronic diseases and prognosis of severe infection. This study aimed to investigate the relationship between serum uric acid （SUA） and prognosis of infection in critical...Serum uric acid level is associated with some chronic diseases and prognosis of severe infection. This study aimed to investigate the relationship between serum uric acid （SUA） and prognosis of infection in critically ill patients. The data from 471 patients with infection admitted from January 2003 to April 2010 were analyzed retrospectively at Huashan Hospital Affiliated to Fudan University, Shanghai, China. The data of SUA, serum creatinine, blood urea nitrogen （BUN） and other relevant examinations within 24 hours after admission were recorded and the levels of SUA in those patients were described, then Student＇s t test was used to evaluate the relationship between SUA and pre-existing disorders. Different levels of SUA were graded for further analysis. The Chi-square test was used to examine the difference in the prognosis of infection. The mean initial level of SUA within 24 hours after admission was 0.232±0.131 mmol/L and the median was 0.199 mmol/L. Remarkable variations in the initial levels of SUA were observed in patients with pre-existing hypertension （t=-3.084, P=0.002）, diabetes mellitus （t=-2.487, P=0.013）, cerebral infarction （t=-3.061, P=0.002）, renal insufficiency （t=-4.547, P〈0.001）, central nervous system infection （t=5.096, P〈0.001） and trauma （t=2.875, P=0.004）. SUAwas linearly correlated with serum creatinine and BUN （F=159.470 and 165.059, respectively, P〈0.001）. No statistical correlation was found between the initial levels of SUA and prognosis of infection （X^2=60.892, P=0.100）. The current study found no direct correlation between the initial levels of SUA after admission and prognosis of infection in critically ill patients.展开更多
文摘Background：As a major complication after orthotopic liver transplantation （OLT）,the occurrence of acute kidney injury （AKI） is frequently defined by serum creatinine （Cr）;however,the accuracy of commonly used blood urea nitrogen （BUN）,uric acid （UA）,and β2-microglobulin （β2-MG） remains to be explored.This retrospective study compared the accuracy of these parameters for post-OLT AKI evaluation.Methods：Patients who underwent OLT in three centers between July 2003 and December 2013 were enrolled.The postoperative AKI group was diagnosed by the Kidney Disease Improving Global Outcomes （KDIGO） criteria and classified by stage.Measurement data were analyzed using the t-test or Wilcoxon rank-sum test;enumerated data were analyzed using the Chi-square test or Fisher＇s exact test.Diagnostic reliability and predictive accuracy were evaluated using receiver operating characteristic （ROC） curve analysis.Results：This study excluded 976 cases and analyzed 697 patients （578 men and 1 1 9 women）;the post-OLT AKI incidence was 0.409.Compared with the no-AKI group,the AKI group showed very significant differences in Model for End-stage Liver Disease score （14.74 ± 9.91 vs.11.07 ± 9.54,Z =5.404;P ＜ 0.001）,hepatic encephalopathy （45 [15.8％] vs.30 [7.3％],x2 =12.699;P ＜ 0.001）,hemofiltration （28 [9.8％] vs.0 [0.0％],x2 =42.171;P ＜ 0.001）,and 28-day mortality （23 [8.1％] vs.9 [2.2％],x2 13.323;P ＜0.001）.Moreover,mean values of Cr,BUN,UA,and β2-MG in the AKI group differed significantly at postoperative days 1,3,and 7 （all P ＜0.001）.ROC curve area was 0.847 of Cr for the detection of AKI Stage 1 （sensitivity 80.1％,specificity 75.7％,cutoffvalue 88.23 μmol/L）,0.916 for Stage 2 （sensitivity 87.6％,specificity 82.6％,cutoff value 99.9 μmol/L）,and 0.972 for Stage 3 （sensitivity 94.1％,specificity 88.2％,cutoff value 122.90 μmol/L）.Conclusion：The sensitivity and specificity of serum Cr might be a high-value indicator for the diagnosis and grading of post-OLT AKI.
文摘Serum uric acid level is associated with some chronic diseases and prognosis of severe infection. This study aimed to investigate the relationship between serum uric acid （SUA） and prognosis of infection in critically ill patients. The data from 471 patients with infection admitted from January 2003 to April 2010 were analyzed retrospectively at Huashan Hospital Affiliated to Fudan University, Shanghai, China. The data of SUA, serum creatinine, blood urea nitrogen （BUN） and other relevant examinations within 24 hours after admission were recorded and the levels of SUA in those patients were described, then Student＇s t test was used to evaluate the relationship between SUA and pre-existing disorders. Different levels of SUA were graded for further analysis. The Chi-square test was used to examine the difference in the prognosis of infection. The mean initial level of SUA within 24 hours after admission was 0.232±0.131 mmol/L and the median was 0.199 mmol/L. Remarkable variations in the initial levels of SUA were observed in patients with pre-existing hypertension （t=-3.084, P=0.002）, diabetes mellitus （t=-2.487, P=0.013）, cerebral infarction （t=-3.061, P=0.002）, renal insufficiency （t=-4.547, P〈0.001）, central nervous system infection （t=5.096, P〈0.001） and trauma （t=2.875, P=0.004）. SUAwas linearly correlated with serum creatinine and BUN （F=159.470 and 165.059, respectively, P〈0.001）. No statistical correlation was found between the initial levels of SUA and prognosis of infection （X^2=60.892, P=0.100）. The current study found no direct correlation between the initial levels of SUA after admission and prognosis of infection in critically ill patients.
