Background:To compare the differences between the Kidney Disease Improving Global Outcomes(KDIGO)criteria of the 48-hour win-dow(early acute kidney injury[AKI],3–5 day window[middle AKI],and 6–7 day window[late AKI]...Background:To compare the differences between the Kidney Disease Improving Global Outcomes(KDIGO)criteria of the 48-hour win-dow(early acute kidney injury[AKI],3–5 day window[middle AKI],and 6–7 day window[late AKI])in the diagnosis of AKI,as well as the relationship between the diagnosis time windows and 90-day mortality.Methods:We conducted a retrospective cohort study.All elderly patients admitted to the Geriatric Department of the Chinese PLA General Hospital between 2007 and 2018 were evaluated for AKI during their hospital stay.Patients with AKI were divided into early,middle,and late AKI groups according to the time of diagnosis.Statistical analyses were performed using SPSS 21.0 statistical software.Continuous para-metric variables are expressed as the means±standard deviations(SDs),and continuous nonparametric variables are presented as the me-dians with interquartile ranges(25th and 75th percentiles).Categorical variables are presented as numbers(n)or percentages(%).Group comparisons were conducted using one-way analysis of variance or the Kruskal-Wallis H test for continuous variables and Pearson’s chi-square or Fisher’s exact test for categorical variables.Logistic regression analyses and a forward stepwise selection method were used to identify risk factors associated with AKI diagnosis time windows and 90-day mortality.Results:During the follow-up period,1847 patients were enrolled.Overall,22.4%of the patients(413/1847)developed early AKI,7.3%(134/1847)developed middle AKI,and 10.7%(197/1847)developed late AKI.Risk factors for early AKI included age,hypoalbuminemia,low prealbumin level,and the need for mechanical ventilation;middle AKI was significantly associated with age,low prealbumin,low hemoglobin,and the need for mechanical ventilation,whereas late AKI was closely associated with age,low baseline estimated glomerular filtration rate,low prealbumin,and low hemoglobin.In the multivariable-adjusted analysis,AKI time windows(early AKI,odds ratio[OR]:6.069;P<0.001;mid-dle AKI,OR:5.000;P<0.001)and late AKI(OR:2.847;P<0.001)were more strongly associated with higher 90-day mortality than non-AKI.Conclusion:Clinical differences and risk factors for AKI in elderly patients depend on the definition used.A better understanding of how AKI develops during different diagnostic windows may lead to improved outcomes.展开更多
Background:Acute kidney injury(AKI)is primarily defined and classified according to the magnitude of theelevation of serum creatinine(Scr).We aimed to determine whether the duration of AKI adds prognostic valuein addi...Background:Acute kidney injury(AKI)is primarily defined and classified according to the magnitude of theelevation of serum creatinine(Scr).We aimed to determine whether the duration of AKI adds prognostic valuein addition to that obtained from the magnitude of injury alone.Methods:This retrospective study enrolled very elderly inpatients(≥75 years)in the Chinese PLA General Hospitalfrom January 2007 to December 2018.AKI was stratified by magnitude according to KDIGO stage(1,2,and 3)andduration(1–2 days,3–4 days,5–7 days,and>7 days).The primary outcome was the 1-year mortality after AKI.Multivariable Cox regression analysis was performed to identify covariates associated with the 1-year mortality.The probability of survival was estimated using the Kaplan–Meier method,and curves were compared using thelog-rank test.Results:In total,688 patients were enrolled,with the median age was 88(84–91)years,and the majority(652,94.8%)were male.According to the KDIGO criteria,317 patients(46.1%)had Stage 1 AKI,169(24.6%)hadStage 2 AKI,and 202(29.3%)had Stage 3 AKI.Of the 688 study subjects,61(8.9%)with a duration of AKIlasted 1–2 days,104(15.1%)with a duration of AKI lasted 3–4 days,140(20.3%)with a duration of AKI lasted5–7 days,and 383(55.7%)with a duration of AKI lasted>7 days.Within each stage,a longer duration of AKIwas slightly associated with a higher rate of 1-year mortality.However,within each of the duration categories,the stage of AKI was significantly associated with 1-year mortality.When considered separately in multivariateanalyses,both the duration of AKI(3–4 days:HR=3.184;95%CI:1.733–5.853;P<0.001,5–7 days:HR=1.915;95%CI:1.073–3.416;P=0.028;>7 days:HR=1.766;95%CI:1.017–3.065;P=0.043)and more advanced AKIstage(Stage 2:HR=3.063;95%CI:2.207–4.252;P<0.001;Stage 3:HR=7.333;95%CI:5.274–10.197;P<0.001)were independently associated with an increased risk of 1-year mortality.Conclusions:In very elderly AKI patients,both a higher stage and duration were independently associated withan increased risk of 1-year mortality.Hence,the duration of AKI adds additional information to predict long-termmortality.展开更多
Background:The kidneys play a central role in serum potassium(K+)homeostasis,and their dysfunction leads to electrolyte disorders.We aimed to examine the relationship between different levels of K+and mortality among ...Background:The kidneys play a central role in serum potassium(K+)homeostasis,and their dysfunction leads to electrolyte disorders.We aimed to examine the relationship between different levels of K+and mortality among very elderly patients with acute kidney injury(AKI).Methods:We retrospectively enrolled very elderly patients(≥75 years)with AKI from the hospital information system of the Chinese PLA General Hospital from January 1,2007 to December 31,2018.All-cause mortality was examined according to six predefined K+levels:<3.50 mmol/L,3.50-3.79 mmol/L,3.80-4.09 mmol/L,4.10-4.79 mmol/L,4.80-5.49 mmol/L,and≥5.50 mmol/L.We estimated the risk of all-cause mortality using the multivariable adjusted Cox proportional hazard model with the normal K+level at 3.50-3.79 mmol/L as a reference.Results:In total,747 patients were deemed suitable for the final evaluation.The median age of the 747 par-ticipants was 88(84-91)years.After 90 days,the mortality rates in the six strata were 28.3%,21.9%,30.1%,35.4%,45.2%,and 58.3%,respectively.In the multivariable adjusted analysis,patients with K+levels of 4.10-4.79 mmol/L(hazard ratio[HR]:1.638;95%confidence interval[CI]:1.016-2.642),4.80-5.49 mmol/L(HR:2.585;95%CI:1.524-4.384),and≥5.50 mmol/L(HR:2.587;95%CI:1.495-4.479)had an increased risk of all-cause mortality.After 1 year,the mortality rates in the six strata were 44.8%,41.1%,45.1%,51.8%,63.1%,and 76.3%,respectively.In the multivariable adjusted analysis,patients with K+levels of 4.10-4.79 mmol/L(HR:1.452;95%CI:1.014-2.079),4.80-5.49 mmol/L(HR:2.151;95%CI:1.427-3.241),and≥5.50 mmol/L(HR:2.341;95%CI:1.514-3.620)had an increased risk of all-cause mortality.Conclusion:Increased serum K+levels,including levels of 4.10-5.49 mmol/L and≥5.50 mmol/L,were associated with a significantly increased short-and long-term risk of death.Serum K+has the potential to be a marker of disease severity among very elderly patients with AKI.展开更多
Background:This study evaluated the prognostic impact of acute kidney injury(AKI)duration on 90-d mortality and new-onset chronic kidney disease(CKD)progression in elderly patients.Methods:We retrospectively enrolled ...Background:This study evaluated the prognostic impact of acute kidney injury(AKI)duration on 90-d mortality and new-onset chronic kidney disease(CKD)progression in elderly patients.Methods:We retrospectively enrolled elderly patients(≥75 years;n=693)from the Chinese PLA General Hospital between January 1,2007 and December 31,2018.The 2012 Kidney Disease Improving Global Outcomes(KDIGO)defined serum creatinine(Scr)criteria were used to identify and classify AKI.Patients were divided into transient AKI(T-AKI)and persistent AKI(P-AKI)groups based on whether Scr levels returned to baseline within 48 h post-AKI.We further classified P-AKI based on AKI duration:(1)short duration:resolving AKI lasting 3–4 days;(2)medium duration:resolving AKI lasting 5–7 days;and(3)long duration:AKI lasting>7 days.Results:Among patients,62(9.0%)had T-AKI(1–2 days),104(15.0%)had short-duration,140(20.2%)had medium-duration,and 387(55.8%)had long-duration.In total,209(30.2%)died within 90 days;122(25.2%)developed CKD.After adjusting for multiple covariates,duration of AKI(3–4 days:hazard ratio[HR]=2.512;P=0.045;5–7 days:HR=3.154;P=0.015;>7 days:HR=6.212;P<0.001)was significantly associated with a higher 90-day mortality.Longer AKI duration(3–4 days:odds ratio[OR]=0.982;P=0.980;5–7 days:OR=1.322;P=0.661;>7 days:OR=7.007;P<0.001)was significantly associated with new-onset CKD of survivors.Conclusion:AKI duration is useful for predicting poorer clinical outcomes in elderly patients,emphasizing the importance of identifying an appropriate treatment window for early intervention.展开更多
BackgroundEmerging evidence suggests that minimal acute kidney injury (stage 1 AKI) is associated with increased hospital mortality rates. However, for those who do not meet the AKI diagnostic criteria, whether a smal...BackgroundEmerging evidence suggests that minimal acute kidney injury (stage 1 AKI) is associated with increased hospital mortality rates. However, for those who do not meet the AKI diagnostic criteria, whether a small increase in serum creatinine (SCr) levels is associated with an increased mortality rate in elderly patients is not known. Therefore, we aimed to investigate small elevations in SCr of <26.5 µmol/L within 48 h after invasive mechanical ventilation (MV) on the short-term mortality of critically ill patients in the geriatric population.MethodsWe conducted a retrospective, observational, multicenter cohort study enrolling consecutive elderly patients (≥75 years) who received invasive MV from January 2008 to December 2020. Recursive partitioning was used to calculate the ratio of SCr rise from baseline within 48 h after MV and divided into six groups, (1) <10%, (2) 10%–<20%, (3) 20%–<30%, (4) 30%–<40%, (5) 40%–<50%, and (6) ≥50%, where the reference interval was defined as the ratio <10% based on an analysis, which confirmed that the lowest mortality risk was found in this range. Clinical data and laboratory data were noted. Their general conditions and clinical characteristics were compared between the six groups. Prognostic survival factors were identified using Cox regression analysis. Kaplan–Meier survival analysis was employed for the accumulative survival rate.ResultsA total of 1292 patients (1171 men) with a median age of 89 (interquartile range: 85–92) with MV were suitable for further analysis. In all, 376 patients had any stage of early AKI, and 916 patients had no AKI. Among 916 non-AKI patients, 349 patients were in the ratio <10%, 291 in the 10%–<20% group, 169 in the 20%–<30% group, 68 in the 30%–<40% group, 25 in the 40%–<50% group, and 14 in the ≥50% group. The 28-day mortality rates in the six groups from the lowest (<10%) to the highest (≥50%) were 8.0%, 16.8%, 28.4%, 54.4%, 80.0%, and 85.7%, respectively. In the multivariable-adjusted analysis, patients with a ratio of 10%–<20% (hazard ratio [HR]=2.244;95% confidence interval [CI]: 1.410 to 3.572;P=0.001), 20%–<30% (HR=3.822;95% CI: 2.433 to 6.194;P <0.001), 30%–<40% (HR=10.472;95% CI: 6.379 to 17.190;P <0.001), 40%–<50% (HR=13.887;95% CI: 7.624 to 25.292;P <0.001), and ≥50% (HR=13.618;95% CI: 6.832 to 27.144;P <0.001) had relatively higher 28-day mortality rates. The 90-day mortality rates in the six strata were 30.1%, 35.1%, 45.0%, 60.3%, 80.0%, and 85.7%, respectively. Significant interactions were also observed between the ratio and 90-day mortality: patients with a ratio of 10%–<20% (HR=1.322;95% CI: 1.006 to 1.738;P=0.045), 20%–<30% (HR=1.823;95% CI: 1.356 to 2.452;P <0.001), 30%–<40% (HR=3.751;95% CI: 2.601 to 5.410;P <0.001), 40%–<50% (HR=5.735;95% CI: 3.447 to 9.541;P <0.001), and ≥50% (HR=6.305;95% CI: 3.430 to 11.588;P <0.001) had relatively higher 90-day mortality rates.ConclusionsOur study suggests that a ≥ 10% SCr rise from baseline within 48 h after MV was independently associated with short-term all-cause mortality in mechanically ventilated elderly patients.展开更多
Background This study aimed to investigate the influence of positive end-expiratory pressure(PEEP)on the right ventricle(RV)of mechanical ventilation-assisted patients through echocardiography.Methods Seventy-six pati...Background This study aimed to investigate the influence of positive end-expiratory pressure(PEEP)on the right ventricle(RV)of mechanical ventilation-assisted patients through echocardiography.Methods Seventy-six patients assisted with mechanical ventilation were enrolled in this study.Positive end-expiratory pressure was upregulated by 4 cm H_(2)O to treat acute respiratory distress syndrome,wherein echocardiography was performed before and after this process.Hemodynamic data were also recorded.All variables were compared before and after PEEP upregulation.The effect of PEEP was also evaluated in patients with and without decreased static lung compliance(SLC).Results Positive end-expiratory pressure upregulation significantly affected the RV function.Remarkable differences were observed in the following:Tei index(P=0.027),pulmonary artery pressure(P=0.039),tricuspid annular plane systolic excursion(P=0.014),early wave/atrial wave(P=0.002),diaphragm excursion(P<0.001),inferior vena cava collapsing index(P<0.001),and SLC(P<0.001).There were no significant changes in heart rate,respiratory rate,central venous pressure,mean arterial pressure,and base excess(P>0.05).Furthermore,the cardiac output of the RV was not significantly affected.In patients with decreased SLC(n=41),there were more significant changes in diaphragm excursion(P<0.001),inferior vena cava collapse index(P=0.025),pulmonary artery pressure(P<0.001),and tricuspid annular plane systolic excursion(P=0.007)than in those without decreased SLC(n=35).Conclusion Positive end-expiratory pressure upregulation significantly affected the RV function of critically ill patients with acute respiratory distress syndrome,especially in those with decreased SLC.展开更多
基金by grants from the National Nature Science Foundation of China(grant number 82172185 to MD YC)。
文摘Background:To compare the differences between the Kidney Disease Improving Global Outcomes(KDIGO)criteria of the 48-hour win-dow(early acute kidney injury[AKI],3–5 day window[middle AKI],and 6–7 day window[late AKI])in the diagnosis of AKI,as well as the relationship between the diagnosis time windows and 90-day mortality.Methods:We conducted a retrospective cohort study.All elderly patients admitted to the Geriatric Department of the Chinese PLA General Hospital between 2007 and 2018 were evaluated for AKI during their hospital stay.Patients with AKI were divided into early,middle,and late AKI groups according to the time of diagnosis.Statistical analyses were performed using SPSS 21.0 statistical software.Continuous para-metric variables are expressed as the means±standard deviations(SDs),and continuous nonparametric variables are presented as the me-dians with interquartile ranges(25th and 75th percentiles).Categorical variables are presented as numbers(n)or percentages(%).Group comparisons were conducted using one-way analysis of variance or the Kruskal-Wallis H test for continuous variables and Pearson’s chi-square or Fisher’s exact test for categorical variables.Logistic regression analyses and a forward stepwise selection method were used to identify risk factors associated with AKI diagnosis time windows and 90-day mortality.Results:During the follow-up period,1847 patients were enrolled.Overall,22.4%of the patients(413/1847)developed early AKI,7.3%(134/1847)developed middle AKI,and 10.7%(197/1847)developed late AKI.Risk factors for early AKI included age,hypoalbuminemia,low prealbumin level,and the need for mechanical ventilation;middle AKI was significantly associated with age,low prealbumin,low hemoglobin,and the need for mechanical ventilation,whereas late AKI was closely associated with age,low baseline estimated glomerular filtration rate,low prealbumin,and low hemoglobin.In the multivariable-adjusted analysis,AKI time windows(early AKI,odds ratio[OR]:6.069;P<0.001;mid-dle AKI,OR:5.000;P<0.001)and late AKI(OR:2.847;P<0.001)were more strongly associated with higher 90-day mortality than non-AKI.Conclusion:Clinical differences and risk factors for AKI in elderly patients depend on the definition used.A better understanding of how AKI develops during different diagnostic windows may lead to improved outcomes.
基金This study was funded by grants from the Special Scientific Research Project of Military Health Care(grant number:20BJZ27 to Dr FHZ)Special Scientific Research Project ofMilitary Key Laboratory of Military Medical Engineering(grantnumber:2022SYSZZKY12 to Dr FHZ).
文摘Background:Acute kidney injury(AKI)is primarily defined and classified according to the magnitude of theelevation of serum creatinine(Scr).We aimed to determine whether the duration of AKI adds prognostic valuein addition to that obtained from the magnitude of injury alone.Methods:This retrospective study enrolled very elderly inpatients(≥75 years)in the Chinese PLA General Hospitalfrom January 2007 to December 2018.AKI was stratified by magnitude according to KDIGO stage(1,2,and 3)andduration(1–2 days,3–4 days,5–7 days,and>7 days).The primary outcome was the 1-year mortality after AKI.Multivariable Cox regression analysis was performed to identify covariates associated with the 1-year mortality.The probability of survival was estimated using the Kaplan–Meier method,and curves were compared using thelog-rank test.Results:In total,688 patients were enrolled,with the median age was 88(84–91)years,and the majority(652,94.8%)were male.According to the KDIGO criteria,317 patients(46.1%)had Stage 1 AKI,169(24.6%)hadStage 2 AKI,and 202(29.3%)had Stage 3 AKI.Of the 688 study subjects,61(8.9%)with a duration of AKIlasted 1–2 days,104(15.1%)with a duration of AKI lasted 3–4 days,140(20.3%)with a duration of AKI lasted5–7 days,and 383(55.7%)with a duration of AKI lasted>7 days.Within each stage,a longer duration of AKIwas slightly associated with a higher rate of 1-year mortality.However,within each of the duration categories,the stage of AKI was significantly associated with 1-year mortality.When considered separately in multivariateanalyses,both the duration of AKI(3–4 days:HR=3.184;95%CI:1.733–5.853;P<0.001,5–7 days:HR=1.915;95%CI:1.073–3.416;P=0.028;>7 days:HR=1.766;95%CI:1.017–3.065;P=0.043)and more advanced AKIstage(Stage 2:HR=3.063;95%CI:2.207–4.252;P<0.001;Stage 3:HR=7.333;95%CI:5.274–10.197;P<0.001)were independently associated with an increased risk of 1-year mortality.Conclusions:In very elderly AKI patients,both a higher stage and duration were independently associated withan increased risk of 1-year mortality.Hence,the duration of AKI adds additional information to predict long-termmortality.
基金the Special Scien-tific Research Project of Military Health Care(grant 20BJZ27 to FHZ),and the Military Medical。
文摘Background:The kidneys play a central role in serum potassium(K+)homeostasis,and their dysfunction leads to electrolyte disorders.We aimed to examine the relationship between different levels of K+and mortality among very elderly patients with acute kidney injury(AKI).Methods:We retrospectively enrolled very elderly patients(≥75 years)with AKI from the hospital information system of the Chinese PLA General Hospital from January 1,2007 to December 31,2018.All-cause mortality was examined according to six predefined K+levels:<3.50 mmol/L,3.50-3.79 mmol/L,3.80-4.09 mmol/L,4.10-4.79 mmol/L,4.80-5.49 mmol/L,and≥5.50 mmol/L.We estimated the risk of all-cause mortality using the multivariable adjusted Cox proportional hazard model with the normal K+level at 3.50-3.79 mmol/L as a reference.Results:In total,747 patients were deemed suitable for the final evaluation.The median age of the 747 par-ticipants was 88(84-91)years.After 90 days,the mortality rates in the six strata were 28.3%,21.9%,30.1%,35.4%,45.2%,and 58.3%,respectively.In the multivariable adjusted analysis,patients with K+levels of 4.10-4.79 mmol/L(hazard ratio[HR]:1.638;95%confidence interval[CI]:1.016-2.642),4.80-5.49 mmol/L(HR:2.585;95%CI:1.524-4.384),and≥5.50 mmol/L(HR:2.587;95%CI:1.495-4.479)had an increased risk of all-cause mortality.After 1 year,the mortality rates in the six strata were 44.8%,41.1%,45.1%,51.8%,63.1%,and 76.3%,respectively.In the multivariable adjusted analysis,patients with K+levels of 4.10-4.79 mmol/L(HR:1.452;95%CI:1.014-2.079),4.80-5.49 mmol/L(HR:2.151;95%CI:1.427-3.241),and≥5.50 mmol/L(HR:2.341;95%CI:1.514-3.620)had an increased risk of all-cause mortality.Conclusion:Increased serum K+levels,including levels of 4.10-5.49 mmol/L and≥5.50 mmol/L,were associated with a significantly increased short-and long-term risk of death.Serum K+has the potential to be a marker of disease severity among very elderly patients with AKI.
基金funded by grants from the Special Scientific Research Project of Military Health Care(grant 20BJZ27 to FHZ)the Military Medical Innovation Project(grants 18CXZ026 and CX19010 to FHZ).
文摘Background:This study evaluated the prognostic impact of acute kidney injury(AKI)duration on 90-d mortality and new-onset chronic kidney disease(CKD)progression in elderly patients.Methods:We retrospectively enrolled elderly patients(≥75 years;n=693)from the Chinese PLA General Hospital between January 1,2007 and December 31,2018.The 2012 Kidney Disease Improving Global Outcomes(KDIGO)defined serum creatinine(Scr)criteria were used to identify and classify AKI.Patients were divided into transient AKI(T-AKI)and persistent AKI(P-AKI)groups based on whether Scr levels returned to baseline within 48 h post-AKI.We further classified P-AKI based on AKI duration:(1)short duration:resolving AKI lasting 3–4 days;(2)medium duration:resolving AKI lasting 5–7 days;and(3)long duration:AKI lasting>7 days.Results:Among patients,62(9.0%)had T-AKI(1–2 days),104(15.0%)had short-duration,140(20.2%)had medium-duration,and 387(55.8%)had long-duration.In total,209(30.2%)died within 90 days;122(25.2%)developed CKD.After adjusting for multiple covariates,duration of AKI(3–4 days:hazard ratio[HR]=2.512;P=0.045;5–7 days:HR=3.154;P=0.015;>7 days:HR=6.212;P<0.001)was significantly associated with a higher 90-day mortality.Longer AKI duration(3–4 days:odds ratio[OR]=0.982;P=0.980;5–7 days:OR=1.322;P=0.661;>7 days:OR=7.007;P<0.001)was significantly associated with new-onset CKD of survivors.Conclusion:AKI duration is useful for predicting poorer clinical outcomes in elderly patients,emphasizing the importance of identifying an appropriate treatment window for early intervention.
文摘BackgroundEmerging evidence suggests that minimal acute kidney injury (stage 1 AKI) is associated with increased hospital mortality rates. However, for those who do not meet the AKI diagnostic criteria, whether a small increase in serum creatinine (SCr) levels is associated with an increased mortality rate in elderly patients is not known. Therefore, we aimed to investigate small elevations in SCr of <26.5 µmol/L within 48 h after invasive mechanical ventilation (MV) on the short-term mortality of critically ill patients in the geriatric population.MethodsWe conducted a retrospective, observational, multicenter cohort study enrolling consecutive elderly patients (≥75 years) who received invasive MV from January 2008 to December 2020. Recursive partitioning was used to calculate the ratio of SCr rise from baseline within 48 h after MV and divided into six groups, (1) <10%, (2) 10%–<20%, (3) 20%–<30%, (4) 30%–<40%, (5) 40%–<50%, and (6) ≥50%, where the reference interval was defined as the ratio <10% based on an analysis, which confirmed that the lowest mortality risk was found in this range. Clinical data and laboratory data were noted. Their general conditions and clinical characteristics were compared between the six groups. Prognostic survival factors were identified using Cox regression analysis. Kaplan–Meier survival analysis was employed for the accumulative survival rate.ResultsA total of 1292 patients (1171 men) with a median age of 89 (interquartile range: 85–92) with MV were suitable for further analysis. In all, 376 patients had any stage of early AKI, and 916 patients had no AKI. Among 916 non-AKI patients, 349 patients were in the ratio <10%, 291 in the 10%–<20% group, 169 in the 20%–<30% group, 68 in the 30%–<40% group, 25 in the 40%–<50% group, and 14 in the ≥50% group. The 28-day mortality rates in the six groups from the lowest (<10%) to the highest (≥50%) were 8.0%, 16.8%, 28.4%, 54.4%, 80.0%, and 85.7%, respectively. In the multivariable-adjusted analysis, patients with a ratio of 10%–<20% (hazard ratio [HR]=2.244;95% confidence interval [CI]: 1.410 to 3.572;P=0.001), 20%–<30% (HR=3.822;95% CI: 2.433 to 6.194;P <0.001), 30%–<40% (HR=10.472;95% CI: 6.379 to 17.190;P <0.001), 40%–<50% (HR=13.887;95% CI: 7.624 to 25.292;P <0.001), and ≥50% (HR=13.618;95% CI: 6.832 to 27.144;P <0.001) had relatively higher 28-day mortality rates. The 90-day mortality rates in the six strata were 30.1%, 35.1%, 45.0%, 60.3%, 80.0%, and 85.7%, respectively. Significant interactions were also observed between the ratio and 90-day mortality: patients with a ratio of 10%–<20% (HR=1.322;95% CI: 1.006 to 1.738;P=0.045), 20%–<30% (HR=1.823;95% CI: 1.356 to 2.452;P <0.001), 30%–<40% (HR=3.751;95% CI: 2.601 to 5.410;P <0.001), 40%–<50% (HR=5.735;95% CI: 3.447 to 9.541;P <0.001), and ≥50% (HR=6.305;95% CI: 3.430 to 11.588;P <0.001) had relatively higher 90-day mortality rates.ConclusionsOur study suggests that a ≥ 10% SCr rise from baseline within 48 h after MV was independently associated with short-term all-cause mortality in mechanically ventilated elderly patients.
文摘Background This study aimed to investigate the influence of positive end-expiratory pressure(PEEP)on the right ventricle(RV)of mechanical ventilation-assisted patients through echocardiography.Methods Seventy-six patients assisted with mechanical ventilation were enrolled in this study.Positive end-expiratory pressure was upregulated by 4 cm H_(2)O to treat acute respiratory distress syndrome,wherein echocardiography was performed before and after this process.Hemodynamic data were also recorded.All variables were compared before and after PEEP upregulation.The effect of PEEP was also evaluated in patients with and without decreased static lung compliance(SLC).Results Positive end-expiratory pressure upregulation significantly affected the RV function.Remarkable differences were observed in the following:Tei index(P=0.027),pulmonary artery pressure(P=0.039),tricuspid annular plane systolic excursion(P=0.014),early wave/atrial wave(P=0.002),diaphragm excursion(P<0.001),inferior vena cava collapsing index(P<0.001),and SLC(P<0.001).There were no significant changes in heart rate,respiratory rate,central venous pressure,mean arterial pressure,and base excess(P>0.05).Furthermore,the cardiac output of the RV was not significantly affected.In patients with decreased SLC(n=41),there were more significant changes in diaphragm excursion(P<0.001),inferior vena cava collapse index(P=0.025),pulmonary artery pressure(P<0.001),and tricuspid annular plane systolic excursion(P=0.007)than in those without decreased SLC(n=35).Conclusion Positive end-expiratory pressure upregulation significantly affected the RV function of critically ill patients with acute respiratory distress syndrome,especially in those with decreased SLC.
