Correction: Phase-3 trial of recombinant human alkaline phosphatase for patients with sepsis-associated acute kidney injury (REVIVAL)
Peter PickkersDerek C. AngusKristie BassRinaldo BellomoErik van den BergJuliane BernholzMorten H. BestleKent DoiChistopher J. DoigRicard FerrerBruno FrançoisHenrik GammelagerU. G. PedersenEric A. J. HosteSusanne IversenMichael JoannidisJohn A. KellumKathleen D. LiuMelanie MeerschRavindra L. MehtaScott J. MillingtonPatrick MurrayAlistair NicholMarlies OstermannVille PettiläChristoffer SøllingMatthias WinkelPaul J. YoungAlexander ZarbockAngus CarterD FrièsPhilip EllerLudovic GérardNicolas DeSchryverElisabeth DiltoerVincent HuberlantIsabelle MichauxPatrick M. HonoréTom FivezChristopher J. DoigGordon WoodJ. Gordon BoydAlexis F. TurgeonMaj K. KamperThomas StrømSussanne IversenHendrik GammelagerBodil Steen RasmussenChristoffer SøllingMorten Hyllander MællerThorbjoern GroefteNilanjan DeyUlf Gøttrup PedersenMila ValkonenPanu UusaloVille JalkanenFerhat MezianiJermie LemarieGaëtan PlantefèveKonstantimos BachoumasJean Louis DufourAnne-Laure FedouPierre AsfarXavier MonnetChristophe VinsonneauSébastien GibotChristophe GuittonJean‐Pierre QuenotGrégoire MüllerJean Yves LefrantEmmanuelle MercierAlexandre MebazaaAndreas KortgenSebastian FichtnerStefan KlugeGernot MarxIgnatio Martin-LoechesBairbre McNicolasHidenobu KamoharaMasahiro HaradaTakuo NakagamiShingo AdachiKohei OtaRyo FuruyaAyumu TsuruokaYasuaki MizushimaSatoki InouePieter R. TuinmanF Wim RoozendaalBert BeishuizenOscar HoitingTom DormansArthur R. H. van ZantenPaul J. YoungAnthony P. WilliamsColin McArthurPaweł TwardowskiShay McGuinnessRicard FerrerCarol Lorencio CardenasAnna Navas PerezFernando Martínez‐SagastiIngeborg WeltersMatt P. WiseSam WaddyNiall MacCallumRaghaven MuruganHernando GómezLarry BusseDavid W. BoldtAndrew C. BernardD. Clark FilesBenjamin D. MargolisJarrod MosierJonathon D. TruwitFélix ZamoraDanielle DavisonMatthew C. ExlineNathan NielsenDuncan Hite
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The brief review, dedicated to Septic Acute Injury (S-AKI) — the syndrome simultaneously corresponding to criteria of sepsis and acute kidney Injury. Sepsis or AKI are diagnosed 30–50 % of critical patients. Sepsis is promoting the developing of AKI and AKI is promoting the development of sepsis. Morbidity and lethality in S-AKI is higher than that is sepsis and in AKI separately. The main mechanisms of the development of: a) AKI in sepsis — the toxic septic blood containing huge amounts of proinflammatory factors damage the renal tubules resulting tubular disfunction; b) sepsis in AKI — uremia is damaging distal organs and functions of immune systems which provoke sepsis development. For early diagnostics of S-AKI in patients admitting in critical care units the simultaneous measurements and monitoring of sepsis and kidney biomarkers are to be made. The problems of such measurements is that AKI decreases the clearance of septic markers and their levels are increasing in noninfectious conditions. From the other hand in septic conditions inflammation can increase the levels of renal markers independently of renal pathologies. In general in sepsis, AKI and in S-AKI the increased levels of sepsis markers reflect simultaneously severity of infectious inflammation and of renal disfunction, and kidney markers reflect simultaneously severity of renal disfunction and of infectious inflammation. The correction of cut-off values of septic markers used for S-AKI diagnostics must be based on the degree of severity of renal disfunction in critical patients.
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To investigate the changes of serum miR-202-3p level and its correlation with prognosis in patients with acute kidney injury (AKI) induced by sepsis. From April 2017 to January 2019, 66 patients with AKI induced by sepsis in our hospital and 70 healthy people in the same period were selected as the research objects. The levels of miR-202-3p, BUN and Cr in serum were tested. Subsequently, cell experiments were carried out to verify the effects of the decrease of miR-202-3p level on BUN, Cr and cell growth and apoptosis. The risk factors were analysed. Compared with healthy volunteers, patients with AKI induced by sepsis had higher levels of miR-202-3p, BUN and Cr in serum. When miR-202-3p level was knocked down, the levels of BUN and Cr were declined, cell growth was improved and apoptosis rate was decreased. The risk factors were analysed, and the results revealed that miR-202-3p, BUN and Cr were independent risk factors for poor prognosis in patients with AKI induced by sepsis. The level of miR-202-3p is elevated in patients with AKI induced by sepsis, which may be a potential biomarker for diagnosis and prognosis of patients with AKI induced by sepsis.
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With the rapid development of medicine,w e have been made a great achievement in anesthesiology.The role and the position o f anesthesiology is obviously important as it was.But in our country the phenome non at present is that the people has a poor education and low puality who work in anesthesiology.Therefore the resident training of anesthesiology is very impo rtant to the whole medicine.In this paper we have expounded the present situatio n of anesthesiology,the importance of the resident training in anesthesiology,an d our experience in resident training of anesthesiology.
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Sepsis is a life-threatening multiple organ dysfunction syndrome caused by infection, and kidney is one of the most organs susceptible to injury in sepsis. Critical ill patients with sepsis often suffer from acute kidney injury (AKI) of varying degrees with a high mortality. There are more and more researches on the early identification, pathogenesis, diagnosis and treatment of acute kidney injury in sepsis. In order to improve the understanding and reduce the mortality of acute kidney injury, this review briefly discussed the early identification, physio-pathologic mechanism, treatment, prognosis and follow up.脓毒症是机体对感染的反应失调而导致危及生命的器官功能障碍，肾脏是脓毒症最常累及的器官之一，脓毒症急性肾损伤发病率高、死亡率高。随着研究的不断深入，关于脓毒症急性肾损伤的早期识别、发病机制、诊疗的研究逐年增多，本文整理相关文献，从脓毒症AKI的早期诊断、病理生理、治疗方法、恢复和随访等方面进行阐述，以期提高脓毒症AKI在临床与基础方面的认识，降低脓毒症AKI的死亡率。.
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The brief review, dedicated to Septic Acute Injury (S-AKI) - the syndrome simultaneously corresponding to criteria of sepsis and acute kidney Injury. Sepsis or AKI are diagnosed 30-50 % of critical patients. Sepsis is promoting the developing of AKI and AKI is promoting the development of sepsis. Morbidity and lethality in S-AKI is higher than that is sepsis and in AKI separately. The main mechanisms of the development of: a) AKI in sepsis - the toxic septic blood containing huge amounts of proinflammatory factors damage the renal tubules resulting tubular disfunction; b) sepsis in AKI - uremia is damaging distal organs and functions of immune systems which provoke sepsis development. For early diagnostics of S-AKI in patients admitting in critical care units the simultaneous measurements and monitoring of sepsis and kidney biomarkers are to be made. The problems of such measurements is that AKI decreases the clearance of septic markers and their levels are increasing in noninfectious conditions. From the other hand in septic conditions inflammation can increase the levels of renal markers independently of renal pathologies. In general in sepsis, AKI and in S-AKI the increased levels of sepsis markers reflect simultaneously severity of infectious inflammation and of renal disfunction, and kidney markers reflect simultaneously severity of renal disfunction and of infectious inflammation. The correction of cut-off values of septic markers used for S-AKI diagnostics must be based on the degree of severity of renal disfunction in critical patients.
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ABSTRACT Sepsis is defined as organ dysfunction resulting from the host’s deleterious response to infection. One of the most common organs affected is the kidneys, resulting in sepsis associated acute kidney injury (SA-AKI) that contributes to the morbidity and mortality of sepsis. A growing body of knowledge has illuminated the clinical risk factors, pathobiology, response to treatment, and elements of renal recovery that have advanced our ability to prevent, detect, and treat SA-AKI. Despite these advances, SA-AKI remains an important concern and clinical burden, and further study is needed to reduce the acute and chronic consequences. This review summarizes the relevant evidence, with a focus on the risk factors, early recognition and diagnosis, treatment, and long term consequences of SA-AKI. In addition to literature pertaining to SA-AKI specifically, pertinent sepsis and acute kidney injury literature relevant to SA-AKI was included.
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Sepsis is often accompanied with acute kidney injury (AKI). The incidence of AKI in patients visiting the emergency department (ED) with sepsis according to the new SOFA criteria is not exactly known, because the definition of sepsis has changed and many definitions of AKI exist. Given the important consequences of early recognition of AKI in sepsis, our aim was to assess the epidemiology of sepsis-associated AKI using different AKI definitions (RIFLE, AKIN, AKIB, delta check, and KDIGO) for the different sepsis classifications (SIRS, qSOFA, and SOFA).We retrospectively enrolled patients with sepsis in the ED in three hospitals and applied different AKI definitions to determine the incidence of sepsis-associated AKI. In addition, the association between the different AKI definitions and persistent kidney injury, hospital length of stay, and 30-day mortality were evaluated.In total, 2065 patients were included. The incidence of AKI was 17.7-51.1%, depending on sepsis and AKI definition. The highest incidence of AKI was found in qSOFA patients when the AKIN and KDIGO definitions were applied (51.1%). Applying the AKIN and KDIGO definitions in patients with sepsis according to the SOFA criteria, AKI was present in 37.3% of patients, and using the SIRS criteria, AKI was present in 25.4% of patients. Crude 30-day mortality, prolonged length of stay, and persistent kidney injury were comparable for patients diagnosed with AKI, regardless of the definition used.The incidence of AKI in patients with sepsis is highly dependent on how patients with sepsis are categorised and how AKI is defined. When AKI (any definition) was already present at the ED, 30-day mortality was high (22.2%). The diagnosis of AKI in sepsis can be considered as a sign of severe disease and helps to identify patients at high risk of adverse outcome at an early stage.
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