This study aimed at developing scores predicting surgical complications in obese transplant recipients, based on preoperative computed tomography (CT) parameters. All consecutive patients with a body ...mass index (BMI) ≥ 30 kg/m
who underwent kidney transplantation between 2012 and 2019 were included. The preoperative CT parameters were assessed: total fatty surface (TFS), subcutaneous fatty surface (SFS), iliac vessel to skin distance (VSD), and abdominal perimeter (AP). Per- and postoperative complications (vascular, urinary, parietal, and digestive complications) within 30 days were listed. Predictive models of surgical complications were generated based on the results of the logistic regression. Among the 163 patients included, 53 (32.5%) experienced surgical complications. The AP was a risk factor for complications in multivariate analysis (OR: 1.050; 95% CI: 1.016-1.087; p = 0.03). Two predictive models of complications were created based on the statistical analysis: a one-variable model based on AP (sensitivity 86.8%, specificity 41.8%, area under the curve (AUC) 65.3, with a cutoff value of 107 cm) and a five-variable model based on BMI, TFS, SFS, VSD, and AP (sensitivity 73.6%, specificity 57.3%, AUC 66.2). These models, based on patient morphometric measurements, could allow predicting the occurrence of surgical complications in obese candidates for kidney transplantation.
Background
Thromboprophylaxis of COVID-19 patients is a highly debated issue. We aimed to compare the occurrence of thrombotic/ischemic events in COVID-19 patients with acute respiratory distress ...syndrome (ARDS) treated with either prophylactic or therapeutic dosage of heparin. All patients referred for COVID-19 ARDS in two intensive care units (ICUs) from two centers of a French tertiary hospital were included in our cohort study. Patients were compared according to their anticoagulant treatment to evaluate the risk/benefit of prophylactic anticoagulation versus therapeutic anticoagulation. Medical history, symptoms, biological data and imaging were prospectively collected.
Results
One hundred and seventy-nine patients (73% men) were analyzed: 108 in prophylactic group and 71 in therapeutic group. Median age and SAPS II were 62 IQR 51; 70 years and 47 IQR 37; 63 points. ICU mortality rate was 17.3%. Fifty-seven patients developed clinically relevant thrombotic complications during their ICU stay, less frequently in therapeutic group (adjusted OR 0.38 0.14–0.94, p = 0.04). The occurrences of pulmonary embolism (PE), deep vein thrombosis (DVT) and ischemic stroke were significantly lower in the therapeutic group (respective adjusted OR for PE: 0.19 0.03–0.81; DVT: 0.13 0.01–0.89, stroke: 0.06 0–0.68, all p < 0.05). The occurrence of bleeding complications was not significantly different between groups, neither were ICU length of stay or mortality rate. D-dimer levels were significantly lower during ICU stay, and aPTT ratio was more prolonged in the therapeutic group (p < 0.05).
Conclusion
Increasing the anticoagulation of severe COVID-19 patients to a therapeutic level might decrease thrombotic complications without increasing their bleeding risk.
Despite more than 148 million infected people, coronavirus disease 2019 (COVID-19) respiratory intermediate and long-term survivors' outcome remains largely unknown. Lungs are the main COVID-19 ...target organ, and 5-10% patients progress to critical disease including acute respiratory distress syndrome (ARDS) 1. Pulmonary function tests (PFT) performed at discharge from hospital showed that >80% of severe COVID-19 patients had lung function impairment 2.
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•Venous thromboembolism (VTE) is a frequent complication in COVID-19 patients.•Single-center study of COVID-19 patients admitted to general ward.•17.0% of patients with VTE•Lack of ...thromboprophylaxis and leukocytosis were independent risk factors of VTE.•VTE is independently associated with worse in-hospital outcomes.
Introduction:
The purpose of this study was to evaluate the efficacy of polycystic kidney embolization, performed to reduce kidney volume before heterotopic kidney transplantation, as this technique ...could be an alternative to pretransplant nephrectomy.
Materials and Methods:
All patients who underwent pretransplant embolization of polycystic kidneys were included in a prospective register from June 2014 to February 2020. All patients underwent computed tomography (CT) scan with volumetric reconstruction (OsiriX, Bernex, Switzerland) before embolization and were then followed up at 3 and 6 months after embolization. Primary outcome was percentage of kidney volume reduction. Secondary outcomes were 30 day mortality and morbidity.
Results:
Thirty-one embolizations performed on 29 patients (medium age = 55.6; 62.1% male) were included between June 2014 and February 2020. All patients were under dialysis before embolization (9 peritoneal dialysis and 20 hemodialysis). Technical success was observed in 96.8% of cases. Mean procedural time was 65 minutes (range = 35–106 minutes) and mean length of in-hospital stay was 3.8 days (range = 3–6 days). A volume reduction allowing a kidney transplant was obtained for 28 patients (96.5%). The mean volume reduction was 39.9% (range = 6.01–68.2). The main observed complication was postembolization pain in 10 cases (32.2%). One patient needed complementary nephrectomy due to insufficient volume reduction. Twenty-three patients (79.3%) received renal transplant during follow-up with a mean delay of 19.5 month (range = 4–54).
Conclusion:
Polycystic kidney embolization is an effective and safe minimally invasive technique. It can be proposed as the first-choice technique for kidney transplant recipients as an alternative to pretransplantation nephrectomy.
•Chest CT accuracy was 85.4 % during ascending, peak and descending phases of the first Covid-19 wave.•It was not significantly different between chest (4 readers, accuracy 86.4 %) and general (6 ...readers, accuracy 85.1 %) radiologists, with a probability of equivalence ≥ 95 %.•There were important variations of CT predictive values whereas CT specificity remained stable over time.
The purpose of this work was to analyze temporal variations in the diagnostic performance of chest CT for Covid-19 throughout the first wave, depending on disease prevalence variations between the ascending, peak and descending phases of the epidemic in North-Eastern France.
From March 6th to April 22nd 2020, all consecutive adult patients referred to the “Covid-19 clinic” of our Emergency Department with the availability of chest CT and of at least one RT-PCR result were retrospectively included in the present study. Chest CT was considered positive when typical Covid-19 lesions were observed (bilateral and predominantly peripheral and sub-pleural ground glass opacities and/or alveolar consolidations). RT-PCR results were considered as the reference standard. Ascending, peak and descending phases were determined based on the number of CT scans performed daily. CT diagnostic performance were calculated and variations between phases were tested for equivalence or difference using Bayesian methods.
2194 consecutive chest CT were analyzed. Overall CT diagnostic performance was Se = 84.2 82.0 ; 86.3, Sp = 86.6 84.5 ; 88.5, PPV = 86.1 84.0 ; 88.1, NPV = 84.7 82.6 ; 86.7 and accuracy = 85.4 83.9 ; 86.8, with no significant differences between chest and non-chest radiologists. Variations between the ascending (11 days, 281 chest CT, disease prevalence 37.0 %), the peak (18 days, 1167 chest CT, disease prevalence 64 %) and the descending phases (19 days, 746 chest CT, disease prevalence 32.2 %) were highest for PPV and NPV with a probability of difference >99.9 %, and smallest for accuracy and specificity with a probability of equivalence >98.8 %.
In a homogenous cohort of 2194 consecutive chest CT performed over a 7-week epidemic wave, we observed significant variations of CT predictive values whereas CT specificity appeared marginally affected.
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