Abstract
Background and Aims
Severe acute kidney injury (AKI) requiring renal replacement therapy (RRT) is a serious clinical disorder in the intensive care unit (ICU), occurring in a substantial ...proportion of critically ill patients. The aim of our single centre retrospective observational study was to analyse the outcomes of patients admitted to a non-surgical ICU and treated with RRT and with/without continuous hemoperfusion with Cytosorb.
Method
One hundred critically ill patients (mean age, 64.3 years; 69 men) admitted to the ICU and requiring RRT for AKI were analysed. Patient demographics, concomitant diseases, type of RRT, and survival were obtained from the medical record. APACHE II and Sofa Scores on admission were calculated. 30-day mortality was assessed using Kaplan-Meyer or Cox proportional hazards models.
Results
Reasons for ICU admission were acute respiratory failure (39%), cardiopulmonary resuscitation (14%), shock (13%), acute coronary syndrome (9%), sepsis (3%), acute pancreatitis (3%), and other (19%). Prior comorbidities were hypertension (70%), diabetes (43%), heart failure (32%), chronic kidney disease (CKD) (30%), coronary artery disease (CAD) (27%), chronic obstructive pulmonary disease (COPD) (15%), malignancies (12%). Eighty-six patients were treated with continuous RRT (CRRT) and 14 with intermittent hemodialysis (IHD). Twenty-four (24%) of patients treated with CRRT were also treated with hemoperfusion with Cytosorb. Using an independent-samples T test, we compared the two groups of patients with respect to the use of Cytosorb (Table 1). 30-day mortality was 82% in all patients and 87.5% in patients treated with CRRT and Cytosorb. Among concomitant diseases, only patients with previous heart failure had worse survival (p = 0.032), previous CKD, CAD, COPD, malignancy had no statistically significant impact. We found no statistically significant differences in 30-day mortality between patients treated with CRRT+Cytosorb and patients treated with CRRT or IHD alone. Multivariate Cox proportional hazard regression showed that of all the variables in the statistical model (age, sex, body mass index, previous diabetes, C-reactive protein, lactate, procalcitonin, serum creatinine, mean arterial pressure, APACHE II, ultrafiltration between CRRT), only lactate levels on admission (p = 0.002; 95%CI 1.08-1.38) were significant predictor of survival.
Conclusion
The use of hemoperfusion with Cytosorb in ICU patients with AKI did not reduce 30-day mortality. Patients with prior heart failure had a worse outcome. Serum lactate levels at ICU admission were an independent highly prognostic factor for death within 30 days of admission.
Abstract Background and Aims Lactic acidosis (LA) is the most common cause of metabolic acidosis in hospitalised patients. LA is frequent in intensive care unit (ICU) patients with acute kidney ...injury (AKI) treated with renal replacement therapy (RRT). The aim of our study was to analyse the impact of LA on mortality. Method We conducted a retrospective observational study in a tertiary care hospital with a 12-bed ICU. During the study period of 4 years before the COVID pandemic, 2939 patients were admitted to the ICU, 503 patients were diagnosed with AKI and 210 of them required RRT. Due to missing data, we retrospectively analysed only 176 patients. LA was defined as a serum lactate concentration above 4 mmol/L on admission to the ICU. Demographic data, comorbidities, laboratory data at ICU admission and 30-day survival after ICU admission were obtained from the medical record. Survival was estimated using the Kaplan-Meier method, and factors associated with 30-day mortality were assessed in a Cox regression. Results The mean age of patients was 63.4±12.9 years, and 68.2% were men. Sixty-five (36.9%) of patients had LA. The prevalence of comorbidities prior to admission and baseline laboratory values are shown in Table 1. All patients were treated with RRT, 137 (77.8%) with continuous RRT and 39 (22.2%) with intermittent hemodialysis. The mean ICU stay was 14.6 ± 12 days, and 114 (64.8%) patients died during the observational period of 30 days. A Kaplan-Meier survival analysis showed that the survival was statistically significantly lower (log-rank; p = 0.027) in the group of patients with LA (Fig. 1). Univariate Cox regression analysis showed that LA was a significant predictor of 30-day survival (HR 1.51; 95% CI 1.038-2.197; p = 0.031). In the multivariate Cox regression analysis, which included age, gender, diabetes, hypertension, LA and C-reactive protein, only age (HR 1.029; 95% CI 1.011-1.046; p = 0.001) and LA (HR 1.515; 95% CI 1.030-2.228; p = 0.035) were independent predictors of mortality. Conclusion LA on ICU admission is an independent, highly prognostic factor for death within 30 days of admission in patients with AKI treated with RRT.
Abstract With the development of IVF procedures, the role of reproductive surgery in the management of infertile couples has been questioned. Pregnancy rates (PR) after IVF procedures are well known, ...but recent data on spontaneous PR after reproductive surgery are scarce. This study aimed to prospectively evaluate how often fertility is restored by reproductive surgery and to identify which independent factors influence spontaneous pregnancy after reproductive surgery. Eight hundred eighty-eight infertile women who underwent surgery for infertility were prospectively included. Women who were referred to IVF after surgery, ceased to plan pregnancy and were lost to follow-up were excluded. Spontaneous PR was analysed for 519 women. A total of 252 (48.6%) women, including 30 treated with clomiphene citrate, conceived spontaneously in the 12–18 months observation period following surgery. Multivariate logistic regression showed that woman's age (OR 0.95, 95% CI 0.90–0.99) and duration of infertility (OR 0.86, 95% CI 0.74–0.99) significantly influence spontaneous PR. Each year of infertility lowers spontaneous PR following surgery by 14% and each year of woman's age by 5%. The study shows a relatively high percentage of women conceived spontaneously after reproductive surgery. The role of reproductive surgery in the management of infertility should be re-evaluated.
The efficiency of universal electric motors that are widely used in home appliances can be improved by optimizing the geometry of the rotor and the stator. Expert designers traditionally approach ...this task by iteratively evaluating candidate designs and improving them according to their experience. However, the existence of reliable numerical simulators and powerful stochastic optimization techniques make it possible to automate the design procedure. We present a comparative study of six stochastic optimization algorithms in designing optimal rotor and stator geometries of a universal electric motor where the primary objective is to minimize the motor power losses. We compare three methods from the domain of evolutionary computation, generational evolutionary algorithm, steady-state evolutionary algorithm and differential evolution, two particle-based methods, particle-swarm optimization and electromagnetism-like algorithm, and a recently proposed multilevel ant stigmergy algorithm. By comparing their performance, the most efficient method for solving the problem is identified and an explanation of its success is offered.PUBLICATION ABSTRACT
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