Epidemiology of surgery associated acute kidney injury (EPIS-AKI) : a prospective international observational multi-center clinical study

The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Busaliol and busalicifol, two new tetrahydrofuran lignans from Bupleurum salicifolium

6 páginas, 2 tablas, 23 referencias.-- [email protected] tetrahydrofuran lignans [l-3} were obtained from the leaves of Bupleurum salicifolium, of which busaliol {l} and busalicifol {2} are novel. Their structures were determined by spectral and chemical methods. Also obtained in this investigation were a number of other lignans, coumarins, a polyacetylene, and a triterpenoid, all of known structure.Canary Islands Government (Project No. 11/08-03-90), CCYT (Projeet SAF 92-1028) and the Colegio Libre de Emerito for financial help. J.A.G.P. is indebted to the Canary Islands Government for a postdoctoral grant.Peer reviewe

Biological activity of secondary metabolites from Bupleurum salicifolium (Umbelliferae)

Secondary metabolites from Bupleurum salicifolium were tested against viruses, Gram-positive and Gram-negative bacteria, the yeast Candida albicans, the nematodes Globodera pallida and G. rostochiensis, the insect Spodoptera littoralis and the crustacean Artemia salina. These compounds were also tested against tumoral and non-tumoral cell lines. The polyacetylene 8S-heptadeca-2(Z)-9(Z)-diene-4,6-diyne-1,8-diol exhibited toxicity for A. salina and specific antibiotic activity against Gram-positive bacteria. Nine of the lignans and one coumarin showed toxicity for A. salina, and the lignans bursehernin and matairesinol inhibited the hatching of the two nematode species. These are the first lignans that have been reported as affecting phytoparasitic nematodes, and the first natural products known to have an effect on the hatching of G. pallida. Lignans may play a role in the defence mechanisms of potato plants, as allelopathic substances acting against cyst-forming nematodes.Peer reviewe