The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe

Meiobenthos of the Oxic/Anoxic Interface in the Southwestern Region of the Black Sea: Abundance and Taxonomic Composition

The Black Sea contains the World’s largest body of anoxic water. Based on new and published data, we describe trends among selected protozoan and metazoan meiofaunal taxa at water depths of 120–240 m in the northwestern part of the Black Sea near the submarine Dnieper Canyon. This transect spans the transition between increasingly hypoxic but non-sulfidic bottom water and the deeper anoxic/sulfidic zone, the boundary between these two domains being located at approximately 150–180 m depth. This transition zone supports a rich rose-Bengal-stained fauna. Among the protozoans, gromiids are common only at 120 and 130 m. All other groups exhibit more or less distinct abundance maxima near the base of the hypoxic zone. Foraminifera peak sharply at ?160 m while ciliates are most abundant at 120, 160–190, and 240 m, where they are possibly associated with concentrations of bacterial cells. The three most abundant metazoan taxa also exhibit maxima in the hypoxic zone, the nematodes and polychaetes at 160 m, and the harpacticoid copepods at 150 m. Most of the polychaetes belong to two species, Protodrilus sp. and Vigtorniella zaikai, the larvae of which are widely distributed in severely hypoxic water just above the anoxic/sulfidic zone of the Black Sea. Both protozoans and metazoans are usually concentrated in the 0–1 cm layer of the sediment, except at the shallowest (120–130 m) site where deeper layers may yield a substantial proportion of the assemblage. The concentration of nematodes in the 3–5 cm layer at 120 m is particularly notable. Our data suggest that some benthic species can tolerate anoxic/sulfidic conditions in the Black Sea. An important caveat is that anoxia or severe hypoxia may lead to the corpses of nonindigenous organisms being preserved in our samples. However, we argue that the morphological integrity of specimens, the high population densities (associated with high bacterial concentrations in the case of ciliates), the presence of taxa often found in hypoxic settings, and the presence of all life stages (including gravid females) among nematodes and harpacticoids, suggests that at least some of the organisms are indigenous. Further comparative studies of shallow- and deep-water meiobenthic communities in the Black Sea are necessary in order to establish which species are characteristic and indicative of hypoxic/anoxic conditions

A worldwide perspective of sepsis epidemiology and survival according to age: Observational data from the ICON audit

Purpose: To investigate age-related differences in outcomes of critically ill patients with sepsis around the world. Methods: We performed a secondary analysis of data from the prospective ICON audit, in which all adult ( >16 years ) patients admitted to participating ICUs between May 8 and 18, 2012, were included, except admissions for routine postoperative observation. For this sub-analysis, the 10,012 patients with completed age data were included. They were divided into five age groups - <= 50, 51-60, 61-70, 71-80, >80 years. Sepsis was defined as infection plus at least one organ failure. Results: A total of 2963 patients had sepsis, with similar proportions across the age groups (<= 50 = 25.2%: 51-60 = 30.3%; 61-70 = 32.8%; 71-80 = 30.7%; >80 = 30.9%). Hospital mortality increased with age and in patients >80 years was almost twice that of patients <= 50 years (493% vs 25.2%, p < .05). The maximum rate of increase in mortality was about 0.75% per year, occurring between the ages of 71 and 77 years. In multilevel analysis, age > 70 years was independently associated with increased risk of dying. Conclusions: The odds for death in ICU patients with sepsis increased with age with the maximal rate of increase occurring between the ages of 71 and 77 years. (C) 2019 Elsevier Inc. All rights reserved