Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Effect of pear, apple and date fibres from cooked fruit by-products on dough performance and bread quality

Abstract This study examined the effect of the incorporation of flesh fibre concentrate (FFC) from apple, pear, and date pomaces on wheat bread dough performance and bread quality. The nutritional composition and techno-functional properties (water-holding capacity, oil-holding capacity, swelling capacity) of FFC were determined beforehand. Dough performance was evaluated by farinograph, alveograph and visco-amylograph. Bread quality was assessed by physical (weight, specific volume, and color) and textural (hardness and elasticity) parameters. Digital imaging analysis was also performed in order to better understand the observed effects. Results showed that the addition of FFC in wheat flour significantly improved (P<0.05) dough properties inducing an increase of water absorption (from 55 to 60 %), of stability (from 4 to 31 min),of tenacity (from 83 to 116 mmH2O) , a reduction of extensibility (from 69 to 29 mm), of softening (from 60 to 20 BU), of breakdown (from 34 to 25 BU) and of setback (from 103 to 93 BU) in comparison to the control dough (without fibre). The formulation containing FFC produced loaves that had various colors (crust, 0<ΔE*<10 and crumb, 0<ΔE*<20;ΔE* corresponding to color variation), a comparable specific volume (2.7 vs 2.9 cm3/g for control) and a more aerated internal crumb structure compared to the control. During storage of breads at 20 °C, there was no significant differenc