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

Redesign of a Compressor Stage for a High-Performance Electric Supercharger in a Heavily Downsized Engine

Engine downsizing is a modern solution for the reduction of CO2 emissions from internal combustion engines. This technology has been gaining increasing attention from industry. In order to enable a downsized engine to operate properly at low speed conditions, it is essential to have a compressor stage with very good surge margin. The ported shroud, also known as the casing treatment, is a conventional way used in turbochargers to widen the working range. However, the ported shroud works effectively only at pressure ratios higher than 3:1. At lower pressure ratio, its advantages for surge margin enhancements are very limited. The variable inlet guide vanes are also a solution to this problem. By adjusting the setting angles of variable inlet guide vanes, it is possible to shift the compressor map toward the smaller flow rates. However, this would also undermine the stage efficiency, require extra space for installing the inlet guide vanes, and add costs. The best solution is therefore to improve the design of impeller blade itself to attain high aerodynamic performances and wide operating ranges. This paper reports a recent study of using inverse design method for the redesign of a centrifugal compressor stage used in an electric supercharger, including the impeller blade and volute. The main requirements were to substantially increase the stable operating range of the compressor in order to meet the demands of the downsized engine. The three-dimensional (3D) inverse design method was used to optimize the impeller geometry and achieve higher efficiency and stable operating range. The predicted performance map shows great advantages when compared with the existing design. To validate the computational fluid dynamics (CFD) results, this new compressor stage has also been prototyped and tested. It will be shown that the CFD predictions have very good agreement with experiments and the redesigned compressor stage has improved the pressure ratio, aerodynamic efficiency, choke, and surge margins considerably