Increased creatinine clearance in polytrauma patients with normal serum creatinine: a retrospective observational study

International audienceINTRODUCTION: The aim of this study, performed in an intensive care unit (ICU) population with a normal serum creatinine, was to estimate urinary creatinine clearance (CLCR) in a population of polytrauma patients (PT) through a comparison with a population of non trauma patients (NPT). METHODS: This was a retrospective, observational study in a medical and surgical ICU in a university hospital. A total of 284 patients were consecutively included. Two different groups were studied: PT (n = 144) and NPT (n = 140). Within the second week after admission to the ICU, renal function was assessed using serum creatinine, 24 h urinary CLCR . RESULTS: Among the 106 patients with a CLCR above 120 mL minute(-1) 1.73 m(-2), 79 were PT and 27 NPT (P < 0.0001). Only 63 patients had a CLCR below 60 mL minute(-1) 1.73 m(-2) with 15 PT and 48 NPT (P < 0.0001). Patients with CLCR greater than 120 mL minute(-1). 1.73 m(-2) were younger, had a lower SAPS II score and a higher male ratio as compared to those having CLCR lower than 120 mL minute(-1). 1.73 m(-2). Through a logistic regression analysis, age and trauma were the only factors independently correlated to CLCR. CONCLUSIONS: In ICU patients with normal serum creatinine, CLCR, is higher in PT than in NPT. The measure of CLCR should be proposed as routine for PT patients in order to adjust dose regimen, especially for drugs with renal elimination

Augmentation de la clairance de la créatinine chez les patients polytraumatisés avec une créatinine plasmatique normale

L'objectif de cette étude prospective est de comparer le débit de filtration glomérulaire (DFG), estimé par la clairance de la créatinine mesurée (CLCR), des polytraumatisés et des non polytraumatisés. 284 patients de réanimation avec une créatinine plasmatique normale ont été analysés sur une période de 5 ans : 55 % des polytraumatisés avaient un DFG augmenté (CLCR supérieure à 120 mL. min-1 .1.73 m-2) et 75 % des patients hyperfiltrants étaient des polytraumatisés. L'analyse par régression logistique montre que seuls l'âge et le polytraumatisme sont des facteurs indépendants de variation de la CLCR. La créatinine plasmatique seule ne permet donc pas de diagnostiquer ces variations du DFG. En pratique clinique, pour éviter les sous dosages notamment chez les patients hyperfiltrants tels que les polytraumatisés, il faut adapter la posologie des médicaments à élimination rénale aux valeurs de la CLCR mesurée.TOULOUSE3-BU Santé-Centrale (315552105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Necrotizing enterocolitis in full term neonates: is there always an underlying cause?

International audienceOBJECTIVE: To review our experience with full-term neonates with necrotizing enterocolitis (NEC) and to compare its characteristics to those published in the literature. DESIGN: Retrospective review of all neonates born after 35 weeks of gestation managed in Reunion Island for NEC from 2000 to 2012. RESULTS: Among the 217 diagnosed NEC, 27 patients (12.4%) were full term neonates, who were born at a mean gestational age of 36.8 ±1.7 weeks. The mean onset of the disease was 12.1±11.2 days after birth. Twenty patients had underlying causes (15 organic pathologies of the child, 3 isolated maternal disease, and 2 infections); 7 had idiopathic NEC. Surgery was required in 12 patients (37.5%) at 23.2±20 days after birth. NEC affected most of the time the colon (n=6) and the rectum (n=3). Overall survival rate was 88.8% (24/27). Two patients required partial non-enteral nutrition for1.3 and 2.1 years. CONCLUSIONS: NEC in full term neonates is a rare pathology. The onset of the disease in our experience was slightly later than described in the literature, but remains earlier than in the premature population. In some cases, no obvious cause can be found, suggesting a different pathogenesis. Further investigations are required in order to better understand this pathology. The goal will be to find measures to reduce global mortality