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

Ensemble Forecast Sensitivity to Observations Impact (EFSOI) applied to a regional data assimilation system over south-eastern South America

Observations that are assimilated into numerical weather prediction systems are conformed by numerous data sets and their impact should be objectively evaluated. This can be efficiently achieved by the Forecast Sensitivity to Observation Impact (FSOI) methodology. In this study we explore the application of the ensemble formulation of FSOI (EFSOI) in a regional data assimilation system over south-eastern South America and evaluate the observations that result beneficial or detrimental to the forecast. In this paper we focus on the impact of two types of surface weather stations: human-operated conventional surface weather station networks from the National Meteorological Service and non-conventional automatic surface weather stations from different public and private networks (CSWS and NSWS respectively). To achieve this, the Weather Research and Forecasting model coupled with the Local Ensemble Transform Kalman Filter is used with 20 members. The experiment was carried out during 30 days of the intensive observing period of the RELAMPAGO-CACTI (Remote sensing of Electrification, Lightning, And Mesoscale/microscale Processes with Adaptive Ground Observations-Clouds, Aerosols, and Complex Terrain Interaction) field campaign that was conducted during the 2018–2019 austral warm season in the center of Argentina. 20 km resolution analyses were obtained every 6-h, assimilating data from soundings, aircrafts, GOES derived motion winds, AIRS retrievals, CSWS and NSWS. It is shown that, considering the entire period, all the observation sources had a positive impact on the 6-h forecasts. However, when each variable is analyzed individually, surface pressure observations from both CSWS and NSWS show on average a negative impact. Two data denial experiments were carried out in order to support EFSOI results. This paper is the first approximation to quantify the impact of different observation sources and observed variables at a regional scale over south-eastern South America, a data sparse region where unconventional networks can help close large geographical data gaps. The results of this work help identify observation data sources detrimental for the data assimilation system, suggesting data selection criteria to improve the regional forecast accuracy.Fil: Casaretto, Gimena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Ministerio de Defensa. Secretaria de Planeamiento. Servicio Meteorológico Nacional; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Ciencias de la Atmósfera y los Océanos; ArgentinaFil: Dillon, María Eugenia. Ministerio de Defensa. Secretaria de Planeamiento. Servicio Meteorológico Nacional. Servicio Metereológico Nacional (sede Dorrego).; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: García Skabar, Yanina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Ciencias de la Atmósfera y los Océanos; Argentina. Ministerio de Defensa. Secretaria de Planeamiento. Servicio Meteorológico Nacional; ArgentinaFil: Ruiz, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Centro de Investigaciones del Mar y la Atmósfera. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Centro de Investigaciones del Mar y la Atmósfera; ArgentinaFil: Sacco, Maximiliano Antonio. Ministerio de Defensa. Secretaria de Planeamiento. Servicio Meteorológico Nacional. Servicio Metereológico Nacional (sede Dorrego).; Argentin

A Rice WRKY Gene Encodes a Transcriptional Repressor of the Gibberellin Signaling Pathway in Aleurone Cells

The molecular mechanism by which GA regulates plant growth and development has been a subject of active research. Analyses of the rice (Oryza sativa) genomic sequences identified 77 WRKY genes, among which OsWRKY71 is highly expressed in aleurone cells. Transient expression of OsWRKY71 by particle bombardment specifically represses GA-induced Amy32b α-amylase promoter but not abscisic acid-induced HVA22 or HVA1 promoter activity in aleurone cells. Moreover, OsWRKY71 blocks the activation of the Amy32b promoter by the GA-inducible transcriptional activator OsGAMYB. Consistent with its role as a transcriptional repressor, OsWRKY71 is localized to nuclei of aleurone cells and binds specifically to functionally defined TGAC-containing W boxes of the Amy32b promoter in vitro. Mutation of the two W boxes prevents the binding of OsWRKY71 to the mutated promoter, and releases the suppression of the OsGAMYB-activated Amy32b expression by OsWRKY71, suggesting that OsWRKY71 blocks GA signaling by functionally interfering with OsGAMYB. Exogenous GA treatment decreases the steady-state mRNA level of OsWRKY71 and destabilizes the GFP:OsWRKY71 fusion protein. These findings suggest that OsWRKY71 encodes a transcriptional repressor of GA signaling in aleurone cells

14-3-3-adaptor proteins are intermediates in ABA signal transduction during barley seed germination.

Proteins of the 14-3-3 family have well-defined functions as regulators of plant primary metabolism and ion homeostasis. However, neither their function nor action mechanism in plant hormonal signaling have been fully addressed. Here we show that abscisic acid (ABA) affects both expression and protein levels of five 14-3-3 isoforms in embryonic barley roots. As ABA prolongs the presence of 14-3-3 proteins in the elongating radicle, we tested whether 14-3-3s are instrumental in ABA action using RNA interference. Transient co-expression of 14-3-3 RNAi constructs along with an ABA-responsive promoter showed that each 14-3-3 is functional in generating an ABA response. In a yeast two-hybrid screen, we identified three new 14-3-3 interactors that belong to the ABF protein family. Moreover, using a yeast two-hybrid assay, we show that the transcription factor HvABI5, which binds to cis-acting elements of the ABA-inducible HVA1 promoter, interacts with three of the five 14-3-3s. Our analyses identify two 14-3-3 binding motifs in HvABI5 that are essential for 14-3-3 binding and proper in vivo trans-activation activity of HvABI5. In line with these results, 14-3-3 silencing effectively blocks trans-activation. Our results indicate that 14-3-3 genes/proteins are not only under the control of ABA, but that they control ABA action as well

Higher Fluid Balance Increases the Risk of Death from Sepsis: Results from a Large International Audit∗

Objectives: Excessive fluid therapy in patients with sepsis may be associated with risks that outweigh any benefit. We investigated the possible influence of early fluid balance on outcome in a large international database of ICU patients with sepsis. Design: Observational cohort study. Setting: Seven hundred and thirty ICUs in 84 countries. Patients: All adult patients admitted between May 8 and May 18, 2012, except admissions for routine postoperative surveillance. For this analysis, we included only the 1,808 patients with an admission diagnosis of sepsis. Patients were stratified according to quartiles of cumulative fluid balance 24 hours and 3 days after ICU admission. Measurements and Main Results: ICU and hospital mortality rates were 27.6% and 37.3%, respectively. The cumulative fluid balance increased from 1,217 mL (-90 to 2,783 mL) in the first 24 hours after ICU admission to 1,794 mL (-951 to 5,108 mL) on day 3 and decreased thereafter. The cumulative fluid intake was similar in survivors and nonsurvivors, but fluid balance was less positive in survivors because of higher fluid output in these patients. Fluid balances became negative after the third ICU day in survivors but remained positive in nonsurvivors. After adjustment for possible confounders in multivariable analysis, the 24-hour cumulative fluid balance was not associated with an increased hazard of 28-day in-hospital death. However, there was a stepwise increase in the hazard of death with higher quartiles of 3-day cumulative fluid balance in the whole population and after stratification according to the presence of septic shock. Conclusions: In this large cohort of patients with sepsis, higher cumulative fluid balance at day 3 but not in the first 24 hours after ICU admission was independently associated with an increase in the hazard of death

Assessment of the worldwide burden of critical illness: The Intensive Care Over Nations (ICON) audit

Background Global epidemiological data regarding outcomes for patients in intensive care units (ICUs) are scarce, but are important in understanding the worldwide burden of critical illness. We, therefore, did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality.Methods 730 participating centres in 84 countries prospectively collected data on all adult (>16 years) patients admitted to their ICU between May 8 and May 18, 2012, except those admitted for fewer than 24 h for routine postoperative monitoring. Participation was voluntary. Data were collected daily for a maximum of 28 days in the ICU and patients were followed up for outcome data until death or hospital discharge. In-hospital death was analysed using multilevel logistic regression with three levels: patient, hospital, and country.Findings 10 069 patients were included from ICUs in Europe (5445 patients; 54.1%), Asia (1928; 19.2%), the Americas (1723; 17.1%), Oceania (439; 4.4%), the Middle East (393; 3.9%), and Africa (141; 1.4%). Overall, 2973 patients (29.5%) had sepsis on admission or during the ICU stay. ICU mortality rates were 16.2% (95% CI 15.5-16.9) across the whole population and 25.8% (24.2-27.4) in patients with sepsis. Hospital mortality rates were 22.4% (21.6-23.2) in the whole population and 35.3% (33.5-37.1) in patients with sepsis. Using a multilevel analysis, the unconditional model suggested significant between-country variations (var=0.19, p=0.002) and between-hospital variations (var=0.43, p<0.0001) in the individual risk of in-hospital death. There was a stepwise increase in the adjusted risk of in-hospital death according to decrease in global national income.Interpretation This large database highlights that sepsis remains a major health problem worldwide, associated with high mortality rates in all countries. Our findings also show a significant association between the risk of death and the global national income and suggest that ICU organisation has an important effect on risk of death