Filter size not the anticoagulation method is the decisive factor in continuous renal replacement therapy circuit survival

Background/Aim: As continuous renal replacement therapy (CRRT) has emerged as a standard therapy in pediatric intensive care units (PICU), many related issues that may have an impact on circuit survival have gained in importance. Objective of the study was an evaluation of factors associated with circuit survival, including anticoagulation (ACG). Methods: Retrospective study that included 40 patients, who in total received 7636 hours of CRRT during 150 sessions (84 filters, 4260 hours with heparin anticoagulation (Hep-ACG); 66 filters, 3376 hours with regional citrate anticoagulation (RCA)). Results: The Kaplan-Meier analysis of the total circuit survival time depending on the type of ACG did not demonstrate a significant difference between Hep-ACG and RCA. The percentage of clotted filters was significantly higher in case of smaller filters (HF20: 58.8%; ST60: 29.5%; ST100: 15.8%), and their lifetime was significantly lower regardless of ACG (the mean and median lifetime for HF20: 38.7/27.0 h; for ST60: 54.1/72.0 h., for ST100: 62.1/72.0 h, respectively). Conclusions: Irrespectively of filter size, filter clotting occurs within the first 24 hours after the initiation of CRRT. Most commonly, clotting affects small filters, and their lifetime is significantly shorter as compared to larger filters regardless of the type of the ACG

Graphical interpretation of logistic regression results for clinical investigation with binomial output variable

W artykule zaproponowano graficzną formę prezentacji wyników regresji logistycznej, zastosowanej dla dwustanowej zmiennej zależnej i dwóch numerycznych zmiennych pomiarowych. Przed wyznaczeniem współczynników regresji jedna z tych zmiennych została poddana transformacji z wykorzystaniem logarytmu o podstawie 2. Opisano sposób przeprowadzenia odpowiednich obliczeń i zaprezentowano przykładowe wyniki, bazując na wynikach badania klinicznego (dla N=47 pacjentów) stężeń interleukiny 6 w surowicy dzieci poddawanych zabiegom kardiochirurgicznym w krążeniu pozaustrojowym, narażonych na ryzyko wystąpienia ostrego uszkodzenia nerek (OUSzN). Metoda pozwala na szybką identyfikację ryzyka i podjęcie właściwych działań terapeutycznych, w tym - terapii nerkozastępczej.In the paper there are proposed nomograms being graphical presentation of logistic regression results. Such graphs depict the probability and odds functions of the considered feature in a readable form. The investigated particular case is suited for the binomial output variable and two numerical input variables. The suggested presentation form has been selected with focus on clinical personnel accustomed to such form of data presentation. After introductory explanation of the logistic regression essentials with emphasis on the Gaussian-based distribution, there are presented assumption and resulting - alternative model formulation supported by the simulation experiment results, basing on the clinically collected data from 47 patients suspected to experience acute kidney injury (AKI) diagnosed accordingly to interleukin 6 serum concentration. The interpretation of unit selection for each input variable is shortly discussed along with the consequences of possible logarithmic transformation. The presented method allows for either quick, graphical, bedside risk identification and mapping of lifethreating condition or early introduction of renal replacement therapy