5 research outputs found

    Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

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    IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

    Accuracy of ultrasound-measured bladder wall thickness for the diagnosis of detrusor overactivity

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    Objectives: To evaluate the usefulness and accuracy of ultrasound-measured urinary bladder wall thickness (BWT) in the diagnosis of detrusor overactivity (DO). Subjects and methods: Patients who had undergone urodynamic testing due to irritative lower urinary tract symptoms (LUTS) were evaluated for participation in this study. All patients were submitted to thorough history taking, general physical and genital examination, urine analysis, urine culture, blood chemistry, uroflowmetry and abdominal ultrasonography. The patients were categorized into 2 groups according to the urodynamic diagnosis: group 1 consisted of 62 patients with documented DO and group 2 of 36 patients with no evidence of DO (controls). Ultrasound measurement of BWT was performed with the bladder filled with 50 ml of normal saline solution. The data were analyzed and the results of both groups were compared using suitable analytical tests. Results: The age and gender distribution were comparable. Urgency was the main symptom in both groups. Mean BWT measured by ultrasound was significantly higher in group 1 than in group 2 (5.54 ± 1.95 mm versus 3.22 ± 0.84 mm, p < 0.001) with an overall sensitivity of 91.9% in predicting DO at a cutoff point of 3.75 mm. Conclusions: Measurement of BWT using ultrasonography is a sensitive diagnostic test for the prediction of DO. Further studies on a larger number of patients are required to validate these results

    Tubular and Glomerular Biomarkers of Acute Kidney Injury in Newborns

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    Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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