Role of Cystatin C in predicting acute kidney injury after surgery

Introduction Surgery is a known risk factor for acute kidney injury (AKI) which causes considerable implications on mortality and morbidity. We investigated the incidence of AKI following surgery and determine the diagnostic capability of Cystatin C (CysC) in diagnosing and predicting AKI. Method This is a single centre, prospective study of patients who underwent surgery under general or regional anaesthesia between September 2021 to February 2022. Serum Creatinine and plasma CysC were measured at three intervals (admission, within 24 hours and 72 hours following surgery). Area under receiver operating characteristic curve (AUROC) analysis was used to derive the CysC cut-off value to diagnose and predict AKI. AKI was defined based on creatinine criteria of the Kidney Disease: Improving Global Outcome (KDIGO) criteria. Result A total of 100 patients included with mean age of 58 ± 14 years old and 51% were male. AKI occurred in 20 (20%) patients, mainly stage 1 (55%), followed by stage 2 (30%) and stage 3 (15%). On AUROC analysis, CysC has the highest AUC at 0.93 (Sensitivity 87.7%, Specificity 86.7%) with a cut-off value at 1.67mg/dL for AKI on day three after surgery. Post operative day one CysC predicts day three AKI at a cut-off value of 1.595mg/dL AUC=0.86, (Sensitivity 87.5%, Specificity 79.5%)]. Conclusion Cystatin C is a strong predictor for AKI as early as 1 day following surgery with a cut-off value at 1.595mg/dL. Early recognition of patients at risk to develop AKI may prompt surgeons to be vigilant in managing at-risk patients postoperatively

Prevalence and factors associated with augmented renal clearance after surgery

Introduction Augmented Renal Clearance (ARC) has been described mainly in critically ill patients which may place patients at risk of therapeutic failure. We investigated the prevalence of ARC following surgery, determine the risk factors and the outcome. Method This is a single centre, prospective study of patients who underwent surgery under general or regional anaesthesia between September 2021 to February 2022. Serum Creatinine, urine Creatinine and 4-hour urine volume were measured within 24 hours following surgery. The significant risk actors for ARC were evaluated by using multiple logistic regression model. ARC was defined as measured Creatinine Clearance >130ml/min/1.73m2. Result A total of 75 patients were included with a mean age of 57 ± 14 years old and 59% were female. ARC occurred in 20 (27%) patients within 24 hours following surgery. The mean age for ARC group was 47.7 ± 13.3 as compared to 60.9 ± 13.6 years old in the No ARC group. On multiple logistic regression analysis, only younger age was found to be an independent predictor for ARC (p< 0.001) (OR 0.9, 95% CI 0.9-1.0). 85% of patients in the ARC cohort were not nursed in the ICU postoperatively (p=0.04). Although patients in the ARC cohort required longer hospital stay (24.7 ± 36.5 vs. 12.7 ± 14.4 days), the figure was not statistically significant (p=0.197). Conclusion Significant proportion of ARC were identified among patients underwent surgery whom did not require ICU admission postoperatively. This represents an important finding as ARC is a key predictor for subtherapeutic drug concentration

Expression of GBS virulence genes in high vaginal swabs of symptomatic pregnant women at Hospital Tengku Ampuan Afzan, Kuantan

During pregnancy, group B streptococcus (GBS) colonization is known as one of the risk factors for preterm birth and consequently neonatal infections. Previous in-vitro experiments using human cells and in vivo animal models have portrayed the important roles of these virulence factors including hemolytic pigment (CylE), hyaluronidase (HylB), serine-rich protein (Srr) and bacterial surface adhesion of GBS (BsaB) in mediating GBS colonization and intrauterine ascending infection, leading to preterm delivery. The aim of this study is to investigate the association between mRNA expression of women and preterm delivery. GBS isolates were obtained from high vaginal swabs of pregnant women(n=40) with gestational age less than 37 weeks and symptoms including preterm labour, preterm premature rupture of membrane (pPROM), vaginal discharge and vaginal bleeding. Socio-demographic details, obstetric history and delivery outcomes of these women were also enquired. RNA was extracted from these GBS isolates and RT-qPCR was performed to determine the relative mRNA expression of GBS virulence genes including CylE,HylB, Srr and BsaB. Socio-demographic details and obstetric history were not found to be associated with the delivery outcomes of these women. Women with preterm labour and pPROM who delivered prematurely were demonstrated with higher expression of HylB and Cyl Egenes, in comparison to women with term delivery. The expression of Srr and BsaB genes were both similar between symptomatic pregnant women who had term and preterm delivery. Theseresultssuggestthatfollowingvaginalcolonization,bothCylEandHylBgenespossiblycontributetointrauterineascendinginfectionandinflammation,leading to preterm delivery in humans.Thus, hemolytic pigment and hyaluronidase may be targeted for exploratory and pre-clinical stages of vaccine development, which is a good alternative to intrapartum antibiotic prophylaxis in order to prevent neonatal GBS infections

Expression of GBS virulence genes in high vaginal swabs of symptomatic pregnant women at Hospital Tengku Ampuan Afzan, Kuantan

During pregnancy, group B streptococcus (GBS) colonization is known as one of the risk factors for preterm birth and consequently neonatal infections. Previous in-vitro experiments using human cells and in vivo animal models have portrayed the important roles of these virulence factors including hemolytic pigment (CylE), hyaluronidase (HylB), serine-rich protein (Srr) and bacterial surface adhesion of GBS (BsaB) in mediating GBS colonization and intrauterine ascending infection, leading to preterm delivery. The aim of this study is to investigate the association between mRNA expression of women and preterm delivery. GBS isolates were obtained from high vaginal swabs of pregnant women(n=40) with gestational age less than 37 weeks and symptoms including preterm labour, preterm premature rupture of membrane (pPROM), vaginal discharge and vaginal bleeding. Socio-demographic details, obstetric history and delivery outcomes of these women were also enquired. RNA was extracted from these GBS isolates and RT-qPCR was performed to determine the relative mRNA expression of GBS virulence genes including CylE,HylB, Srr and BsaB. Socio-demographic details and obstetric history were not found to be associated with the delivery outcomes of these women. Women with preterm labour and pPROM who delivered prematurely were demonstrated with higher expression of HylB and Cyl Egenes, in comparison to women with term delivery. The expression of Srr and BsaB genes were both similar between symptomatic pregnant women who had term and preterm delivery. Theseresultssuggestthatfollowingvaginalcolonization,bothCylEandHylBgenespossiblycontributetointrauterineascendinginfectionandinflammation,leading to preterm delivery in humans.Thus, hemolytic pigment and hyaluronidase may be targeted for exploratory and pre-clinical stages of vaccine development, which is a good alternative to intrapartum antibiotic prophylaxis in order to prevent neonatal GBS infections

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)