EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Análise de custos de diferentes grupos genéticos de bovinos de corte terminados em confinamento Cost analyses on different beef cattle genetic groups finished in feedlot condition

O desempenho de 149 animais, machos inteiros, confinados por períodos variáveis de acordo com acabamento de carcaça, foi utilizado para avaliar a eficiência econômica dos grupos genéticos Nelore sobreano, Nelore desmamado, ½ Valdostana ½ Nelore, ½ Simental ½ Nelore, ½ Braford ½ Brangus, ½ Braford ¼ Angus ¼ Nelore, Brangus, ½ Canchim ¼ Angus ¼ Nelore e ½ Canchim ¼ Simental ¼ Nelore. O custo operacional variável, o custo por quilograma de carne produzida e a margem bruta foram analisados pelo método dos quadrados mínimos ordinários, mediante modelo estatístico que incluiu o efeito do grupo genético e o peso inicial como covariável, comparando-se as médias pelo teste Duncan (P<0,05). Os maiores custos operacionais variáveis no período, em US$, foram do ½ Canchim ¼ Simental ¼ Nelore (160,8), Nelore desmamado (158,7) e ½ Canchim ¼ Angus ¼ Nelore (155,1). Os menores custos por quilograma de carne, em US$, foram do Nelore sobreano (0,79) e Brangus (0,82). A maior margem bruta, em US$, foi obtida pelo grupo genético Nelore sobreano (94,6), seguida do Brangus (71,5) e do ½ Simental ½ Nelore (46,6). Os grupos genéticos mais pesados no início do confinamento e que permaneceram menos tempo confinados apresentaram maior margem bruta.<br>Data on feedlot performance of 149 steers were used to evaluate the economic efficiency of yearling Nellore, weaned Nellore, ½ Valdostana ½ Nellore, ½ Simmental ½ Nellore, ½ Braford ½ Brangus, ½ Braford ¼ Angus ¼ Nellore, Brangus, ½ Canchim ¼ Angus ¼ Nellore and ½ Canchim ¼ Simmental ¼ Nellore. Variable operational costs, kg of meat costs, and gross margin income were analyzed by ordinary least squares procedure including the effects of genetic groups and initial weight in the feedlot as a covariate. The means were compared by Duncan test (P<.05). The largest variable operational costs in the period, in US$, were observed for ½ Canchim ¼ Simmental ¼ Nellore (160.8), weaned Nellore (158.7) and ½ Canchim ¼ Angus ¼ Nellore (155.1). The lowest kg of meat costs, in US$, were observed for yearling Nellore (0.79) and Brangus (0.82). The highest gross margin was obtained for yearling Nellore (94.6), followed by Brangus (71.5) and ½ Simmental ½ Nellore (46.6) The heaviest genetic groups in the beginning of the feed lot were confined for shorter periods and had the largest gross margins