Anti-MuSK positivity on plasmapheresis liquid in a double seronegative myasthenia gravis patient

International audienc

Short- and Long-Term Outcome of Chronic Dialyzed Patients Admitted to the ICU and Assessment of Prognosis Factors

International audienceObjectives: Data about end-stage kidney disease patients admitted to the ICU are scarce, dated, and mostly limited to short-term survival. The aim of this study was to assess the short- and long-term outcome and to determine the prognostic factors for end-stage kidney disease patients admitted to the ICU.Design: Prospective observational study.Setting: Medical ICUs in two university hospitals.Patients: Consecutive end-stage kidney disease patients admitted in two ICUs between 2012 and 2017.Intervention: None.Measurements and Main Results: Renal replacement therapy variables, demographic, clinical, and biological data were collected. The requirement of mechanical ventilation and vasopressive drugs were also collected. In-ICU and one-year mortality were estimated and all data were analyzed in order to identify predictive factors of short and long-term mortality. A total of 140 patients were included, representing 1.7% of total admissions over the study period. Septic shock was the main reason for admission mostly of pulmonary origin. Median Simplified Acute Physiology Score II and Sequential Organ Failure Assessment score were at 63 and 6.7, respectively. In-ICU, hospital, and 1-year mortality were 41.4%, 46.4%, and 63%, respectively. ICU mortality was significantly higher as compared with ICU control group non-end-stage kidney disease (25% vs 41.4%; p = 0.005). By multivariate analysis, the short-term outcome was significantly associated with nonrenal Sequential Organ Failure Assessment score, and with the requirement of mechanical ventilation or/and vasoconstrictive agents during ICU stay. One-year mortality was associated with increased dialysis duration (> 3 yr) and phosphatemia (> 2.5 mmol/L), with lower albuminemia (< 30 g/L) and nonrenal Sequential Organ Failure Assessment greater than 8.Conclusions: End-stage kidney disease patients presented frequently severe complications requiring critical care that induced significant short- and long-term mortality. ICU and hospital mortality depended mainly on the severity of the critical event reflected by Sequential Organ Failure Assessment score and the need of mechanical ventilation and/or catecholamines. One-year mortality was associated with both albuminemia and phosphatemia and with prior duration of chronic dialysis treatment, and with organ failure at ICU admission

Heterogeneity of Cause, Care, and Prognosis in Severe Acute Kidney Injury in Hospitalized Patients: A Prospective Observational Study

International audienceKDIGO (Kidney Disease: Improving Global Outcomes) defines acute kidney injury (AKI) solely by serum creatinine (SCr) and urine output variation. Severe AKI is a syndrome covering various clinical situations.Objective:To describe severe AKI heterogeneity by department of hospitalization.Design:This is a prospective observational single-center study.Setting:Adult patients hospitalized in a French tertiary hospital from August 2016 to December 2017.Patients:All adults with severe AKI, defined by dialysis for AKI or an increase in SCr above 354 μmol/L.Measurements:Patient characteristics, clinical and laboratory presentation, AKI cause, medical indication for renal replacement therapy (RRT), planned palliative care, and vital status 30 days after severe AKI.Methods:A global description of patient characteristics, care, and prognosis and comparison by department of hospitalization: intensive care unit (ICU), nephrology, and others.Results:The study included 480 patients (73% men, median age: 72 years, range: 64-83), with medical histories including cardiovascular disease, diabetes, cancer, and chronic kidney disease. Principal causes were sepsis (104; 22%), hypovolemia (98; 20%), obstructive AKI (84; 18%), acute tubular necrosis (ATN; 74; 15%), and cardiorenal syndrome (51; 11%). Severe AKI was diagnosed in the ICU for 188 (39%) patients, the nephrology department for 130 (27%), and in other wards for 162 (34%). Patient characteristics differed by department for age, comorbidity, cause, and RRT use and indications. Palliative care was planned for 72 (15%) patients, most frequently in other wards.Limitations:We studied a subgroup of stage 3 KDIGO AKI patients in a single center without cardiac surgery.Conclusion:Patients hospitalized for severe AKI have frequent and various comorbidities, different clinical presentations, care, hospitalization in various departments, and different prognosis. The heterogeneity of this severe AKI implies the need for personalized care, which requires prognostic tools that include information besides SCr and diuresis.Le KDIGO définit l’insuffisance rénale aigüe (IRA) uniquement par une variation de la créatinine sérique (SCr) et de la diurèse. L’IRA grave est un syndrome couvrant diverses situations cliniques.Objectif:Décrire l’hétérogénéité de l’IRA grave selon l’unité d’hospitalisation.Type d’étude:Étude observationnelle prospective menée dans un seul centre.Sujets:Des adultes hospitalisés entre août 2016 et décembre 2017 dans un centre de soins tertiaires en France.Participants:Tous les adultes atteints d’IRA grave, définie par un traitement de dialyse ou un taux de SCr au-delà de 354 µmol/l.Mesures:Les caractéristiques du patient, le tableau clinique et de laboratoire, l’étiologie de l’IRA, l’indication médicale pour une thérapie de remplacement rénal (TRR), le plan de soins palliatifs et le statut vital 30 jours après l’épisode d’IRA grave.Méthodologie:Une description globale des caractéristiques des patients, des soins et du pronostic, ainsi qu’une comparaison selon l’unité d’hospitalisation: unité de soins intensifs (USI), néphrologie et autres.Résultats:L’étude portait sur 480 patients (73 % d’hommes) âgés de 64 à 83 ans (âge médian: 72 ans) avec des antécédents incluant maladies cardiovasculaires, diabète, cancer ou insuffisance rénale chronique. Les principales causes de l’IRA grave étaient une septicémie (104, 22 %), une hypovolémie (98, 20 %), une IRA obstructive (84, 18 %), une nécrose tubulaire aigüe (74, 15 %) ou un syndrome cardio-rénal (51, 11 %). Le diagnostic avait été posé à l’USI pour 188 patients (39 %), en néphrologie pour 130 patients (27 %) et dans d’autres unités pour 162 patients (34 %). Les caractéristiques des patients différaient entre les unités de soins en ce qui concerne l’âge, les comorbidités, l’étiologie et les indications de TRR. Un plan de soins palliatifs existait pour 72 patients (15 %), le plus souvent dans les autres unités.Limites:Nous avons étudié un sous-groupe de patients atteints d’IRA de stade 3 (classification KDIGO) dans un seul centre sans chirurgie cardiaque.Conclusion:Les patients hospitalisés pour une IRA grave présentent des comorbidités, des tableaux cliniques, des soins et des pronostics variés et sont admis dans différentes unités d’hospitalisation. Cette hétérogénéité de l’IRA grave met en relief le besoin de soins personnalisés qui nécessitent des outils pronostics basés sur des informations autres que la SCr et la diurèse