The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury

<p>Abstract</p> <p>Background</p> <p>Animal and human studies suggest that inflammation and malnutrition are common in acute kidney injury (AKI) patients. However, only a few studies reported CRP, a marker of inflammation, albumin, prealbumin and cholesterol, markers of nutritional status were associated with the prognosis of AKI patients. No study examined whether the combination of inflammatory and nutritional markers could predict the mortality of AKI patients.</p> <p>Methods</p> <p>155 patients with hospital-acquired AKI were recruited to this prospective cohort study according to RIFLE (Risk, Injury, Failure, Lost or End Stage Kidney) criteria. C-reactive protein (CRP), and the nutritional markers (albumin, prealbumin and cholesterol) measured at nephrology consultation were analyzed in relation to all cause mortality of these patients. In addition, CRP and prealbumin were also measured in healthy controls (n = 45), maintenance hemodialysis (n = 70) and peritoneal dialysis patients (n = 50) and then compared with AKI patients.</p> <p>Results</p> <p>Compared with healthy controls and end-stage renal disease patients on maintenance hemodialysis or peritoneal dialysis, patients with AKI had significantly higher levels of CRP/prealbumin (<it>p </it>< 0.001). Higher level of serum CRP and lower levels of albumin, prealbumin and cholesterol were found to be significant in the patients with AKI who died within 28 days than those who survived >28 days. Similarly, the combined factors including the ratio of CRP to albumin (CRP/albumin), CRP/prealbumin and CRP/cholesterol were also significantly higher in the former group (<it>p </it>< 0.001 for all). Multivariate analysis (Cox regression) revealed that CRP/prealbumin was independently associated with mortality after adjustment for age, gender, sepsis and sequential organ failure assessment (SOFA, <it>p </it>= 0.027) while the others (CRP, albumin, prealbumin, cholesterol, CRP/albumin and CRP/cholesterol) became non-significantly associated. The hazard ratio was 1.00 (reference), 1.85, 2.25 and 3.89 for CRP/prealbumin increasing according to quartiles (<it>p </it>= 0.01 for the trend).</p> <p>Conclusions</p> <p>Inflammation and malnutrition were common in patients with AKI. Higher level of the ratio of CRP to prealbumin was associated with mortality of AKI patients independent of the severity of illness and it may be a valuable addition to SOFA score to independent of the severity of illness and it may be a valuable addition to SOFA score to predict the prognosis of AKI patients.</p

New SIMS U-Pb age constraints on the largest lake transgression event in the Songliao Basin, NE China.

The largest lake transgression event (LTE) associated with lake anoxic events (LAE) and periodic seawater incursion events (SWIE) in the Songliao Basin, northeastern China, occurred during deposition of the Cretaceous Nenjiang Formation. The Yaojia-Nenjiang Formation boundary (YNB) marks the beginning of the LTE, as well as LAE and SWIE. However, there is an absence of direct radioisotopic dating, and therefore the age of the YNB, as well as the beginning of LTE, together with their relationship with other geological events, is strongly debated. Here we present a new SIMS U-Pb zircon age from the lowermost Nenjiang Formation. The bentonite bed located 9.88 m above the YNB of the X1-4 borehole was analyzed. Twenty-five analyses of 25 zircons were conducted, which produced a weighted mean age of 85.5±0.6 Ma (MSWD = 0.87). Based on the average sediment accumulation rate, the age of the YNB is suggested to be 85.7 Ma, indicating that the LTE began in the Early Santonian. The new ages provide a precise chronostratigraphic framework for climatic and geological events. Our new results imply that the beginning of the LTE, LAE and SWIE occurred almost simultaneously with short-term sea level rise, and probably had a close relationship with OAE3

Citrate Pharmacokinetics in Critically Ill Patients with Acute Kidney Injury.

Regional citrate anticoagulation (RCA) is gaining popularity in continous renal replacement therapy (CRRT) for critically ill patients. The risk of citrate toxicity is a primary concern during the prolonged process. The aim of this study was to assess the pharmacokinetics of citrate in critically ill patients with AKI, and used the kinetic parameters to predict the risk of citrate accumulation in this population group undergoing continuous veno-venous hemofiltration (CVVH) with RCA.Critically ill patients with AKI (n = 12) and healthy volunteers (n = 12) were investigated during infusing comparative dosage of citrate. Serial blood samples were taken before, during 120 min and up to 120 min after infusion. Citrate pharmacokinetics were calculated and compared between groups. Then the estimated kinetic parameters were applied to the citrate kinetic equation for validation in other ten patients' CVVH sessions with citrate anticoagulation.Total body clearance of citrate was similar in critically ill patients with AKI and healthy volunteers (648.04±347.00 L/min versus 686.64±353.60 L/min; P = 0.624). Basal and peak citrate concentrations were similar in both groups (p = 0.423 and 0.247, respectively). The predicted citrate curve showed excellent fit to the measurements.Citrate clearance is not impaired in critically ill patients with AKI in the absence of severe liver dysfunction. Citrate pharmacokinetic data can provide a basis for the clinical use of predicting the risk of citrate accumulation.ClinicalTrials.gov Identifier NCT00948558

U-Pb concordia diagram showing secondary ion mass spectrometry analytical data for zircons from sample XING988 obtained from a bentonite layer in K₂n.

<p>Data-point error ellipses are 2σ.</p

Stratigraphy of borehole X1-4.

<p>Fig 2 was created by CorelDRAW X8 (<a href="http://www.coreldraw.com/us/pages/free-download" target="_blank">http://www.coreldraw.com/us/pages/free-download</a>). Copyright (c) 2018 [Huaiyu He] and its licensors. All rights reserved.</p

Secondary ion mass spectrometry zircon U-Pb data.

<p>Secondary ion mass spectrometry zircon U-Pb data.</p

Cathodoluminescence images of representative zircons from sample XING988.

<p>Ellipses on the analyzed zircon grains show the positions of U-Pb analytical sites.</p