2012 February 22

Predictors of Hyperkalemia and Death in Patients With Cardiac and Renal Disease.

Feb 222012

Predictors of Hyperkalemia and Death in Patients With Cardiac and Renal Disease.

Am J Cardiol. 2012 Feb 17;

Authors: Jain N, Kotla S, Little BB, Weideman RA, Brilakis ES, Reilly RF, Banerjee S

Abstract
Predictors of hyperkalemia in patients with cardiovascular disease (CVD; defined as patients with hypertension and heart failure) and associated chronic kidney disease (CKD) are not well established. The aim of this study was to ascertain risk factors of hyperkalemia (defined as serum potassium concentration >5.0 mEq/L) and associated all-cause mortality in patients with CVD treated with antihypertensive drugs that impair potassium homeostasis. In a retrospective analysis using a logistic regression model, risk factors for hyperkalemia and all-cause mortality were analyzed in 15,803 patients with CVD treated with antihypertensive drugs. The mean estimated glomerular filtration rate and mean serum potassium concentration were 55.55 ml/min/1.73 m(2) and 4.06 mEq/L, respectively. Hyperkalemia was observed in 24.5% of study patients and 1.7% of total hospital admissions. Compared to patients with normokalemia, those with hyperkalemia had a higher percentage of death (6.25% vs 2.92%, p = 0.0001) and admissions (7.80% vs 5.04%, p = 0.0001). Predictors of hyperkalemia were CKD stage (odds ratio [OR] 2.14, 95% confidence interval [CI] 2.02 to 2.28), diabetes mellitus (OR 1.59, 95% CI 1.47 to 1.72), coronary artery disease (OR 1.32, 95% CI 1.21 to 1.43), and peripheral vascular disease (OR 1.55, 95% CI 1.36 to 1.77). Predictors of all-cause mortality were CKD stage (OR 1.26, 95% CI 1.12 to 1.43), hyperkalemic event (OR 1.56, 95% CI 1.30 to 1.88), age (OR 1.04, 95% CI 1.03 to 1.05), and hospitalization (OR 1.04, 95% CI 1.04 to 1.05). In conclusion, hyperkalemia is encountered frequently in patients with established CVD who are taking antihypertensive drugs and is associated with increases in all-cause mortality and hospitalizations. Advanced CKD, diabetes mellitus, coronary artery disease, and peripheral vascular disease are independent predictors of hyperkalemia.

PMID: 22342847 [PubMed - as supplied by publisher]

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Brain Natriuretic Peptide Levels as a Predictor for New Atrial Fibrillation During Hospitalization in Patients With Acute Ischemic Stroke.

Am J Cardiol Start a Discussion »

Feb 222012

Brain Natriuretic Peptide Levels as a Predictor for New Atrial Fibrillation During Hospitalization in Patients With Acute Ischemic Stroke.

Am J Cardiol. 2012 Feb 14;

Authors: Shibazaki K, Kimura K, Fujii S, Sakai K, Iguchi Y

Abstract
The aim of this study was to investigate the relation between brain natriuretic peptide (BNP) levels and the detection rate of new documented atrial fibrillation (AF) after ischemic stroke. Consecutive patients with ischemic stroke prospectively enrolled within 24 hours of onset. Patients with AF on admission electrocardiography or with histories of AF were excluded. The plasma BNP level was measured on admission, and the factors associated with new documented AF were investigated by multivariate logistic regression analysis. Furthermore, the detection rates of AF according to BNP level were evaluated. A total of 584 patients were enrolled. AF was detected in 40 patients (new AF group; 6.8%). The median BNP level of the new AF group was significantly higher than for the non-AF group (186.6 pg/ml [interquartile range 68.7 to 386.3] vs 35.2 pg/ml [interquartile range 15.9 to 80.1], p <0.0001). The cut-off level, sensitivity, and specificity of BNP levels to distinguish the new AF group from the non-AF group were 65.0 pg/ml, 80%, and 70%, respectively. Multivariate logistic regression analysis demonstrated that National Institutes of Health Stroke Scale score >7 (odds ratio 3.4, 95% confidence interval 1.685 to 7.006, p = 0.0007) and a plasma BNP level >65.0 pg/ml (odds ratio 6.8, 95% confidence interval 2.975 to 15.359, p <0.0001) were independently associated with new AF. The detection rates of AF according to BNP level were as follows: 2% of patients with <50 pg/ml, 4% of those with 50 to <100 pg/ml, 12% of those with 100 to <200 pg/ml, 26% of those with 200 to <400 pg/ml, and 38% of those with ?400 pg/ml. In conclusion, BNP levels can predict new AF in patients with acute ischemic stroke. Elevated BNP levels result in an increase in the frequency of detection of new AF.

PMID: 22341921 [PubMed - as supplied by publisher]

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Modified-orientation log to assess hepatic encephalopathy.

Aliment Pharmacol Ther Start a Discussion »

Feb 222012

Modified-orientation log to assess hepatic encephalopathy.

Aliment Pharmacol Ther. 2012 Feb 21;

Authors: Salam M, Matherly S, Farooq IS, Stravitz RT, Sterling RK, Sanyal AJ, Gibson DP, Wade JB, Thacker LR, Heuman DM, Fuchs M, Puri P, Luketic V, Bickston SJ, Bajaj JS

Abstract
BACKGROUND: The subjectivity of the West-Haven criteria (WHC) hinders hepatic encephalopathy (HE) evaluation. The new HE classification has emphasised assessment of orientation. The modified-orientation log (MO-log, eight questions, scores 0-24; 24 normal) is adapted from a validated brain injury measure. AIM: To validate MO-log for HE assessment in cirrhosis. METHODS: Cirrhotics admitted with/without HE were administered MO-log. We collected cirrhosis/HE details, admission/daily MO-logs and WHC (performed by different examiners), time to reach normal mentation (MO-log ?23) and MO-log/WHC change (?) over day 1. Outcomes were in-hospital mortality, duration to normal mentation and length-of-stay (LOS). Regressions were performed for each outcome. MO-log inter-rater reliability was measured. RESULTS: Ninety-six HE (55 ± 8 years, MELD 21) and 20 non-HE (54 ± 5 years, MELD 19) in-patients were included. In HE patients, median admission WHC was 3 (range 1-4). Mean MO-log was 12 ± 8 (range 0-22). Their LOS was 6 ± 5 days and 13% died. Time to reach normal mentation was 2.4 ± 1.7 days. Concurrent validity: there was a significant negative correlation between admission MO-log and WHC (r = -0.79, P < 0.0001). Discriminant validity: admission MO-logs were significantly lower in those who died (7 vs. 12, P = 0.03) and higher in those admitted without HE (23.6 vs. 12, P < 0.0001). MO-log improved in 69% on day 1 (?MO-log 4 ± 8) which was associated with lower duration to normal mentation (2 vs. 3.5 days, P = 0.03) and mortality (3% vs.43%, P < 0.0001), not ?WHC. Regression models for all outcomes included admission/?MO-log but not WHC as a predictor. Inter-rater reliability: ICC for MO-log inter-rater observations was 0.991. CONCLUSIONS: Modified-orientation log is a valid tool for assessing severity and is better than West-Haven criteria in predicting outcomes in hospitalised hepatic encephalopathy patients.

PMID: 22348593 [PubMed - as supplied by publisher]

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Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound.

Crit Care Start a Discussion »

Feb 222012

Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound.

Crit Care. 2012 Feb 17;16(1):R30

Authors: Testa A, Soldati G, Copetti R, Giannuzzi R, Portale G, Gentiloni-Silveri N

Abstract
ABSTRACT: INTRODUCTION: The clinical picture of the pandemic influenza A (H1N1)v ranges from a self-limiting afebrile infection to a rapidly progressive pneumonia. Prompt diagnosis and well-timed treatment are recommended. Chest radiography (CRx) often fails to detect the early interstitial stage. The aim of this study was to evaluate the role of bedside chest ultrasonography (US) in the early management of 2009 influenza A (H1N1)v infection. METHODS: 98 patients who addressed to the Emergency Department complaining influenza-like symptoms were enrolled in the study. Patients not displaying symptoms of acute respiratory distress were discharged without further investigations. Among patients with clinical suspect of a community-acquired pneumonia, cases encountering other diagnosis or comorbidities were excluded from the study. Clinical history, laboratory tests, chest Rx, CT scan if indicated, contributed to define the diagnosis of pneumonia in remaining patients. Chest US was performed by an emergency physician, looking for presence of interstitial syndrome, alveolar consolidation, pleural line abnormalities and pleural effusion, in 34 patients with a final diagnosis of pneumonia, 16 having normal initial CRx, and in 33 without pneumonia, as controls. RESULTS: Chest US was carried out without discomfort in all subjects, requiring a relatively short time (9 minutes, range 7-13). An abnormal US pattern was detected in 32/34 patients with pneumonia (94.1%). A prevalent US pattern of interstitial syndrome was depicted in 15/16 patients with normal initial CRx, of whom 10 (62.5%) encountering a final diagnosis of viral (H1N1) pneumonia. Patients with pneumonia and abnormal initial CRx, of whom only 4 having a final diagnosis of viral (H1N1) pneumonia (22,2 %, P<0.05), mainly displayed an US pattern of alveolar consolidation. Finally, a positive US pattern of interstitial syndrome was found in 5/33 controls (15.1%). False negatives were 2/34 cases (5.9%) and false positives 5/33 (15.1%), with sensitivity of 94.1%, specificity 84.8%, positive predictive value 86.5% and negative predictive value 93.3%. CONCLUSIONS: Bedside chest US represents an effective tool for diagnosing pneumonia in Emergency Department. Also, it can accurately provide early stage detection of patients with (H1N1)v pneumonia having an initial normal CRx. Its routine integration into their clinical management is proposed.

PMID: 22340202 [PubMed - as supplied by publisher]

Link to Article at PubMed

Antibiotic use in Vietnamese hospitals: A multicenter point-prevalence study.

Am J Infect Control Start a Discussion »

Feb 222012

Antibiotic use in Vietnamese hospitals: A multicenter point-prevalence study.

Am J Infect Control. 2012 Feb 16;

Authors: Thu TA, Rahman M, Coffin S, Harun-Or-Rashid M, Sakamoto J, Hung NV

Abstract
BACKGROUND: Inappropriate antibiotic prescribing appears to be common worldwide and is contributing to the selection of resistant organisms. This study examined the prevalence of antibiotic prescription and the appropriateness of indications for these prescriptions in 36 representative general hospitals across Vietnam. METHODS: A point-prevalence study was performed between February and December 2008. All inpatients on the day of the survey were included in the analysis. Standard published guidelines were used to evaluate the appropriateness of indications for antibiotic prescription. RESULTS: On the day of the study, 5,104 of 7,571 patients (67.4%) were receiving antibiotic therapy. The antibiotic prescription rate was highest in surgery wards (93.2%) and lowest in medical wards (48.2%). Of the 5,104 patients receiving antibiotics, the most commonly prescribed agents were cephalosporins (70.2%), penicillins (21.6%), and aminoglycosides (18.9%). Approximately one-third of the patients (1,573 of 5,104) had an inappropriate indication for prescription. Risk factors independently associated with inappropriate indication for antibiotic prescription were seen in hospitals at the national level, obstetrics and gynecology departments, and surgical wards. CONCLUSIONS: Our data indicate a high rate of antibiotic use in Vietnamese hospitals, and also a high prevalence of inappropriate indications for antibiotic prescriptions. These findings suggest important areas for intervention and implementation of antibiotic stewardship policies in Vietnamese hospitals.

PMID: 22341530 [PubMed - as supplied by publisher]

Link to Article at PubMed

Inappropriate use of urinary catheters and its common complications in different hospital wards.

Saudi J Kidney Dis Transpl Start a Discussion »

Feb 222012

Inappropriate use of urinary catheters and its common complications in different hospital wards.

Saudi J Kidney Dis Transpl. 2012 Jan;23(1):63-7

Authors: Davoodian P, Nematee M, Sheikhvatan M

Abstract
Inappropriate use of indwelling urinary catheters (IUCs) and their related complications is one of the most important problems in hospital wards. The aim of this study was to evaluate inappropriate use of IUCs and their complications among patients in Tehran, Iran. Two hundred and six consecutive patients hospitalized in the intensive care unit (ICU) as well as medical and surgical wards at the Shahid Mohammadi Hospital in Bandarabbas from September 1 to 30, 2005 and in whom IUCs were used, were studied. Data collected included age of the patients, diagnoses, reason for use of IUC and the complications related to it. Overall, 164 patients (79.6%) had IUCs used appropriately while 42 of them (20.6%) were catheterized unjustifiably. Inappropriate use of IUCs in the ICU, medical and surgical wards was reported in 12 (18.5%), 16 (19.0%) and 14 patients (24.6%), respectively. The most common complication of IUCs was urinary tract infection, which occurred in 91 patients (44.2%) and hematuria, which was seen in 3.9% of the patients. Our study suggests that inappropriate use of IUCs is prevalent, particularly in the surgical wards, and the most common complication observed was catheter-associated urinary tract infection.

PMID: 22237221 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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