Srivali, Narat

Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for patients with symptomatic severe aortic stenosis who are at high risk of perioperative mortality. Previous studies showed increased risk of postoperative AKI with TAVR, but it is unclear whether differences in patient risk profiles confounded the results. To conduct a propensity-matched study, we identified all adult patients undergoing isolated aortic valve replacement for aortic stenosis at Mayo Clinic Hospital in Rochester, Minnesota from January 1, 2008 to June 30, 2014. Using propensity score matching on the basis of clinical characteristics and preoperative variables, we compared the postoperative incidence of AKI, defined by Kidney Disease Improving Global Outcomes guidelines, and major adverse kidney events in patients treated with TAVR with that in patients treated with SAVR. Major adverse kidney events were the composite of in-hospital mortality, use of RRT, and persistent elevated serum creatinine ≥200% from baseline at hospital discharge. Of 1563 eligible patients, 195 matched pairs (390 patients) were created. In the matched cohort, baseline characteristics, including Society of Thoracic Surgeons risk score and eGFR, were comparable between the two groups. Furthermore, no significant differences existed between the TAVR and SAVR groups in postoperative AKI (24.1% versus 29.7%; P =0.21), major adverse kidney events (2.1% versus 1.5%; P =0.70), or mortality >6 months after surgery (6.0% versus 8.3%; P =0.51). Thus, TAVR did not affect postoperative AKI risk. Because it is less invasive than SAVR, TAVR may be preferred in high-risk individuals.

AbstractAimTo investigate the association between giant cell arteritis (GCA) and risk of peripheral arterial disease (PAD).MethodsWe conducted a systematic review and meta‐analysis of observational cohort studies that reported relative risks, hazard ratios or standardized incidence ratios with 95% confidence comparing PAD risk in patients with GCA versus non‐GCA subjects. Pooled risk ratios and 95% confidence intervals were calculated using a random‐effect, generic inverse variance of DerSimonian and Laird.ResultsFour studies with 9789 patients with GCA and 236 728 controls were identified and included in our data analysis. The pooled risk ratio of PAD among patients with GCA compared with controls was 1.88 (95% CI 1.04–3.41). The statistical heterogeneity was high with an I2 of 89%.ConclusionOur study demonstrated a statistically significant increased risk of PAD among patients with GCA.

AbstractAimThis study aimed to investigate how varied methods of determining baseline serum creatinine (SCr) would affect acute kidney injury (AKI) diagnosis and prediction of 60 day mortality in critically ill patients following an episode of AKI.MethodsThis is a single‐centre retrospective study conducted at a tertiary referral hospital. All adult intensive care unit (ICU) patients between January and December 2011, who had at least one SCr values measured between 7 days and 180 days before hospital admission and during ICU stay, were analyzed. The baseline SCr was calculated using either the most recent (SCrmost recent) or the minimum (SCrmin) value of SCr measurement over the specified assessment period before hospital admission. AKI was defined based on KDIGO SCr definition. The primary outcome was 60 day mortality after ICU admission.ResultsA total of 4020 patients were included in the analysis. AKI was detected in 1204 (30.0%) using the SCrmin and 945 (23.5%) using the SCrmost recent (P < 0.001). Compared with patients without AKI regardless of baseline SCr methodology, the 60 day mortality risk of patients who developed AKI using the SCrmin and SCrmost recent was significantly increased (odds ratio (OR) = 3.74; 95% confidence interval (CI) 2.98–4.70). Similarly, the risk of 60 day mortality in patients who met AKI criteria using the SCrmin but not the SCrmost recent was significant higher than in patients without AKI (OR = 2.04; 95% CI 1.36–3.00).ConclusionUsing the minimum value of preadmission SCr as a baseline kidney function not only can detect more AKI cases, but also provides the better predictive ability for 60 day mortality.

Abstract Aim The objective of this meta‐analysis was to compare the effects of off‐pump and on‐pump coronary artery bypass grafting ( CABG ) on acute kidney injury ( AKI ) and the need of dialysis after surgery. Methods Comprehensive literature searches for randomized controlled trials ( RCTs ) of CABG with on‐pump and off‐pump was performed using MEDLINE , EMBASE , C ochrane D atabase of S ystematic R eviews, C ochrane C entral R egister of C ontrolled T rials S ystematic R eviews and clinicaltrials.gov from inception through S eptember 2014. Primary outcomes were the incidence of AKI and the need of dialysis. Mortality was assessed among the studies that reported renal outcomes. Pooled risk ratios ( RR s) and 95% confidence interval ( CI ) were calculated using a random‐effect, generic inverse variance method. Results Thirty‐three RCTs with 17 322 patients were enrolled in our study. Patients in the off‐pump CABG group had overall lower incidence of AKI (19.1%) compared with the on‐pump CABG group (22.2%). There was a protective effect of off‐pump CABG on the incidence of AKI compared with the on‐pump CABG group ( RR : 0.87; 95% CI : 0.77–0.98). However, there was no significant difference in the need for dialysis in the off‐pump group compared with the on‐pump group ( RR : 0.84; 95% CI 0.63–1.13). Within the selected trials, post hoc analysis assessing the mortality outcome demonstrated a pooled RR of 0.97 (95% CI , 0.77–1.23) in off‐pump versus on‐pump CABGs . Conclusions Our study demonstrates a beneficial effect of off‐pump CABG on the incidence of AKI . However, our meta‐analysis does not show benefits of the need of dialysis or survival among patients undergoing off‐pump CABG .

AbstractBackgroundThe reported risk of depression in patients with hypomagnesaemia is controversial.AimThe objective of this meta‐analysis was to assess the association between depression and hypomagnesaemia.MethodsA literature search was performed using MEDLINE, EMBASE, Cochrane Database and clinicaltrials.gov from inception through October 2014. Studies that reported odds ratios, relative risks or hazard ratios comparing the risk of depression in patients with hypomagnesaemia were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random‐effect, generic inverse variance method.ResultsSix observational studies (three cohort studies, two cross‐sectional studies and a case–control study) with a total of 19 137 patients were identified and included in the data analysis. The pooled RR of depression in patients with hypomagnesaemia was 1.34 (95% CI, 1.01–1.79, I2 = 33%). The association between depression and hypomagnesaemia was marginally insignificant after the sensitivity analysis including only cohort and case–control studies, with a pooled RR of 1.38 (95% CI, 0.92–2.07, I2 = 24%).ConclusionOur study demonstrates a potential association between hypomagnesaemia and depression. Further studies assessing the benefits of treatment of hypomagnesaemia in patients with depression are needed.

AbstractA possible causal relationship between sarcoidosis and malignancy has been the subject of debates for decades. To better understand this association, we conducted a systematic review and meta‐analysis of cohort studies that reported relative risk, hazard ratio or standardized incidence ratio with 95% confidence interval (CI) comparing the incidence of malignancy in patients with sarcoidosis versus non‐sarcoidosis participants. Pooled risk ratios (RR) and 95% CI were calculated using a random‐effect, generic inverse variance methodology. Five studies were identified and included in our data analyses. The pooled RR of malignancy in patients with sarcoidosis was 1.21 (95% CI: 1.04–1.40). However, when we performed a sensitivity analysis that included only studies that compared the incidence of malignancy after the first year of the diagnosis of sarcoidosis with the incidence of malignancy after the first year of index date for non‐sarcoidosis controls, the pooled risk ratio decreased and did not reach statistical significance (RR 1.13, 95% CI: 0.97–1.32). Furthermore, analysis for publication bias has suggested that publication bias in favour of positive studies may be present. In conclusion, after accounting for possible detection bias and publication bias, there does not appear be a significant association between sarcoidosis and malignancy.