Thongprayoon, Charat

Background: The aim of this study was to assess the relationship between admission serum potassium and one-year mortality in all adult hospitalized patients. Methods: All adult hospitalized patients who had an admission serum potassium level between the years 2011 and 2013 at a tertiary referral hospital were enrolled. End-stage kidney disease patients were excluded. Admission serum potassium was categorized into levels of ≤2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4, 4.5–4.9, 5.0–5.4, and ≥5.5 mEq/L. Cox proportional hazard analysis was performed to assess the independent association between admission serum potassium and one-year mortality after hospital admission, using an admission potassium level of 4.0–4.4 mEq/L as the reference group. Results: A total of 73,983 patients with mean admission potassium of 4.2 ± 0.5 mEq/L were studied. Of these, 12.6% died within a year after hospital admission, with the lowest one-year mortality associated with an admission serum potassium of 4.0–4.4 mEq/L. After adjustment for age, sex, race, estimated glomerular filtration rate (eGFR), principal diagnosis, comorbidities, medications, acute kidney injury, mechanical ventilation, and other electrolytes at hospital admission, both a low admission serum potassium ≤3.9 mEq/L and elevated admission potassium ≥5.0 mEq/L were significantly associated with an increased risk of one-year mortality, when compared with an admission serum potassium of 4.0–4.4 mEq/L. Subgroup analysis of chronic kidney disease and cardiovascular disease patients showed similar results. Conclusion: This study demonstrated that hypokalemia ≤3.9 mEq/L and hyperkalemia ≥5.0 mEq/L at the time of hospital admission were associated with higher one-year mortality.

Abstract Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for many inflammatory disorders and pain-related illnesses. Despite their widespread use, the association between NSAIDs and the incidence of atrial fibrillation (AF) remains unclear. The aim of this systematic review and meta-analysis is to investigate this association. Methods A systematic review was conducted in MEDLINE, EMBASE and Cochrane databases from inception through August 2019 to identify studies that evaluated the risk of AF among patients using NSAIDs. Pooled risk ratios (RRs) and 95% CI were calculated using a random-effect, generic inverse variance method. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42019141609). Results Eight observational studies (four case–control studies and four cohort studies) with a total of 14 806 420 patients were enrolled. When compared with nonNSAIDs users, the pooled RR of AF in patients with NSAIDs use was 1.29 (95% CI 1.19–1.39). Meta-analyses based on the type of study were additionally performed. Subgroup analysis by study design revealed a significant association between the use of NSAIDs and AF for both case–control studies (pooled RR 1.37; 95% CI, 1.15–1.63) and cohort studies (pooled RR 1.22; 95% CI, 1.14–1.31). Sub-analyses based on specific NSAIDs showed pooled RRs of AF in patients using ibuprofen of 1.30 (95% CI 1.22–1.39), naproxen of 1.44 (95% CI 1.18–1.76) and diclofenac of 1.37 (95% CI 1.10–1.71), respectively. Funnel plot and Egger’s regression asymmetry tests were performed and showed no publication bias. Conclusion NSAID use is associated with incident AF. Our study also demonstrated a consistent result among different NSAIDs.

AbstractBackgroundIn the United States, increasing ethnic diversity has been apparent. However, the epidemiology and trends of BKV genotypes remain unclear. This meta‐analysis was conducted with the aim to assess the prevalence of BKV genotypes among kidney transplant (KTx) recipients in the United States.MethodsA comprehensive literature review was conducted through October 2018 utilizing MEDLINE, Embase, and Cochrane Database to identify studies that reported the prevalence of BKV subtypes and/or subgroups in KTx recipients in the United States. Pooled prevalence rates were combined using random effects, generic inverse variance method. The protocol for this study is registered with PROSPERO (no. CRD42019134582).ResultsA total of eight observational studies with a total of 193 samples (urine, blood, and kidney tissues) from 188 BKV‐infected KTX recipients were enrolled. Overall, the pooled estimated prevalence rates of BKV subtypes were 72.2% (95% confidence of interval [CI]: 62.7‐80.0%) for subtype I, 6.8% (95% CI: 2.5‐16.9%) for subtype II, 8.3% (95% CI: 4.4‐15.1%) for subtype III, and 16.1% (95% CI: 10.4‐24.2%) for subtype IV, respectively. While metaregression analysis demonstrated a significant positive correlation between year of study and the prevalence of BKV subtype I (slopes = +0.1023, P = .01), there were no significant correlations between year of study and percentages of BKV subtype II‐IV (P > .05). Among KTx recipients with BKV subtype I, the pooled estimated percentages of BKV subgroups were 22.4% (95% CI: 13.7‐34.5%) for subgroup Ia, 30.6% (95% CI: 17.7‐47.5%) for subgroup Ib1, 47.7% (95% CI: 35.8‐59.9%) for subgroup Ib2, and 4.1% (95% CI:1.2‐13.3%) for subgroup Ic, respectively.ConclusionBKV subtype I is the most prevalent subtype among KTx recipients in the United States and its prevalence seems to increasing overtime. Subgroup Ib2 is the most common subgroup among BKV subtype I.

Background This study aimed to evaluate the hospitalization rate for Hepatitis A virus (HAV) among kidney transplant (KTx) recipients and its outcomes as well as resource utilization. Methods The 2005–2014 National Inpatient Sample database was used to identify all hospitalized KTx recipients with an associated diagnosis of HAV. The hospital mortality, resource utilization, and associated liver conditions were compared between patients with and without HAV, adjusting for potential confounders. Results Of 871 024 KTx recipients identified, 204 had HAV. The overall inpatient prevalence of HAV in KTx recipients over 10 years in the United States was 23.42 cases per 100 000 admissions. There were no statistically significant changes in the inpatient prevalence of HAV in KTx recipients during the study period (P = 0.77), ranging from 9.2 to 34.3 per 100 000 admissions. Among hospitalized KTx recipients with HAV, 27.9% were from Northeast, 29.2% were from Midwest, 23.8% were from South, and 19.1% were from West. HAV was not significantly associated with increased hospital mortality, multiorgan failure, need for abdominal ultrasound, hospital length of stay, and total hospitalization costs and charges when compared with those without HAV. However, it is significantly associated with increased ICU stay, coexisting hepatitis B and C infection, and liver failure. Conclusion Overall, inpatient prevalence of HAV in KTx recipients in the United States (years 2005–2014) was 23.42 cases per 100 000 admissions. Hospitalization for HAV after KTx is associated with increased ICU stay, coexisting hepatitis B and C infection, and liver failure.

Abstract Aim The aim of this study is to assess the association between admission serum albumin and short- and long-term mortality in all hospitalized patients. Design A single-center cohort study. Methods A retrospective cohort of all adult hospitalized patients at a tertiary referral hospital between January 2009 and December 2013 were analysed. Admission serum albumin was stratified into six groups: ≤2.4, 2.5–2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4 and ≥4.5 g/dl. The outcomes of interest were in-hospital mortality, length of hospital stay and 1-year mortality. Serum albumin of 4–4.4 g/dl was selected as a reference group for outcome comparison. Results A total of 14 075 patients were studied. Admission serum albumin of ≥4.5 g/dl had the lowest in-hospital and 1-year mortality with progressively increased in-hospital mortality observed with decreased admission serum albumin. In adjusted analysis, compared with serum albumin of 4.0–4.4 g/dl, serum albumin of ≤2.4, 2.5–2.9, 3.0–3.4 and 3.5–3.9 were significantly associated with increased in-hospital and 1-year mortality. In contrast, serum albumin of ≥4.5 g/dl was significantly associated with lower 1-year mortality but not in-hospital mortality. Admission serum albumin <4.0 g/dl was significantly associated with a prolonged hospital stay, while admission serum albumin of ≥4.5 g/dl was significantly associated with shorter hospital stay, compared with serum albumin of 4.0–4.4 g/dl. Conclusion Low albumin level at admission was progressively associated with increased short- and long-term mortality in all hospitalized patients even when albumin level was considered in normal range.

Background: Acute kidney injury (AKI) is a well-established complication of extra-corporal membrane oxygenation (ECMO) in the adult population. The data in the pediatric and neonatal population is still limited. Moreover, the mortality risk of AKI among pediatric patients requiring ECMO remains unclear. Thus, this meta-analysis aims to assess the incidence of AKI, AKI requiring renal replacement therapy and AKI associated mortality in pediatric/neonatal patients requiring ECMO. Methods: A literature search was performed utilizing MEDLINE, EMBASE, and the Cochrane Database from inception through June 2019. We included studies that evaluated the incidence of AKI, severe AKI requiring renal replacement therapy (RRT) and the risk of mortality among pediatric patients on ECMO with AKI. Random-effects meta-analysis was used to calculate the pooled incidence of AKI and the odds ratios (OR) for mortality. Results: 13 studies with 3523 pediatric patients on ECMO were identified. Pooled incidence of AKI and AKI requiring RRT were 61.9% (95% confidence interval (CI): 39.0–80.4%) and 40.9% (95%CI: 31.2–51.4%), respectively. A meta-analysis limited to studies with standard AKI definitions showed a pooled estimated AKI incidence of 69.2% (95%CI: 59.7–77.3%). Compared with patients without AKI, those with AKI and AKI requiring RRT while on ECMO were associated with increased hospital mortality ORs of 1.70 (95% CI, 1.38–2.10) and 3.64 (95% CI: 2.02–6.55), respectively. Conclusions: The estimated incidence of AKI and severe AKI requiring RRT in pediatric patients receiving ECMO are high at 61.9% and 40.9%, respectively. AKI among pediatric patients on ECMO is significantly associated with reduced patient survival.

Background: Acute kidney injury (AKI) is a common complication following solid-organ transplantation. However, the epidemiology of AKI and mortality risk of AKI among patients undergoing cardiac transplantation is not uniformly described. We conducted this study to assess the incidence of AKI and mortality risk of AKI in adult patients after cardiac transplantation. Methods: A systematic review of EMBASE, MEDLINE, and Cochrane Databases was performed until June 2019 to identify studies evaluating the incidence of AKI (by standard AKI definitions), AKI requiring renal replacement therapy (RRT), and mortality risk of AKI in patients undergoing cardiac transplantation. Pooled AKI incidence and mortality risk from the included studies were consolidated by random-effects model. The protocol for this study is registered with PROSPERO (no. CRD42019134577). Results: 27 cohort studies with 137,201 patients undergoing cardiac transplantation were identified. Pooled estimated incidence of AKI and AKI requiring RRT was 47.1% (95% CI: 37.6–56.7%) and 11.8% (95% CI: 7.2–18.8%), respectively. The pooled ORs of hospital mortality and/or 90-day mortality among patients undergoing cardiac transplantation with AKI and AKI requiring RRT were 3.46 (95% CI, 2.40–4.97) and 13.05 (95% CI, 6.89–24.70), respectively. The pooled ORs of 1-year mortality among patients with AKI and AKI requiring RRT were 2.26 (95% CI, 1.56–3.26) and 3.89 (95% CI, 2.49–6.08), respectively. Conclusion: Among patients undergoing cardiac transplantation, the incidence of AKI and severe AKI requiring RRT are 47.1% and 11.8%, respectively. AKI post cardiac transplantation is associated with reduced short term and 1-year patient survival.

Aim Depression is a major disease burden in Thailand. In rural areas, young adults will leave home to work in cities, and older adults are left behind. Loneliness and comorbidities can lead to depression in older adults. The present study aimed to evaluate the prevalence and associated factors for geriatric depression. Methods A cross‐sectional study was carried out. Questionnaires including the Thai Geriatric Depression Scale and family relationship were obtained by healthcare professions by face‐to‐face interviews of 584 older people aged ≥60 years in Ban Nayao community, Chachoengsao Province, Thailand. Geriatric depression can be defined as depressive syndromes that arise in adults aged ≥60 years. We excluded those who had visual or auditory disabilities or did not pass the Thai Mini‐Mental Status Examination. The prevalence and associated factors for geriatric depression were obtained. Associated factors were analyzed by multivariate logistic regression. Results A total of 433 older people were eligible. The prevalence of geriatric depression was 18.5%. Of the participants, 54.1% lived in an imbalanced family type. Multivariate analysis showed the significance for female sex (adjusted OR 2.78, 95% CI 1.54–7.49, P = 0.01), illiteracy (adjusted OR 2.86, 95% CI 1.19–6.17, P ‐value 0.04), current smoker (adjusted OR 4.25, 95% CI 2.12–10.18, P = 0.009) and imbalanced family type (low attachment, low cooperation and poor alignment between each member; adjusted OR 4.52, 95% CI 2.14–7.86, P < 0.001) as risk factors for depression. Conclusions The prevalence of geriatric depression in rural Thailand is high. Imbalanced family type is an important risk factor for geriatric depression in the rural community. Geriatr Gerontol Int 2019; 19: 1248–1253 .

Abstract Background Bloodstream infections (BSIs) are an important cause of morbidity and mortality among kidney transplant (KT) recipients, especially within the first year. We investigated for an epidemiology, risk factors and outcome of this specific infection following KT. Methods We conducted a retrospective study of all adult KT recipients who developed BSI within the first year after KT from January to December 2016 at a large referral single transplant center in Bangkok, Thailand. The cumulative incidence of BSI after transplant was estimated with Kaplan–Meier methodology. Clinical characteristics, microbiological data, and outcome were extracted. Risk factors for BSI were assessed with multivariate Cox proportional hazards models. Results A total of 26 (15.2%) episodes of BSI occurred in 171 KT recipients, 58.5% of them were men and the mean ± SD age was 43 ± 12 years. The majority received deceased-donor allograft (58.5%) and induction therapy (59%). The Kaplan–Meier estimated for BSIs were 12.3% at 3 months, 13.5% at 6 months, and 15.2% at 12 months after KT. Gram-negative bacteria were responsible for 92% of BSI, with Escherichia coli was the most common causative pathogen (65%) and 71% of those produced extended-spectrum β-lactamases enzyme. The genitourinary tracts were the predominant source of BSIs (85%). In a multivariate analysis, the second kidney transplantation [HR, 4.55; 95% CI, 1.24–16.79 (P =0.02)] and receiving induction therapy [HR, 3.05; 95% CI, 1.15–8.10 (P<0.03)] were associated with BSI. One patient (4%) developed acute cellular rejection and one patient (4%) died from septic shock. Conclusion One-sixth of KT recipients could develop gram-negative bloodstream infection within the first year after KT especially those underwent the second transplantation or received induction therapy. Disclosures All authors: No reported disclosures.