No abstract

No abstract

ObjectiveIn this study, we aimed to determine whether plasma NGAL levels could be used as a biomarker for distinguishing between AKI and CKD in emergency medicine.Materials and methodsThis prospective study was conducted at the ED of a training and research hospital over a six-month period in 2015. Three groups were defined: an AKI group – defined as a new onset of at least a 1.5-fold or ≥0.3 mg increment increase of SCr values from the normal baseline, a stable CKD group – only included presence of stages 2 through 4 of CKD according to the National Kidney Foundation's KDIGO 2012, and a control group. After the initial evaluation of patients, venous blood samples were taken for routine biochemical, counter blood cell, and plasma NGAL measurement at admission.ResultsA total of 25 patients with AKI, 22 patients with stable CKD, and 22 control subjects were enrolled. Level of plasma NGAL in AKI group was higher than those of the stable CKD group (median: 794 ng/ml IQR: 317–1300 & 390 ng/ml IQR: 219–664, p < 0.001). AUC was measured as 0.68 (p = 0.02, 95% CIs: 0.54–0.84) to assess the utility of plasma NGAL levels at varying cut-off values for distinguishing between AKI and CKD. For plasma NGAL, the best cut-off level was found to be 457 ng/ml (sensitivity: 72.0%, specificity: 64%).ConclusionThis study has clearly demonstrated that plasma NGAL levels were higher in AKI patients than in CKD patients. However, in clinical practice, the use of plasma NGAL levels to distinguish between AKI and CKD is limited.

Background: Despite its risks associated with renal injury, intravenous contrast media increases diagnostic efficacy and hence the chance of early diagnosis and treatment, which leaves clinicians in a dilemma regarding its use in emergency settings. Objective: The aim of this study was to determine the risk and predictors of contrast-induced acute kidney injury following intravenous contrast media administration for computed tomography in the emergency department. Methods: All patients aged 18 years and older who had a basal creatinine measurement within the last 8 h before contrast-enhanced computed tomography and a second creatinine measurement within 48–72 h after computed tomography scan between 1 January 2015 and 31 December 2017 were included in the study. Characteristics of patients with and without contrast-induced acute kidney injury development were compared. Multivariate regression analysis was used to assess the predictors for contrast-induced acute kidney injury. Results: A total of 631 patients were included in the final statistical analysis. After contrast media administration, contrast-induced acute kidney injury developed in 4.9% ( n = 31) of the patients. When the characteristics of patients are compared according to the development of contrast-induced acute kidney injury, significant differences were detected for age, initial creatinine, initial estimated glomerular filtration rate, and all acute illness severity indicators (hypotension, anemia, hypoalbuminemia, and need for intensive care unit admission). A multivariate logistic regression analysis was performed. The need for intensive care unit admission (odds ratio: 6.413 (95% confidence interval: 1.709–24.074)) and hypotension (odds ratio: 5.575 (95% confidence interval: 1.624–19.133)) were the main factors for contrast-induced acute kidney injury development. Conclusion: Our study results revealed that hypotension, need for intensive care, and advanced age were associated with acute kidney injury in patients receiving contrast media. Therefore, we believe that to perform contrast-enhanced computed tomography in emergency department should not be decided only by checking for renal function tests and that these predictors should be taken into consideration.

Background: Acute gastroenteritis is a clinical syndrome that may cause severe dehydration in affected individuals and a reason of mortality and morbidity in all age groups. Measurement of perfusion index and plethysmography variability index may provide emergency physicians valuable information about hemodynamics of the patient. Objectives: Our study aimed to investigate the role of perfusion index and plethysmography variability index measurement at admission for estimating dehydration severity and determiningthe possible change in those parameters after fluid replacement among patients presenting to emergency department with acute gastroenteritis. Methods: This was a prospective cross-sectional study. Patients diagnosed with acute gastroenteritis at the emergency department were consecutively enrolled. The two groups were defined according to the severity of dehydration: mild and moderate/severe dehydration groups. The values of perfusion index and plethysmography variability index of all patients were measured. Results: A total of 180 patients were included in the study. As compared with the mild dehydration group, moderate/severe dehydration group had a significantly lower perfusion index value and significantly higher plethysmography variability index value on admission (p < 0.001 for both comparisons). Among moderate/severe dehydration patients, perfusion index value significantly increased and plethysmography variability index significantly decreased after treatment (p < 0.001). There was a significant positive correlation between osmolarity and plethysmography variability index (r = 0.298; p = 0.007) and a significant negative correlation between osmolality and perfusion index (r = −0.259; p = 0.019) in the patients with moderate/severe dehydration. Conclusion: The study show that perfusion index and plethysmography variability index may be useful for determining the severity of dehydration in acute gastroenteritis and may be use for assessing the response to fluid replacement especially in patients with severe dehydration at emergency department.