Sp232plasmic Score for a Quick Assessment of Adamts13 Activity in Patients From Southern Italy With Thrombotic Microangiopathies

Abstract

INTRODUCTION AND AIMS:Osmotic changes during hemodialysis have been reported to cause development of cerebral edema and intracranial hypertension in some patients. Patients with pre-existing acute brain injury are likely at increased risk. Such patients are few and only case reports have been published. Furthermore continuous hemodialysis (CRRT) has been suggested to be less likely to cause increases in intracranial pressure compared to intermittent hemodialysis (IHD) Aim : To study changes in intracranial pressure (ICP) during hemodialysis in patients with acute brain injury in the intensive care unit. METHODS: All patients with acute brain injury admitted to our intensive care units who were treated with IHD or CRRT while undergoing ICP monitoring from 2012-2016 were identified retrospectively. Patients were excluded if ICP values were not documented during hemodialysis. Data from each patient's first dialysis session in the intensive care unit were collected. For CRRT data from the first 8 hours of dialysis were collected. Area under the curve divided by time (AUC/t) for ICP was calculated separately before and during dialysis. Total plasma osmolarity was estimated before and after the dialysis session. RESULTS: Thirteen patients were included. During hemodialysis, ICP increased from a baseline of 11.9 mmHg (median; interquartile range 6.3-14.7) to a maximum of 21 mmHg (18-27) (p ¼ 0.0024), and AUC/t for ICP was greater during dialysis (15.2 (13.4-18.8) vs. 11.7 mmHg (6.4-15.1), p ¼ 0.042).The magnitude of the increase was independent of dialysis modality, but occurred earlier in patients treated with IHD (N¼4) compared to CRRT (N¼9) (75 (30-90) vs. 375 min (180-420) after start of treatment, p ¼ 0.0095). The maximum increase in ICP during dialysis correlated positively to the baseline plasma urea concentration (Spearman's r ¼ 0.69, p ¼ 0.017). Biochemical data before and after the initial hemodialysis session are shown in the table below (as median (interquartile range)). CONCLUSIONS: Despite its limitations the present study is, to our knowledge currently the largest cohort of its kind published. We found that hemodialysis is followed by a clinically significant increase in ICP in patients with acute brain injury regardless the choice of hemodialysis modality (CRRT vs IHD). The increase in ICP during CRRT seems equal to the increase during IHD, but occurs somewhat later which must be considered when observing these patients. Changes in estimated osmolarity were rather modest, but maximum ICP during hemodialysis correlated positively to the plasma urea concentration before start of treatment. measures were used as developmental cohort. Primary outcome was development of CIN, defined as 25% increase of serum creatinine within 2-6 days after contrast exposure. A predictive model was developed using logistic regression analyses. The model was evaluated for prognostic utility in independent cohort from other tertiary hospital (N¼555 SP231 RISK PREDICTION OF CONTRAST INDUCED NEPHROPATHY IN CANCER PATIENTS UNDERG...