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- The risk of chronic kidney disease and mortality are increased after community-acquired acute kidney injuryPublication . Soto, Karina; Campos, Pedro; Pinto, Iola; Rodrigues, Bruno; Frade, Francisca; Papoila, Ana Luisa; Devarajan, PrasadWe investigated whether community-acquired acute kidney injury encountered in a tertiary hospital emergency department setting increases the risk of chronic kidney disease (CKD) and mortality, and whether plasma biomarkers could improve the prediction of those adverse outcomes. In a prospective cohort study, we enrolled 616 patients at admission to the emergency department and followed them for a median of 62.1 months. Within this cohort, 130 patients were adjudicated as having acute kidney injury, 159 transient azotemia, 15 stable CKD, and 312 normal renal function. Serum cystatin C and plasma neutrophil gelatinase-associated lipocalin (NGAL) were measured at index admission. After adjusting for clinical variables, the risk of developing CKD stage 3, as well as the risk of death, were increased in the acute kidney injury group (hazard ratio [HR],5.7 [95% confidence interval, 3.8–8.7] and HR, 1.9 [95% confidence interval, 1.3–2.8], respectively). The addition of serum cystatin C increased the ability to predict the risk of developing CKD stage 3, and death (HR, 1.5 [1.1–2.0] and 1.6 [1.1–2.3], respectively). The addition of plasma NGAL resulted in no improvement in predicting CKD stage 3 or mortality (HR,1.0 [0.7–1.5] and 1.2 [0.8–1.8], respectively). The risk of developing CKD stage 3 was also significantly increased in the transient azotemia group (HR, 2.4 [1.5–3.6]). Thus, an episode of community acquired acute kidney injury markedly increases the risk of CKD, and moderately increases the risk of death. Our findings highlight the importance of follow-up of patients with community acquired acute kidney injury, for potential early initiation of renal protective strategies
- Laboratory biomarkers associated to death in the first three COVID-19 waves in PortugalPublication . Von Rekowski, Cristiana; Fonseca, Tiago; Calado, Cecília; Bento, Luís; Pinto, Iola; Araújo, RúbenBesides the pandemic being over, new SARS-CoV-2 lineages, and sub-lineages, still pose risks to global health. Thus, in this preliminary study, to better understand the characteristics of COVID-19 patients and the effect of certain hematologic biomarkers on their outcome, we analyzed data from 337 patients admitted to the ICU of a single-center hospital in Lisbon, Portugal, in the first three waves of the pandemic. Most patients belonged to the second (40.4%) and third (41.2%) waves. The ones from the first wave were significantly older and relied more on respiratory techniques like invasive mechanic ventilation and extracorporeal membrane oxygenation. There were no significant differences between waves regarding mortality in the ICU. In general, non-survivors had worse laboratory results. Biomarkers significantly associated with death changed depending on the waves. Increased high-sensitivity cardiac troponin I results, and lower eosinophil counts were associated to death in all waves. In the second and third waves, the international normalized ratio, lymphocyte counts, and neutrophil counts were also associated to mortality. A higher risk of death was linked to increased myoglobin results in the first two waves, as well as increased creatine kinase results, and lower platelet counts in the third wave.