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BACKGROUND Nonoperative management (NOM) is a promising therapeutic modality for patients with perforated peptic ulcer (PPU). However, the risk factors for poor efficacy and adverse events of NOM are a concern. AIM To investigate the factors predictive of poor efficacy and adverse events in patients with PPU treated by NOM. METHODS This retrospective case-control study enrolled 272 patients who were diagnosed with PPU and initially managed nonoperatively from January 2014 to December 2018. Of these 272 patients, 50 converted to emergency surgery due to a lack of improvement (surgical group) and 222 patients were included in the NOM group. The clinical data of these patients were collected. Baseline patient characteristics and adverse outcomes were compared between the two groups. Logistic regression analysis and receiver operating characteristic curve analyses were conducted to investigate the factors predictive of poor efficacy of NOM and adverse outcomes in patients with PPU. RESULTS Adverse outcomes were observed in 71 patients (32.0%). Multivariate analyses revealed that low serum albumin level was an independent predictor for poor efficacy of NOM and adverse outcomes in patients with PPU. CONCLUSION Low serum albumin level may be used as an indicator to help predict the poor efficacy of NOM and adverse outcomes, and can be used for risk stratification in patients with PPU.

Aim: This is a prospective study that studies the various factors predicting the anastomotic leakage in small bowel anastomoses Patients with suture line disruption were compared with patients whose anastomoses did not leak.Materials and Methods: All patients above the age of 18 years undergoing surgical closure of a full thickness small intestinal breach, were analyzed and followed up until their discharge from hospital or death.Type of study: Prospective, analytical studyPlace of study: Department of General Surgery, Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, PuducherryDuration: April 2018 to March 2020Methodology: Detection of suture line disruptionResult: ASA grade and leak, Biochemical Parameters and leak, Parameters associated with mortality, Anastomotic procedure and leak, Intraoperative factors and leak rate, Typhoid perforations (Widal positive) and leak all the parameters were tabulated conducted to clarify issues relating to factors causing small bowel anastomotic leakage with specific reference to emergency surgeries. Logistic regression and multivariate analysis were used to identify independent predictors of anastomotic leak.Conclusion: Factors found to have a significant association with suture line disruption by univariate analysis included ASA grade of 3 or above, low hemoglobin, low serum albumin, low preoperative serum sodium, higher mean duration of surgery, presence of gross peritoneal contamination, use of drains in primary anastomoses, higher mean amount of fluids infused intraoperatively, intraoperative hypotension and postoperative ventilatory support.

Introduction: Albumin is a single polypeptide chain of 585 amino acids synthesized by the liver which accounts for 75-80% Osmotic pressure. Hypo albuminemia in burns occurs due to loss from damage tissues, reduction in hepatic blood and due to inhibitory tissue factor such as Necrotic tissue factor, interleukin 1 and 6 released at burn sites. Method: The information about the 73 patients in our study was from our unit records and the hospital records. We Used the Cobas C III system, colorimetric assay method to carry out the serum albumin and total protein investigations. Result: We had 11 burn mortality out of the 73 patients, and based on the serum albumin at the time of death, those with serum albumin of < 25g/L have burn mortality sensitivity of 90.9% and specificity of 83.3%. Discussion: Amongst all the prognostic factors we evaluated such as type, size of burns, age of patients, inhalational injury, co-morbid factors, we found that serum albumin of < 25g/L to be a more useful prognostic factor in burn mortality. Conclusion: We used serum albumin of < 25g/L in our patients to prognosticate burn mortality and to use this knowledge to optimize their serum albumin to avert death.

Objectives: The aim of this study was to determine the frequency of operative mortality in patients who had low serum albumin on admission and were undergoing coronary artery bypass grafting (CABG) after nutritional support at a tertiary care cardiac center in Karachi, Pakistan. Methodology: A retrospective study was conducted at an adult cardiac surgery department of the largest tertiary care cardiac center in Karachi, Pakistan. Patients who had undergone isolated CABG during January to December 2019 admitted with low serum albumin (less than 3.5mg/dl) and received nutritional treatment before surgery were included in the study. Patients were monitored for a month to measure the 30 day mortality. Results: There were 82.4% male patients and the mean age was 55.49±8.52 years. Preoperative mean serum haemoglobin, serum creatinine, and serum albumin levels were 12.225±1.19 mg/dl, 1.05±0.21 mg/dl, and 2.825±0.39 mg/dl respectively. Postoperative mortality was recorded in 1.7% of the total patients. Conclusion: In patients with low serum albumin levels and had undergone isolated CABG after nutritional pre-treatment, mortality was mainly associated with peri-operative myocardial infarction. While, the incidence of delayed wound healing and atrial fibrillation were found to be high in these patients.

We compared the effects on the nutritional condition and health-related quality of life (HR-QoL) of the treatment of patients with on-line hemodiafiltration (OL-HDF) and conventional hemodialysis (CHD) using a superflux dialyzer. In total, 47 maintenance (M) HD patients were treated by CHD with a high-flux dialyzer for the first 4 months (1st CHD) and were then switched to predilution OL-HDF for the next 4 months (OL-HDF), after which CHD was resumed for the last 4 months (2nd CHD). We assessed the clinical parameters, fat mass value, muscle mass value, and HR-QoL. In patients with low serum albumin levels, these levels significantly (p < 0.05) increased in the OL-HDF period. Moreover, the fat mass values significantly (p < 0.05) increased in patients with decreased fat mass values in the OL-HDF period. Although there was no significant difference in the patients with higher scores of physical functioning, role physical, vitality, and social functioning, patients with lower scores in the 1st CHD period had significantly increased (p < 0.05) in the OL-HDF period. In this crossover study, we revealed that OL-HDF treatment significantly improved the nutritional conditions and HR-QoL scores compared with the improvement observed after CHD with a superflux dialyzer, especially for maintenance hemodialysis patients with malnutrition and a low QoL.

American Journal of Public Health Research, 2021, Vol. 9, No. 3, 100-105Available online at http://pubs.sciepub.com/ajphr/9/3/3Published by Science and Education PublishingDOI:10.12691/ajphr-9-3-3Are Nutritional Screening Scores Associated with theSerum Albumin Levels and the Presence of Bedsores inBedridden and Chairbound Home Care Patients?Emre Adıgüzel1, Nilüfer Acar-Tek2,*1Department of Nutrition and Dietetics, Faculty of Health Sciences, Karamanoğlu Mehmetbey University, Karaman, Turkey 2Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey*Corresponding author:Received March 04, 2021; Revised April 10, 2021; Accepted April 18, 2021Abstract Based on the fact that immobile bedridden patients have a high risk of developing bedsores andinfection, we evaluated whether the presence of bedsores and low serum albumin levels significantly alter the scoresof long and short forms of Mini Nutritional Assessment and body mass index. From January to July 2016, 143bedridden/chairbound home care patients were visited with the Karaman State Hospital home healthcare team. TheMini Nutritional Assessment and Mini Nutritional Assessment-short form were used for nutritional evaluation. Theretrospective serum albumin levels that had been analysed in the last 30 days, were recorded from the patients’ files.Also, the skin integrity was evaluated by the home care physician to detect the presence of bedsores. The mean MiniNutritional Assessment and Mini Nutritional Assessment-short form scores of the patients were 13.2±7.0 and6.4±3.8, respectively. The mean serum albumin level was 3.2±0.6 g/dL, and 33 patients had bedsores. The MiniNutritional Assessment and Mini Nutritional Assessment-short form scores, and body mass index values in patientswith normal serum albumin levels were significantly higher than those in patients with low serum albumin levels.Moreover, these nutritional parameters in patients with bedsores were significantly lower than those in patientswithout bedsores. Lastly, the serum albumin levels were found to be significantly positively correlated with all thesenutritional parameters. (r=0.477 for Mini Nutritional Assessment; r=0.456 for Mini Nutritional Assessment-shortform; r=0.451 for body mass index). Low Mini Nutritional Assessment and Mini Nutritional Assessment-short formscores were significantly related to the presence of bedsores, providing strong evidence that malnutrition may be amajor risk factor for bedsore formation. An effective, comprehensive, and holistic treatment protocol and care plan,including nutritional intervention, is important and necessary for immobile home care patients.Keywords: nutritional assessment, bedridden patients, bedsore, serum albumin, body mass index&nbsp

Background:This study aims todevelop a scoring system that will predict in-hospital morbidity post gastrointestinal (GI), pancreatic, hepatic cancer surgery in adult patients. This study took place in De La Salle University Medical Center.Method: Two hundred eighty five (285) adult patients 18 years old and above who underwent gastrointestinal, pancreatic and hepatic cancer surgery from 2010 to July 31, 2014 were included. Variables were evaluated in the univariate and multivariate analysis. Calculation of specific score from the resulting factors was performed by logistic regression analysis to develop the scoring system and to determine the best cut-off score in predicting in-hospital morbidity.Results: Out of 142 patients with post-operative complications, factors significantly associated with morbidity were as follows: age ≥ 75 years (p = 0.002), low serum albumin (p = 0.00), abnormal electrocardiogram (ECG) findings (p = 0.036) and emergency surgery (p = 0.000). Calculated best cut-off score was 1.4.Conclusion: The RAPHA scoring system may serve as a promising aid in predicting morbidity and mortality among patients who will undergo GI cancer surgery.

Serum albumin is generally used to assess the nutritional status, severity of disease, disease progression and prognosis. In the hospital setting, many reports have related serum albumin level to in-hospital mortality, length of stay (LOS), and nosocomial infection. Serum albumin has also been described as an independent prognosticator of survival in various diseases of lung, pancreatic, gastric, colorectal and breast. Low serum albumin has also been shown to be an independent indicator for prognosis in patients. However, these studies differ from each other with regard to population studied, study design, sample size, definition of low serum albumin used and factors adjusted for in the analyses.

Blood components, especially plasma, are excellent volume expanders but increased osmotic loads draw volume into the intravascular space resulting in volume overload, particularly in patients with cardiac and renal insufficiency. In addition, allogeneic blood transfusion exposes the recipient to large amounts of alloantigen which can create a variety of immunological responses including allo-immunisation and down regulation of immune response. All children between the age of 1 year to 15 years admitted to PICU at our teaching Hospital over a 24 month period with acute systemic infections were evaluated. In our study, of the total of 178 cases, seventy two cases (40%) received fresh frozen plasma for deranged coagulation profile which was considered as an appropriate indication. Eighty two cases (46%) received fresh frozen plasma for hypotension and thirty one cases (17%) for low serum albumin which were both considered as inappropriate indications.Clinical outcome in these two groups of patients showed that there was no significant difference in duration of hospital stay. There was an increase incidence of mortality in children who received FFP for inappropriate indications, though it was not statistically significant (P=0.375). It was also noted that a statistically significant increase in morbidity in the form of increased requirement of ventilatory support for the inappropriately transfused group (P=0.008) was seen in our study.

Background/Aim: We examined the relationship between preoperative serum albumin levels and long-term outcomes in patients with breast cancer. Patients and Methods: We retrospectively analyzed the records of 157 patients who underwent breast cancer surgery at a single institution. We divided the patients into those with

Protein-losing enteropathy (PLE) occurs when protein losses throughout the gastrointestinal (GI) tract exceed the liver’s ability to produce new protein. This is a rare presentation of Crohn's disease and few reported cases of PLE related to Crohn’s exist in the literature. We describe two patients who presented with symptoms of PLE. After extensive diagnostic workup both were diagnosed with Crohn’s disease and managed with prednisone.

Supplemental Digital Content is available in the text., OBJECTIVES: We hypothesized that low serum albumin would contribute to pulmonary edema formation, thereby independently increasing the risk of developing acute respiratory distress syndrome in critically ill patients. DESIGN: Retrospective analysis of prospective cohort. SETTING: Medical, surgical, and cardiovascular ICUs at Vanderbilt University Medical Center. PATIENTS: Patients (n = 993) with serum albumin measured for clinical reasons within 24 hours of study enrollment on ICU day 2 were included. MEASUREMENTS AND MAIN RESULTS: The primary outcome was presence of acute respiratory distress syndrome at any time during the first 4 days in the ICU, as defined by the Berlin definition. Secondary outcomes included ventilator-free days and ICU length of stay. In an unadjusted analysis, lower serum albumin levels were associated with a higher occurrence rate of acute respiratory distress syndrome (p < 0.001). In a multivariable analysis controlling for prespecified confounders, lower serum albumin was independently associated with an increased risk of acute respiratory distress syndrome (odds ratio, 1.48 per 1-g/dL decrease in albumin; 95% CI, 1.14–1.94; p = 0.004). Additionally, lower serum albumin was associated with increased mortality (odds ratio, 1.56 per 1-g/dL decrease in albumin; 95% CI, 1.19–2.04; p = 0.001), increased ICU length of stay (incidence rate ratio, 1.19; 95% CI, 1.15–1.23; p < 0.001), higher Sequential Organ Failure Assessment score (p < 0.001), and fewer ventilator-free days (incidence rate ratio, 1.21; 95% CI, 1.19–1.24; p < 0.001). CONCLUSIONS: Among adult ICU patients, lower serum albumin was independently associated with increased risk of acute respiratory distress syndrome after controlling for severity of illness and potential confounders. These findings support the hypothesis that low plasma oncotic pressure contributes to pulmonary edema formation in patients at risk for acute respiratory distress syndrome, independent of severity of illness.

Hepatocellular carcinoma (HCC) is, globally, one of the most prevalent and deadly human cancers, despite curative surgical resection, its high recurrence rate after surgery remains a large threat, resulting in poor patient survival. The hepatitis B virus (HBV) pre-S2 mutant that harbors deletions spanning the pre-S2 gene segment has emerged as an important oncoprotein for HCC development and a valuable prognostic biomarker for HCC recurrence, however, its relationship with clinicopathological factors is largely unexplored. In this study, the correlation of the deletion spanning the pre-S2 gene segment with clinicopathological factors and the association of such correlation with HCC recurrence after curative surgical resection were examined in HBV-related HCC patients. Inverse correlation between serum albumin level and the deletion spanning the pre-S2 gene segment was identified. HCC patients with the presence of the deletion spanning the pre-S2 gene segment and a low serum albumin level were associated with higher HCC recurrence than patients with either factor alone or neither factor were. Moreover, a combination of the serum albumin level and the deletion spanning the pre-S2 gene segment exhibited better performance than that of either factor alone in predicting HCC recurrence. Collectively, this study shows an association of low serum albumin level with pre-S2 mutant-positive HCC patients, and validates the prognostic value of this association in identifying patients with higher HCC recurrence after curative surgical resection.

Background: The dose–response association between serum albumin and atrial fibrillation is not well known. This study aims to assess the relationship between albumin and atrial fibrillation and the potential dose–response effect.Methods: Studies reported that the serum albumin and AF were identified by searching the EMBASE, PubMed, and Cochrane Library databases. The potential dose–response effect was performed by using a stage robust error meta-regression.Results: Nine studies were included with a total of 32,130 individuals. Patients with high albumin level were associated with a decreased risk of atrial fibrillation compared with patients with low serum albumin (OR[odds ratio]: 0.62, 95% CI [0.44, 0.89]; I2 = 76%; P = 0.009). In the dose–response analysis, for each 10 g/L increase in serum albumin level, the risk of atrial fibrillation decreased by 36% (95% CI: 0.51–0.81, I2 = 87%, P < 0.001). Furthermore, a significant negative linear relationship between serum albumin and the risk of atrial fibrillation (Pnonlinearity = 0.33) was found.Conclusion: Our dose–response meta-analysis suggests that low serum albumin level is associated with an increased risk of atrial fibrillation. Further studies are needed to explore the effect of induction of elevated serum albumin levels on the prevention of atrial fibrillation.

Azacitidine (AZA) is the standard of care for higher-risk myelodysplastic syndrome (HR-MDS) patients ineligible for intensive therapy. Clinical outcome discrepancies reported in clinical trials and real-life settings stimulate the search for new prognostic factors. We retrospectively evaluated 315 MDS, 20–30% blast acute myeloid leukemia (AML) and chronic myelomonocytic leukemia (CMML) patients treated with azacitidine in 12 centers cooperating within the Polish Adult Leukemia Group (PALG). The median number of AZA cycles was 7 (1–69) and 24% patients received fewer than 4 cycles (early failure, EF). Serum albumin level was an independent predictor of EF occurrence. Complete remission (CR) was obtained in 20% and partial remission (PR) in 12% of patients. Hematologic improvement – erythroid (HI-E), neutrophil (HI-N), or platelet (HI-P) was achieved in 51%, 36%, and 48% of patients, respectively. No factors significantly predicted CR or PR in the multivariate analysis. For HI-E and HI-P, lower LDH level predicted response. Median survival was 15 (13–19) months. Lower serum albumin level, serious infection and receiving p < 0.05). Serum albumin assessment before azacitidine treatment can help to identify patients with higher risk of early failure and worse clinical outcome.

Aim To clarify factors associated with changes in care needs level and mortality among disabled older people receiving home medical care over a period of 2.5 years. Methods The study included 179 participants, aged ≥65 years, receiving home medical care, who consented to join the Osaka Home Care Registry study. The main outcome was changes in the care needs level of participants eligible for the long-term care insurance system. We investigated the association of changes in care needs level with basic characteristics and care-receiving status. Results At the 2.5-year follow up, 20.0% of participants showed deteriorated levels, and 41.8% of participants died. In multiple logistic regression, age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.00-1.21; P = 0.051) and bone joint diseases (OR 0.34, CI 0.09-1.22; P = 0.098) were possible risks associated with deterioration of the care needs level. Male sex (OR 3.28, CI 0.91-11.74; P = 0.068) was a possible risk factor for mortality, and lower serum albumin (OR 0.22, CI 0.07-0.73) was a significant risk factor for mortality. Conclusions We clarified the different factors associated with deterioration of the care needs level and mortality among disabled older people. Old age and bone joint diseases might be predictive factors for the further deterioration of independence of physical activity, and a low serum albumin level is considered to be strongly associated with increased mortality. Geriatr Gerontol Int 2019; 19: 1198-1205.

Background Sarcopenia is defined as the old age syndrome characterized by profound decline in muscle mass and function. This study aimed to investigate the prevalence of sarcopenia and its risk factors in older adults. Methods Totally, 501 older people aged 65 years and older were recruited. Sarcopenia was defined according to the criteria of the Asian Working Group for Sarcopenia (AWGS). For obtaining Skeletal Muscle mass Index (SMI), body composition was evaluated using Bioelectrical Impedance Analysis (BIA). Muscle strength and physical performance were measured by Handgrip Strength (HGS) and Gait Speed (GS), respectively. Nutritional status, physical activity level, and biochemical indicators were assessed, as well. Results The prevalence of sarcopenia was 20.8%. Multiple logistic regression models of the predictors of decline in the components of sarcopenia showed that older age, low Body Mass Index (BMI), and serum albumin level were associated with a higher risk of low SMI. Low serum albumin level and older age were also predictive of low HGS. Besides, old age, high body fat mass, and low BMI were the risk factors of low GS. Conversely, increased Calf Circumference (CC) was protective against low SMI and GS. Finally, older age, male gender, low BMI, decreased mini-nutritional assessment score, low serum albumin level, and high body fat were associated with a higher risk of sarcopenia, whereas higher CC reduced its risk. Conclusion The prevalence of sarcopenia is high among elderly individuals. This study underlined that sarcopenia might develop in older adults with impaired nutritional status and high body fat mass. Further studies could evaluate the effects of appropriate nutritional interventions on sarcopenia management and prevention.

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether low serum albumin (sAlb) was associated with postoperative bronchopleural fistula (BPF) in patients undergoing pulmonary resections. Altogether 660 papers were found using the reported search, of which 5 retrospective cohort studies represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Four of the 5 cohort studies showed that the preoperative sAlb level in patients who experience a BPF was significantly lower than that in patients who did not experience a BPF. One of the 5 studies also reported that the incidence of BPF in patients with a lower sAlb (13.6%) was found to be significantly higher than that in patients with a higher sAlb (7.0%). The level of hypoalbuminaemia is not defined, but it may be

Background Oral health is thought to be associated with diet quality, and socioeconomic status (SES) affects both oral health and diet. The aim of this study was to investigate the association between the number of teeth and dietary intake as well as nutritional biomarker, considering the subjects’ SES. Methods We conducted a cross-sectional analysis of data from 2049 individuals aged ≥ 50 years from the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 2010. The number of remaining teeth was categorized into age-specific quartiles (Q1 to Q4). We assessed the adjusted means and 95% confidence intervals for dietary variables by the number of teeth using analysis of covariance. Stratified analyses by SES were also conducted. Results The intake of grain products was 31 g higher, and those of vegetables and meat were 30 g and 8 g lower, respectively, in Q1 (fewer teeth) than in Q4 (more teeth). Carbohydrate intake was higher whereas protein, minerals (potassium, magnesium, and zinc), vitamins (vitamins A, E, B1, B6, β-carotene, and folic acid), and dietary fiber intakes were lower among individuals with fewer teeth. Adjusted mean serum albumin levels were low in Q1. The associations between the number of teeth and dietary intake were more evident in individuals with a low SES. Conclusions Having few remaining teeth was associated with a low nutrient intake and low serum albumin levels in middle-aged and older Japanese adults, and these associations were more evident in individuals with low SES. Electronic supplementary material The online version of this article (10.1186/s12199-018-0752-x) contains supplementary material, which is available to authorized users.

BACKGROUND Staging laparoscopy (SL) is used to avoid resection failure and thus increase the curative resection rate. SL utilization in extra-hepatic biliary tumors (EHBT) is variable. METHODS Data from 1090 patients with potentially resectable EHBT including gallbladder (GBC), distal (DC), and hilar (HC) subtypes were retrospectively collected from 10 academic centers (2000-2015). RESULTS The SL utilization rate increased over time and was significantly higher in GBC than DC and HC. SL yield was 16.8% and did not differ between groups or over time. In patients undergoing attempted resection with prior SL, the curative resection rate did not differ between subtypes. In patients undergoing attempted resection without prior SL, the curative resection rate was less in GBC compared with DC or HC. After matching cohorts by inverse probability weighting, prior SL was associated with curative resection in GBC only (odds ratio [OR], 2.41, 95% CI, 1.36-4.27). On multivariable regression analysis, elevated carbohydrate antigen 19-9 (CA 19-9), low serum albumin, and GBC were strong predictors of distant disease on SL. After categorizing patients undergoing SL into low, intermediate, and high-risk groups based on these parameters, SL yield improved progressively from 10.0% to 19.6% to 52.6%. CONCLUSIONS We recommend routine SL for patients with GBC, particularly with elevated CA19-9 level and/or decreased serum albumin.

Background: Patients undergoing transcatheter aortic valve replacement (TAVR) are mostly elderly patients with substantial comorbidities. Established risk scores are not validated for TAVR and collectives with elderly patients making periprocedural risk stratification difficult. Serum albumin is known to be an indicator for malnutrition and frailty and is simple to measure, independent of physician’s bias. Using serum albumin as a preoperative marker for postoperative complications might help estimating morbidity and mortality of these patients. Methods: A total of 457 patients with severe symptomatic aortic stenosis undergoing TAVR at our institution in a period from January 2014 to December 2015 were included in this retrospective study. Baseline characteristics as well as preoperative laboratory parameters were registered. Postoperative morbidity and 30-day mortality were analyzed as primary end points. Enrolled patients with preoperative low serum albumin ( Results: Among 457 patients, 51 (11%) presented pre-procedural low serum albumin and 406 (89%) had normal serum albumin. Patients’ mean age was 81±6 years and 50% of them were male. Postoperative complications such as requirement of blood transfusions (63% versus 33%, P Conclusions: Preoperative low serum albumin might be an indicator for higher morbidity and mortality in patients undergoing TAVR.

Introduction: Although low serum albumin (ALB) may worsen acute kidney injury (AKI), additional study is needed to establish the connection between ALB and the prognosis of critically ill patients with AKI and treated with continuous renal replacement therapy (CRRT).Methods:A secondary analysis of a bi-center, retrospective, and observational study, such as critically ill patients with AKI and treated with CRRT from January 2009 to September 2016. The univariate analysis, multi-factor regression analysis, sensitivity analysis, and curve-fitting analysis were applied to explore the association of ALB with the 28 and 90 days mortality of critically ill patients with AKI and treated with CRRT, and the removal efficiency of serum phosphorus.Results: From January 2009 to September 2016, 1,132 cases with AKI and treated with CRRT met the inclusion criteria and enrolled in this study. We found that the higher ALB before CRRT, the lower the 28- and 90-day mortality of patients with AKI and treated with CRRT, the higher removal efficiency of serum phosphorus, the adjusted hazard ratio (HR) value for 28-day mortality in the four models were separately 0.92 (0.90, 0.95), 0.91 (0.89, 0.94), 0.92 (0.89, 0.95), and 0.92 (0.89, 0.95); the adjusted HR value for 90 day mortality in the four models were 0.91 (0.89, 0.94), 0.92 (0.89, 0.95), 0.92 (0.89, 0.95), and 0.92 (0.89, 0.96); the adjusted OR value for the removal efficiency of serum phosphorus in the four models were separately −0.04 (−0.07, −0.01), −0.05 (−0.08, −0.01), −0.04 (−0.08, −0.01), and −0.04 (−0.08, −0.01). The sensitivity analysis and curve-fitting analysis also showed that ALB before CRRT was correlated with the 28 and 90 days mortality of critically ill patients with AKI and treated with CRRT and the removal efficiency of serum phosphorus.Conclusion: The higher the serum ALB before CRRT, the lower the mortality of critically ill patients with AKI and treated with CRRT, and the higher the clearance efficiency of serum phosphorus.

Background In high-dose methotrexate (HD-MTX) therapy, delayed elimination of MTX from plasma leads to severe adverse effects. However, the risk factors for the delayed elimination of plasma MTX are still unclear. Objective The purpose of this study was to investigate the factors related to the delayed MTX elimination in HD-MTX monotherapy. Methods This retrospective study was performed on patients who received HD-MTX monotherapy between April 2009 and March 2019 at the Hiroshima University Hospital. Patients were divided into a “Normal” and a “Delayed” group according to their MTX plasma concentration at 48 or 72 hours after administration. Patient characteristics, dose of HD-MTX, MTX plasma concentration, and adverse effects were analyzed and compared between the 2 groups. Results A total of 74 patients were included in this study. Logistic analysis of patient baseline characteristics was performed to identify risk factors for delayed MTX elimination. Serum albumin (ALB) was detected as a risk factor. Univariate and multivariate analysis revealed that low ALB level (Conclusions and Relevance Our study showed that low ALB is a risk factor for delayed MTX elimination in HD-MTX monotherapy. Pharmacokinetic analysis is needed to establish the dose of HD-MTX in patients with a low ALB level.

BackgroundIn order to manage the COVID-19 systemic inflammatory response, it is important to identify clinicopathological characteristics across multiple cohorts.MethodsElectronic patient records for 2 consecutive cohorts of patients admitted to two urban teaching hospitals with COVID-19 during two 7-week periods of the COVID-19 pandemic in Glasgow, U.K. (cohort 1: 17th March 2020 – 1st May 2020) and (cohort 2: 18th May 2020 – 6th July 2020) were examined for routine clinical, laboratory and clinical outcome data.ResultsCompared with cohort 1, cohort 2 were older (pConclusionIn addition to the 4C mortality score, frailty score and a low albumin were strongly independently associated with 30-day mortality in two consecutive cohorts of patients admitted to hospital with COVID-19.Article summaryIn two consecutive cohorts of patients with COVID-19 infection admitted to two urban teaching hospitals in Glasgow, UK, there were variations in a number of clinicopathological characteristics despite similar mortality (23 and 22%).In these two cohorts, in a multivariate analysis that included the 4C mortality score, clinical frailty score >3, low serum albumin concentration (145 mmol/L) remained independently associated with 30-day mortality.

The Hodgkin lymphoma (HL) genomic landscape is hardly known due to the scarcity of tumour cells in the tissue. Liquid biopsy employing circulating tumour DNA (ctDNA) can emerge as an alternative tool for non-invasive genotyping. By using a custom next generation sequencing (NGS) panel in combination with unique molecule identifiers, we aimed to identify somatic variants in the ctDNA of 60 HL at diagnosis. A total of 277 variants were detected in 36 of the 49 samples (73·5%) with a good quality ctDNA sample. The median number of variants detected per patient was five (range 1–23) with a median variant allele frequency of 4·2% (0·84–28%). Genotyping revealed somatic variants in the following genes: SOCS1 (28%), IGLL5 (26%), TNFAIP3 (23%), GNA13 (23%), STAT6 (21%) and B2M (19%). Moreover, several poor prognosis features (high LDH, low serum albumin, B-symptoms, IPI ≥ 3 or at an advanced stage) were related to significantly higher amounts of ctDNA. Variant detection in ctDNA by NGS is a feasible approach to depict the genetic features of HL patients at diagnosis. Our data favour the implementation of liquid biopsy genotyping for the routine evaluation of HL patients., This work was partially supported by the Instituto de Salud Carlos III (ISCIII), Spanish Ministry of Economy and Competitiveness CIBERONC-CB16/12/00233, and “Una manera de hacer Europa” (Innocampus; CEI-2010-1-0010)”, the Health Council of the Junta de Castilla y León (GRS2037/A/19) (GRS1845/A/18) and private Gilead (GLD/18/00063). MGA is supported with a grant from the Accelerator consortia (Cancer Research UK; C355/A26819). CJ and AM are supported by the ISCII (CD19/00030 and FI19/00320). MES is supported by Contrato Miguel Servet tipo II (CPII18/00028). MA is financed by CIBER-CB16/12/00233. All Spanish funding is co-sponsored by the European Union FEDER program.

Calciphylaxis is a rare but highly fatal vascular calcification disorder with a predilection for patients with end stage renal disease (ESRD). The pathogenesis of calciphylaxis is unknown, however, several risk factors have been identified such as hypercalcemia, hyperphosphatemia, hyperparathyroidism, low serum albumin, and history of warfarin therapy. This article presents a case of calciphylaxis induced by warfarin in a COVID-19 patient.

Low serum albumin (LSA) on admission for acute myocardial infarction (AMI) is related to adverse in-hospital outcomes. However, the relationship between LSA and long-term post-AMI cardiovascular outcomes is unknown. A single-center, non-randomized, retrospective study was performed to investigate the prognostic impact of LSA at admission for AMI on cardiovascular death or newly developed HF in the remote phase after AMI. Admission serum albumin tertiles (&lt, 3.8, 3.8&ndash, 4.2, &ge, 4.2 g/dL) were used to divide 2253 consecutive AMI from February 2008 to January 2016 patients into three groups. Primary outcome was a composite of hospitalization for HF and cardiovascular death remotely after AMI. Cox proportional hazard models were used to explore the relationship between admission LSA and primary outcome. During follow-up (median: 3.2 years), primary composite outcome occurred in 305 patients (13.5%). Primary composite outcome occurred individually for hospitalization for HF in 146 patients (6.5%) and cardiovascular death in 192 patients (8.5%). The cumulative incidence of primary composite outcome was higher in the LSA group than the other groups (log-rank test, p &lt, 0.001). Even after adjustments for relevant clinical variables, LSA (&lt, 3.8 mg/dL) was an independent predictor of remote-phase primary composite outcome, irrespective of the clinical severity and subtype of AMI. Thus, LSA on admission for AMI was an independent predictor of newly developed HF or cardiovascular death and has a useful prognostic impact even remotely after AMI.

Background Kawasaki Disease (KD) is considered a major acquired heart disease in children under the age of 5. Coronary artery aneurysm (CAA) can occur in serious cases despite extreme therapy efforts. Previous studies have reported low serum albumin level was associated with disease outcome, but no further investigation was addressed yet. Method This retrospective (case-control) study randomly included children with KD who were admitted and underwent laboratory tests before undergoing IVIG treatment in this institution, the largest tertiary medical center in southern Taiwan from 2012 to 2016. Prognostic nutrition index (PNI), an albumin-based formula product, was evaluated as a predictor of CAA the first time. The progression of CAA was monitored using serial echocardiography for six months. We performed multivariable logistic regression analysis on the laboratory test and PNI with the disease outcome of the KD patients. Result Of the 275 children, 149 had CAA, including transient dilatation, while the other 126 did not develop CAA during the 6-month follow-up period. A multivariate logistic regression model revealed that PNI, gender, IVIG non-responder, and platelet count are significant predictors of CAA with a 95% confidence interval estimator of 1.999, 3.058, 3.864 and 1.004, respectively. Using PNI to predict CAA presence gave an area under the receiver-operating-characteristics (ROC) curve of 0.596. For a cutoff of 0.5 in the logistic regression model and the PNI cut-off point is taken as 55 together with IVIG non-responder, boy gender, and platelet count take into account, sensitivity and specificity were 65.7 and 70.4%. Conclusion PNI could be a candidate of adjunctive predictor of coronary artery aneurysm in addition to IVIG non-responder. Together with low PNI, IVIG non-responder, male gender and platelet count will give high odds to predict coronary artery aneurysm within 6 months of illness.

Background: Relatively low dehydroepiandrosterone sulfate (DHEA-S) and high cortisol/DHEA ratio have been suggested to be associated with frailty, evaluated using a physical scale. However, the significance of these two hormones for frailty in elderly patients with type 2 diabetes mellitus (T2DM) has not been assessed using a wider range of measures of frailty, including physical, mental, and social indices. Methods: We performed a cross-sectional study to investigate the significance of these two hormones for frailty in elderly T2DM patients (n=148; ≥65 years), using a broad assessment, the clinical frailty scale, and to reevaluate the risk factors for frailty in elderly T2DM patients. We compared parameters between the non-frail and frail groups using the unpaired t and Mann-Whitney U tests. The Jonckheere-Therpstra test was used to identify relationships with the severity of frailty and risk factors were identified using binary regression analysis. Results: Simple regression analysis identified a number of significant risk factors for frailty, including DHEAS

Clostridiodes difficile infection (CDI) is one of the most common hospital-acquired infections with high mortality rates. Optimal management of CDI depends on early recognition of severity. However, currently, there is no acceptable standard of prediction. We reviewed severe CDI predictors in published literature and its definition according to clinical guidelines. We systematically reviewed studies describing clinical predictors for severe CDI in medical databases (Cochrane, EMBASE, Global Health Library, and MEDLINE/PubMed). They were independently evaluated by two reviewers. Six hundred thirty-three titles and abstracts were screened, and 31 studies were included. We excluded studies that were restricted to a specific patient population. There were 16 articles that examined mortality in CDI, as compared with 15 articles investigating non-mortality outcomes of CDI. The commonest risk factors identified were comorbidities, white blood cell count, serum albumin level, age, serum creatinine level and intensive care unit admission. Generally, the studies had small patient populations, were retrospective in nature, and mostly from Western centers. The commonest severe CDI criteria in clinical guidelines were raised white blood cell count, followed by low serum albumin and raised serum creatinine levels. There was no commonly agreed upon definition of severe CDI severity in the literature. Current clinical guidelines' definitions for severe CDI are heterogeneous. Hence, there is a need for prospective multi-center studies using standardized protocol for biospecimen investigation collection and shared data on outcomes of patients in order to devise a universally accepted definition for severe CDI.

Background. Hyponatraemia is the most common electrolyte abnormality in hospital admissions. It occurs in a quarter of medical admissions in Ghana, and it is associated with high mortality. Mortality has been suggested to be due to the underlying medical condition and not necessarily the hyponatraemia. We set out to compare the outcomes of patients with documented hyponatraemia as compared to those with normonatraemia in terms of mortality and length of hospital stay. Methods. We conducted a comparative analysis of patients with hyponatraemia and those with normonatraemia on the medical ward at the Komfo Anokye Teaching Hospital between May 2018 and December 2018. The medical diagnoses, demographics, and laboratory data of the patients were recorded. Participants’ age and gender were matched. Student’s t-test was used to test for differences in continuous variables when parametric and Wilcoxon signed-rank test for nonparametric variables. Multiple logistic regression was used to identify predictors of in-hospital mortality. Apvalue of p=0.002). In-hospital stay was longer in patients with hyponatraemia than normonatraemia (7 (4–10) vs. 6 (3–10) days) but not statistically significantp=0.09. Multiple logistic regression showed that low serum sodiump<0.001and low serum albuminp=0.009were the predictors of in-hospital mortality. Conclusion. Hyponatraemia is associated with significantly higher mortality than normonatraemia and predicts worse prognosis in patients on medical admission. Low serum albumin is also a predictor of mortality in medical admission.

Introduction:Low serum albumin is associated with higher perioperative complications following total hip arthroplasty (THA). The distinct threshold for a significant rise in perioperative complications has not been defined for THA. The purpose of this study was to define the threshold at which perioperative complications rise after THA.Methods:We analysed the American College of Surgeons NSQIP database from 2006 to 2013. Our study cohort included unilateral primary THA with reported preoperative albumin levels. Patients were stratified by albumin level. We analysed mortality and 6 composite complication variables (any complication, any complication without transfusion, wound infection, systemic infection, cardiac/pulmonary complications, and any major complication). All data analysis was executed in STATA statistical software. Multivariable logistic regression analysis was used to adjust for odds ratios.Results:The final cohort included 24,586 patients who were stratified based upon serum albumin levels. Odds ratios after multivariable regression adjustment for age, gender, race, body mass index, ASA classification, and Charlson Comorbidity Index indicated a trend to elevated odds of complication for all composite complications (3 of which were statistically significant) when serum albumin level was Conclusion:Low serum albumin is associated with increased perioperative complications following THA. The threshold associated with an increase in major perioperative complications appears to be an albumin level of

BACKGROUND The aim of the current study was to identify the distribution of length and cost of hospital stay and their associated risk factors in poor-risk Japanese critical limb ischemia (CLI) patients undergoing revascularization. Methods and Results: We analyzed prospectively collected data from 507 CLI patients who required assistance in their daily lives due to disability in activities of daily living and/or cognitive function impairment and who underwent revascularization. The median length and cost of hospital stay were 23 days (IQR, 9-52 days) and ¥2.25m (IQR, ¥1.33m-3.58m), respectively. Reduced albumin, tissue loss, infection, surgical reconstruction, and bilateral revascularization were associated with prolonged hospital stay (P=0.012, 0.019

Background Pelvic exenteration carries significant risks of morbidity and mortality. Preoperative management is therefore crucial, and the exenteration procedure is usually performed in an elective setting. In cases of rectal cancer, however, tumor-related complications may cause a patient's condition to deteriorate rapidly, despite optimal management. Urgent pelvic exenteration then may be an option for these patients. Objective This study aims to compare the outcomes of pelvic exenteration between the urgent and elective settings. Design This is a retrospective study. Setting This study was conducted at King Chulalongkorn Memorial Hospital between February 2006 and June 2012. Patients Fifty-three patients with locally advanced rectal cancer were included. Intervention All patients underwent pelvic exenteration for locally advanced rectal cancer. They were assigned to urgent and elective setting groups according to their preoperative conditions. The urgent setting group included patients who required urgent pelvic exenteration because of intestinal obstruction, bowel perforation, bleeding, or uncontrolled sepsis, despite optimal management preoperatively. Main outcome measures Twenty-six patients were classified in the urgent setting group, and 27 were classified in the elective setting group. Three-year overall and disease-free survivals were compared between the 2 groups. Thirty-day postoperative morbidity and mortality were also studied. Results Three-year overall survival was 62.2% and 54.4% in the elective and urgent groups (p = 0.7), whereas three-year disease-free survival was 43% and 63.8% (p = 0.33). The median follow-up time was 33 months. Thirty-day morbidity did not differ between the 2 groups (p = 0.49). A low serum albumin level was a significant risk factor for complications. There was no postoperative mortality in this study. Limitations This was a retrospective study performed at 1 institution, and it lacked quality-of-life scores. Conclusion Pelvic exenteration in an urgent setting is feasible and could offer acceptable outcomes. See Video Abstract at http://links.lww.com/DCR/A591.

Background In peritoneal dialysis, technique failure is an important metric to be considered. This study was performed in order to identify the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure on end-stage renal disease patients according to diabetic status. Furthermore, this study was performed to reveal predictors of serum albumin and technique failure simultaneously. Methods This retrospective cohort study included 300 (189 non-diabetic and 111 diabetic) end-stage renal disease patients on continuous ambulatory peritoneal dialysis treated in Al-Zahra Hospital, Isfahan, Iran, from May 2005 to March 2015. Bayesian joint modeling was carried out in order to determine the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure in the patients according to diabetic status. Death from all causes was considered as a competing risk. Results Using joint modeling approach, a relationship between trajectories of serum albumin with hazard of transfer to hemodialysis was estimated as -0.720 (95% confidence interval [CI], -0.971 to -0.472) for diabetic and -0.784 (95% CI, -0.963 to -0.587) for non-diabetic patients. From our findings it was showed that predictors of low serum albumin over time were time on peritoneal dialysis for diabetic patients and increase in age and time on peritoneal dialysis, history of previous hemodialysis, and lower body mass index in non-diabetic patients. Conclusion The results of current study showed that controlling serum albumin over time in non-diabetic and diabetic patients undergoing continuous ambulatory peritoneal dialysis treatment can decrease risk of adverse outcomes during the peritoneal dialysis period.

[BACKGROUND/OBJECTIVES]The level of serum albumin is an index of nourishment care and management. However, the distribution and correlates of serum albumin levels among individuals with motor disorders have not been reported until now. Therefore, we examined the distribution and correlates of serum albumin levels among individuals with motor disorders. [SUBJECTS/METHODS]A cross-sectional study on 249 individuals with motor disabilities (144 men, mean age: 51.4 years; 105 women, mean age: 51.4 years) was conducted at five institutions in Ibaraki Prefecture, Japan in 2008. The results were compared with data from the National Health and Nutrition Survey. [RESULTS]The mean serum albumin levels were 4.0 ± 0.4 g/dL for men and 3.8 ± 0.5 g/dL for women. Overall, 17 (11.8%) men and 25 (23.8%) women had hypoalbuminemia (serum albumin level ≤ 3.5 g/dL); these proportions were greater than those among healthy Japanese adults (≤ 1%). Low serum albumin level was related with female sex, older age, low calf circumference, low relative daily energy intake, low hemoglobin (Hb), low blood platelet count, low high-density lipoprotein cholesterol (HDL-C), low HbA1c, and high C-reactive protein (CRP) levels. The strongest correlates, based on standardized betas, were Hb (0.321), CRP (-0.279), and HDL-C (0.279) levels. [CONCLUSIONS]These results indicate that the prevalence of hypoalbuminemia is higher in individuals with motor disabilities than in healthy individuals and that inflammation is a strong negative correlate of serum albumin levels. Therefore, inflammation should be examined for the assessment of hypoalbuminemia among institutionalized individuals with motor disabilities.

Background The occurrence of urinary tract infection (UTI) in nephrotic syndrome has been reported. However, the only causes for the infection reported to date are bacteria and prior reported series did not identify yeast or fungi as causative organisms. Methods A retrospective study of 2880 children with nephrotic syndrome was made to determine the incidence of UTI, predisposing factor and bacterial and fungal etiologies. Results Between January 2000 and November 2016, we identified that 15% of the children developed UTI. Within this group, bacterial UTI and fungal UTI were 84.0% and 16.0%, respectively. The genus Klebsiella (25.33%) predominates among bacteria, while Candida cruzi (26.08%) predominates among fungal etiologies. Statistical analysis was performed for biochemical indices and UTI and was found significant for low serum albumin and high serum cholesterol (P ≤ 0.05). Conclusion This study emphasizes the importance of UTI in children and can be underdiagnosed in children with nephrotic syndrome because steroid therapy is anti-inflammatory and can mask the symptoms of UTI.

BACKGROUND The aim of this study was to investigate the nutrition support team (NST) reconsultation practice and to evaluate reasons and describe risk factors for NST reconsultation during nutrition therapy (NT) in hospitalized patients. METHODS This study included 2505 patients aged >18 years who received NT through NST consultation between January 2016 and December 2016 at Seoul National University Hospital. NST reconsultation refers to consulting the NST more than twice during a single hospitalization period. Risk factors affecting NST reconsultation were included only when NST reconsultation occurred for specific reasons other than routine evaluations. RESULTS The NST reconsultation rate was 36.4% (913/2505) with 926 reasons, including 'changes in the nutrition provision method' (n = 474, 51.2%), 'NT-related complications' (n = 284, 30.7%), 'routine evaluations' (n = 137, 14.8%), and 'discharge planing including home NT' (n = 31, 3.3%). The reconsultation rate of enteral nutrition (EN) was 40.8% (n = 378) and that of parenteral nutrition (PN) was 59.2% (n = 548). Among the NT-related complications, diarrhea (n = 65, 49.2%) was the most common with EN, whereas electrolyte abnormality (n = 52, 34.2%) was the most common with PN. Performance of surgery (odds ratio [OR], 2.061; P < .001), low serum albumin levels (

Previous studies have reported conflicting results on the association between hypoalbuminaemia and morbidity and mortality in hospitalised patients.To investigate the association of albumin levels on admission and change in levels during hospitalisation of patients in general surgery wards with hospitalisation outcomes.Historical prospective data of patients hospitalised between January 2011 and December 2017. Albumin levels were classified as follows: marked hypoalbuminaemia (2.5 mg/dL), mild hypoalbuminaemia (2.5-3.5 mg/dL), normal albumin (3.5-4.5 mg/dL) and hyperalbuminaemia (4.5 mg/dL). Main outcomes were length of hospitalisation, 30-days and long-term mortality.The cohort included 17 930 patients (mean age 58 ± 20 years, 49% male). Most had normal albumin levels on admission (n = 11 087, 62%), 16% had mild hypoalbuminaemia (n = 2824) and 3% had marked hypoalbuminaemia (n = 529). Hyperalbuminaemia on admission was evident in 20% of the patients (n = 3490). Follow-up time was up to 7.2 years (median ± SD = 3 ± 2 years). Compared to 30-day mortality with normal albumin on admission (2%), mortality was higher with mild (9%) and marked hypoalbuminaemia (22%) and lower with hyperalbuminaemia (0.4%). The mortality rate at the end of follow up was 14% with normal albumin levels, and 35% and 58% with mild and marked hypoalbuminaemia respectively. Patients with hyperalbuminaemia on admission and before discharge had the best short- and long-term survival. This pattern was similar when analysed separately in different age groups. In patients with hypoalbuminaemia on admission, normalisation of albumin levels before discharge was associated with lower short- (12% vs 1%) and long-term mortality risk (42% vs 17%).Low albumin levels on admission to general surgery wards are associated with increased short- and long-term mortality. Normalisation of albumin levels before discharge was associated with lower mortality, compared to hypoalbuminaemia before discharge.

Reductions in masticatory function as a result of tooth loss have a negative impact on nutrient intake, decreasing general health. In addition, studies have reported an association between lower socioeconomic status (SES) and both higher numbers of lost teeth and worse nutrient intake status. Nakamura et al. conducted a study to clarify the relationship between number of teeth and nutrient intake status in their paper “Having few remaining teeth is associated with a low nutrient intake and low serum albumin levels in middle-aged and older Japanese individuals: Findings from the NIPPON DATA”, evaluating not only data obtained from a household-based dietary survey but also serum albumin levels as a nutritional biomarker. Importantly, the present study also took into account the individual SES of subjects in the analysis of number of teeth and nutrient intake. The present results show that the trend for poorer nutrient intake with lower number of teeth is more marked among individuals with low SES. It is therefore essential that individual SES is taken into account in efforts to improve nutrient intake and thus contribute to general health through oral health.

Cognitive impairment (CI, ~15-20%) and malnutrition (~38.7%) are common concerns among older adults ≥65 years. CI and malnutrition may be used as predictive risk factors for poor surgical outcomes. The 2012 ACS NSQIP/AGS Best Practice Guidelines for the preoperative assessment of geriatric surgical patients classify severe nutritional risk as either having a BMI < 18.5 kg/m2, serum albumin (SA) < 3.0 g/dL and/or unintentional weight loss > 10%-15% within 6 months. Using SA as a surrogate marker for malnutrition, we evaluated the relationship between CI, malnutrition, and risk for poor surgical outcomes in a geriatric population. Electronic medical record chart reviews of patients (≥65 years old) undergoing elective intermediate or high-risk surgery (IHRS), between 2016 and 2019 in Tucson, AZ, were conducted. Pre-and-post assessment factors such as cognitive status via mini-cog, laboratory markers (SA), and hospital complications were examined. Multivariate regression analyses were performed to determine the association between cognitive status, SA levels, and hospital complications. Of the 173 patients undergoing IHRS included in this assessment (mean age: 75.5±7.4 years, [60-93 years], 54.9% male), 42.8% experienced hospital complications. Multivariate regression analysis revealed cognitive impairment and low SA levels were significantly associated with this outcome (p

Malignant ureteral obstruction can result in renal dysfunction or urosepsis and can limit the physician's ability to treat the underlying cancer. There are multiple methods to deal with ureteral obstruction including regular polymeric double J stents (DJS), tandem DJS, nephrostomy tubes, and then more specialized products such as solid metal stents (e.g., Resonance Stent, Cook Medical) and polyurethane stents reinforced with nickel-titanium (e.g., UVENTA stents, TaeWoong Medical). In patients who require long-term stenting, a nephrostomy tube could be transformed subcutaneously into an extra-anatomic stent that is then inserted into the bladder subcutaneously. We outline the most recent developments published since 2012 and report on identifiable risk factors that predict for failure of urinary drainage. These failures are typically a sign of cancer progression and the natural history of the disease rather than the individual type of drainage device. Factors that were identified to predict drainage failure included low serum albumin, bilateral hydronephrosis, elevated C-reactive protein, and the presence of pleural effusion. Head-to-head studies show that metal stents are superior to polymeric DJS in terms of maintaining patency. Discussions with the patient should take into consideration the frequency that exchanges will be needed, the need for externalized hardware (with nephrostomy tubes), or severe urinary symptoms in the case of internal DJS. This review will highlight the current state of diversions in the setting of malignant ureteral obstruction. Keywords: Malignant ureteral obstruction, Ureteral stent, Hydronephrosis

The most common acute glomerulonephritis in children is poststreptococcal glomerulonephritis (PSGN) usually occurring between 3 and 12 years old. Hypertension and gross hematuria are common presenting symptoms. Most PSGN patients do not experience complications, but rapidly progressive glomerulonephritis and hypertensive encephalopathy have been reported. This paper reports 17 patients seen in 1 year for PSGN including 4 with atypical PSGN, at a pediatric tertiary care center. Seventeen children (11 males), mean age of 8 years, were analyzed. Ninety-four percent had elevated serum BUN levels and decreased GFR. Four of the hospitalized patients had complex presentations that included AKI along with positive ANA or ANCAs. Three patients required renal replacement therapy and two were thrombocytopenic. PSGN usually does not occur as a severe nephritis. Over the 12-month study period, 17 cases associated with low serum albumin in 53%, acute kidney injury in 94%, and thrombocytopenia in 18% were treated. The presentation of PSGN may be severe and in a small subset have associations similar to SLE nephritis findings including AKI, positive ANA, and hematological anomalies.

Although MELD score is a reliable tool for estimating mortality in the waiting list, criteria for preoperative prediction of survival after liver transplantation (LT) are lacking. ALBI score was validated as a prognostic marker for hepatocellular carcinoma patients undergoing transarterial chemoembolization, hepatic resection, and sorafenib treatment but not for LT outcomes yet. This study aimed to evaluate ALBI score as a prognostic factor in LT. This is a single-center analysis of patients undergoing LT between October 2001 and June 2017. Primary endpoint was overall post-LT mortality. Secondary endpoint was 90-day mortality. Of all 301 patients included in this study, 185 (61.5%) were males. The median age was 54.1 ± 11.3 years. Univariate and multivariate analysis revealed that ALBI grade 3 (HR 1.836, 95% CI 1.154–2.921, p = 0.010), low serum albumin (HR 0.628, 95% CI 0.441–0.893, p = 0.010), black race (HR 2.431, 95% CI 1.160–5.092, p = 0.019), and elevated body mass index (HR 1.061, 95% CI 1.022–1.102, p = 0.002) all were associated with decreased overall survival following LT. Patients with both ALBI grade 3 (n = 25) and calculated MELD score ≥ 25 had the lowest overall survival (p