Abstract Background and Aims: Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with poor outcomes. However, data on the epidemiology of AKI and sepsis-associated AKI (SA-AKI) from Indian intensive care units (ICUs) remain limited. This study aimed to develop a risk prediction model for SA-AKI and evaluate the incidence and outcomes of AKI in a tertiary care ICU. Material and Methods: This retrospective, single-center observational study included adult patients admitted to a multidisciplinary ICU between January and December 2020. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria, and SA-AKI according to the Acute Disease Quality Initiative 28 consensus statement. Multivariable logistic regression was used to identify predictors of SA-AKI, and Kaplan–Meier analysis was performed to assess survival. Results: Of 379 patients, 253 (66.7%) developed AKI, with 208 (82.0%) having AKI at ICU admission. SA-AKI accounted for 81.2% of AKI cases. In the SA-AKI prediction model, lower serum bicarbonate levels and higher APACHE II scores were independently associated with the development of SA-AKI, and the model demonstrated good discriminatory performance (AUC 0.839). Compared with patients without AKI, those with AKI had higher ICU mortality (47.8% vs. 12.6%; P < 0.001). AKI was also associated with significantly reduced survival (hazard ratio 2.74, 95%CI: 1.62–4.64; P < 0.001). Conclusions: AKI, predominantly SA-AKI, was highly prevalent among critically ill patients and was associated with worse outcomes. The proposed SA-AKI prediction model showed promising performance but requires external validation before clinical application.
Abstract Background and Aims: Total hip arthroplasty (THA) is associated with significant postoperative pain, and while regional anesthesia techniques such as fascia iliaca compartment block (FICB) and erector spinae plane block (ESPB) are employed to manage postoperative pain, their relative efficacy and safety have not been systematically established. This review aimed to compare the efficacy and safety of ESPB and FICB for postoperative analgesia in patients undergoing THA. Material and Methods: PubMed, Embase, APA PsycINFO, Cochrane Library, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature were searched from inception to July 30, 2024. Two independent reviewers screened titles, abstracts, and full texts to include randomized trials comparing ESPB and FICB for postoperative analgesia in adult patients undergoing THA. Reference list screening and citation tracking of included studies ensured literature saturation. The primary outcome was 24-hour postoperative opioid consumption measured as morphine equivalents. The secondary outcomes were time to first rescue analgesic requirement, postoperative static and dynamic pain scores, and any block-related adverse effects. A prepiloted data extraction sheet, Risk of Bias 2 tool, GRADE approach, inverse variance meta-analysis, and I 2 statistic were used for data extraction, risk of bias assessment, grading certainty of evidence, meta-analysis, and assessing outcome heterogeneity, respectively. Mean (MD) or standardized mean difference (SMD) and relative risk (RR) or odds ratio (OR) with 95% confidence intervals (CIs) were used for continuous and dichotomous outcomes, respectively. Results: Five studies randomized 280 patients undergoing THA under spinal anesthesia to receive either ultrasound (USG)-guided single shot ESPB (n = 140) or FICB (n = 140). A low to moderate level of evidence indicated no significant difference between ESPB and FICB with respect to 24-hour postoperative oral morphine milligram equivalent consumption (MD 1.23, 95% CI -3.55 to 6.01; P 0.62, I 2 = 86%), pain scores at rest at 2 (SMD -0.22, 95% CI -0.65 to 0.21; P 0.31, I 2 = 49%), 4 (SMD 0.09, 95% CI -0.39 to 0.58; P 0.70, I 2 = 61%), and 24 hours (SMD 0.25, 95% CI -0.01 to 0.51; P 0.06, I 2 = 0%) and on movement at 24 hours (SMD 0.14, 95% CI -0.30 to 0.58; P 0.52; I 2 = 54%), time to first rescue analgesic requirement in hours (MD -0.77, 95% CI -4.07 to 2.53; P 0.65, I 2 = 90%), and postoperative nausea vomiting (Peto’s OR 0.50, 95% CI 0.10 to 2.56; P 0.41). A moderate level of evidence indicated ESPB to be associated with significantly earlier onset of ambulation and reduced quadriceps weakness compared to FICB (Peto’s OR 0.17, 95% CI 0.07 to 0.42; P 0.0002, I 2 = 0%). An NNTH of 4 (95% CI 2 to 7) indicated that one additional patient incurs quadriceps muscle weakness for every four patients receiving FICB rather than ESPB for THA. Conclusions: There was no significant difference between ESPB and FICB for postoperative analgesia in terms of postoperative opioid consumption, pain scores, and time to first rescue analgesic requirement based on the current limited evidence, and either type of block can be used for postoperative analgesia in total hip arthroplasty. However, ESPB was associated with reduced quadriceps weakness and faster onset of ambulation as compared to FICB after THA, but the evidence comes from only two studies. Further well conducted and adequately powered randomized controlled trials comparing the two types of blocks are warranted. PROSPERO Registration: CRD42024551027, dated 09 June 2024.
