Debora M Hofer's research while affiliated with Inselspital, Universitätsspital Bern and other places

Background Fluid accumulation (FA) is known to be associated with acute kidney injury (AKI) during intensive care unit (ICU) stay but data on mid-term renal outcome is scarce. The aim of this study was to investigate the association between FA at ICU day 3 and major adverse kidney events in the first 30 days after ICU admission (MAKE30). Methods Retrospective, single-center cohort study including adult ICU patients with sufficient data to compute FA and MAKE30. We defined FA as a positive cumulative fluid balance greater than 5% of bodyweight. The association between FA and MAKE30, including its sub-components, as well as the serum creatinine trajectories during ICU stay were examined. In addition, we performed a sensitivity analysis for the stage of AKI and the presence of chronic kidney disease (CKD). Results Out of 13,326 included patients, 1,100 (8.3%) met the FA definition. FA at ICU day 3 was significantly associated with MAKE30 (adjusted odds ratio [aOR] 1.96; 95% confidence interval [CI] 1.67–2.30; p < 0.001) and all sub-components: need for renal replacement therapy (aOR 3.83; 95%CI 3.02–4.84), persistent renal dysfunction (aOR 1.72; 95%CI 1.40–2.12), and 30-day mortality (aOR 1.70; 95%CI 1.38–2.09), p all < 0.001. The sensitivity analysis showed an association of FA with MAKE30 independent from a pre-existing CKD, but exclusively in patients with AKI stage 3. Furthermore, FA was independently associated with the creatinine trajectory over the whole observation period. Conclusions Fluid accumulation is significantly associated with MAKE30 in critically ill patients. This association is independent from pre-existing CKD and strongest in patients with AKI stage 3.

Purpose: Maintenance and hidden/creep fluids are a major source of fluid and sodium intake in intensive care unit (ICU) patients. Recent research indicates that low versus high sodium content maintenance fluids could decrease fluid and sodium burden. We conducted a systematic review (SR) with meta-analysis to summarize the impact of maintenance fluid choice on total daily sodium in ICU patients. Materials and methods: Systematic literature search in Pubmed, Embase, the Cochrane Library and the. Clinical trials registry: Only controlled clinical trials were included. Exclusion criteria: trials on resuscitation fluids, performed in the emergency department only and in pediatric patients. Primary objective was the reduction in mean total sodium intake with low versus high sodium content maintenance/creep fluids. Results: Five studies (1105 patients) were included. Heterogeneity was high.Risk of bias was moderate. Mean daily sodium reduction was 117 mmol (95%Confidence Interval [CI] -174; -59; p < 0.001) with low versus high sodium content maintenance/creep fluids. Incidence of hyperchloremia was lower (OR 0.26; 95%CI 0.1; 0.64) with low sodium. There were no differences in the incidences of hyper-/hyponatremia and fluid balances. Conclusion: Using low sodium content maintenance/creep fluids substantially reduces daily sodium burden in adult ICU patients. Significant knowledge/research gaps exist regarding relevance and safety. Trial registration: PROSPERO 2022 CRD42022300577 (February 2022).

Purpose: To systematically assess test performance of patient-adapted D-dimer cut-offs for the diagnosis of venous thromboembolism (VTE). Methods: Systematic review and analysis of articles published in PubMed, Embase, ClinicalTrials.gov, and Cochrane Library databases. Investigations assessing patient-adjusted D-dimer thresholds for the exclusion of VTE were included. A hierarchical summary receiver operating characteristic model was used to assess diagnostic accuracy. Risk of bias was assessed by QUADAS-2. Results: 68 studies involving 141,880 patients met the inclusion criteria. The standard cut-off revealed a sensitivity of 0.99 (95% confidence interval [CI] 0.98 - 0.99) and specificity of 0.23 (95% CI 0.16 - 0.31). Sensitivity was comparable to the standard cut-off for age-adjustment (0.97 [95% CI 0.96 - 0.98]) and YEARS algorithm (0.98 [95% CI 0.91 - 1.00]) but lower for pre-test probability (PTP)-adjusted (0.95 [95% CI 0.89 - 0.98) and COVID-19-adapted thresholds (0.93 [95% CI 0.82 - 0.98]). Specificity was significantly higher across all adjustment strategies (age: 0.43 [95% CI 0.36 - 0.50]; PTP: 0.63 [95% CI 0.51 - 0.73]; YEARS algorithm: 0.65 [95% CI 0.39 - 0.84]; and COVID-19: 0.51 [95% CI0.40 - 0.63]). The YEARS algorithm provided the best negative likelihood ratio (0.03 [95% CI 0.01 - 0.15]), followed by age-adjusted (both 0.07 [95% CI 0.05 - 0.09]), PTP (0.08 [95% CI 0.04 - 0.17), and COVID-19-adjusted thresholds (0.13 [95% CI 0.05 - 0.32]). Conclusions: This study indicates that adjustment of D-dimer thresholds to patient-specific factors is safe and embodies considerable potential for reduction of imaging. However, robustness, safety, and efficiency vary considerably between different adjustment strategies with a high degree of heterogeneity. This article is protected by copyright. All rights reserved.

Chronic postsurgical pain (CPSP) is defined by pain intensity and pain-related functional interference. This study included measures of function in a composite score of patient-reported outcomes (PROs) to investigate the incidence of CPSP. Registry data were analyzed for PROs one day and 12 months postoperatively. Based on pain intensity and pain-related interference with function, patients were allocated to the groups "CPSPF" (at least moderate pain with interference), "Mixed" (milder symptoms) and "No CPSPF". The incidence of CPSPF was compared to CPSP rates referring to published data. Variables associated with the PRO-12 score (composite PROs at 12 months; NRS 0-10) were analyzed by linear regression analysis. Of 2319 patients, 8.6%, 32.5% and 58.9% were allocated to the groups CPSPF, Mixed and No CPSPF. Exclusion of patients whose pain scores did not increase compared to the preoperative status, resulted in a 3.3% incidence. Of the patients without pre-existing pain, 4.1% had CPSPF. Previously published pain cut-offs of NRS >0, ≥3 or ≥4, used to define CPSP, produced rates of 37.5%, 9.7% and 5.7%. Pre-existing chronic pain, pre-operative opioid medication and type of surgery were associated with the PRO-12 score (all p<0.05). Opioid doses and PROs 24 hours postoperatively improved the fit of the regression model. A more comprehensive assessment of pain and interference resulted in lower CPSP rates than previously reported. Although inclusion of CPSP in the ICD-11 is a welcome step, evaluation of pain characteristics would be helpful in differentiation between CPSPF and continuation of pre-existing chronic pain.