Although serum cystatin C (sCysC), urinary N-acetyl-β-d-glucosaminidase (uNAG), and urinary albumin/creatinine ratio (uACR) are clinically available, their optimal combination for acute kidney injury (AKI) detection and prognosis prediction remains unclear. We aimed to assess the discriminative abilities of these biomarkers and their possible combinations for AKI detection and intensive care unit (ICU) mortality prediction in critically ill adults. A multicenter, prospective observational study was conducted in mixed medical-surgical ICUs at three tertiary care hospitals. One thousand eighty-four adult critically ill patients admitted to the ICUs were studied. We assessed the use of individual biomarkers (sCysC, uNAG, and uACR) measured at ICU admission and their combinations with regard to AKI detection and prognosis prediction. AUC-ROCs for sCysC, uNAG, and uACR were calculated for total AKI (0.738, 0.650, and 0.683, respectively), severe AKI (0.839, 0.706, and 0.771, respectively), and ICU mortality (0.727, 0.793, and 0.777, respectively). The panel of sCysC plus uNAG detected total and severe AKI with significantly higher accuracy than either individual biomarkers or the other two panels (uNAG plus uACR or sCysC plus uACR). For detecting total AKI, severe AKI, and ICU mortality at ICU admission, this panel yielded AUC-ROCs of 0.756, 0.863, and 0.811, respectively; positive predictive values of 0.71, 0.31, and 0.17, respectively; and negative predictive values of 0.81, 0.97, and 0.98, respectively. Moreover, this panel significantly contributed to the accuracy of the clinical models for AKI detection and ICU mortality prediction, as measured by the AUC-ROC, continuous net reclassification index, and incremental discrimination improvement index. The comparable performance of this panel was further confirmed with bootstrap internal validation. The combination of a functional marker (sCysC) and a tubular damage marker (uNAG) revealed significantly superior discriminative performance for AKI detection and yielded additional prognostic information on ICU mortality.

Short-term recurrence of positive SARS-CoV-2 RNA PCR in discharged COVID-19 patients attracts the public’s concern. This study aimed to determine clinical and epidemiological results of such patients. This retrospective study was conducted on 32 designated hospitals for COVID-19 patients discharged from January 14 ^th to March 10 ^th, 2020. After 28-day followed-up, re-positive patients confirmed by SARS-CoV-2 RNA RT-PCR were re-admitted to hospital for further treatments. All the close contacts of re-positive patients were asked 14-day self-segregating. Data of epidemiology, symptoms, laboratory tests and treatments were analyzed in re-positive patients and their close contacts were investigated. Of 1,282 discharged patients, 189 (14.74%) were tested re-positive of SARS-CoV-2 RNA during 28-day follow-up. The median time from discharge to re-positivity was 8 days (IQR 5-13). Patients in re-positive group were younger (34yr vs 45yr, p&0.001) with higher proportion of moderate symptoms (95.77% vs 84.35%, p&0.001) in the first hospitalization than negative group. During the second hospitalization, all re-positive patients showed normal in peripheral white blood cell and lymphocyte, and no new symptoms of COVID-19; 78.31% further improved on chest CT scan compared with the first discharge, yet 25.93% accepted antiviral therapy. The median time of re-positive to negative was 8 days (IQR 4-15). None of close contacts developed COVID-19. Our data suggested that the short term recurrence of positive SARS-CoV-2 RNA in discharged patients is not a relapse of COVID-19, and the risk of onward transmission is very low. This provides important information for managing COVID-19 patients.

Background: Despite the extensive use of arterial catheterization (AC), clinical effectiveness of AC to alter the outcomes among patients with sepsis and septic shock has not been evaluated. The purpose of this study is to examine the association between the use of AC and in-hospital mortality in septic patients. Methods: Adult patients with sepsis from Medical Information Mart for Intensive Care database were screened to conduct this retrospective observational study. Propensity score matching (PSM) was employed to estimate the relationship between arterial catheterization (AC) and in-hospital mortality. Multivariable logistic regression and inverse probability of treatment weighing (IPTW) were used to validate our findings. Results: A total of 14,509 septic patients without shock and 4,078 septic shock patients were identified. 3,489 pairs in sepsis patients without shock and 589 pairs in septic shock patients were yielded respectively after PSM. For patients in the sepsis without shock group, AC placement was associated with increased in-hospital mortality (OR, 1.34; 95% CI, 1.17–1.54; p < 0.001). In the septic shock group, there was no significant difference in hospital mortality between AC group and non-AC group. The results of logistic regression and propensity score IPTW model support our findings. Conclusions: In hemodynamically stable septic patients, AC is independently associated with higher in-hospital mortality, while in patients with septic shock, AC was not associated with improvements in hospital mortality.