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Mav Manji

Publications and source records attributed to Mav Manji.

4 recordsLinked to original sources
PubMed2006

Microalbuminuria in the intensive care unit: Clinical correlates and association with outcomes in 431 patients.

OBJECTIVE: Comparison of urine albumin within 6 hrs of intensive care unit (ICU) admission with demography, clinical classification, outcome, inotrope/vasopressor requirement, clinical assessment of mortality risk, and Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. DESIGN: Urine albumin-creatinine ratio (ACR) was measured on ICU admission (ACR 1) and after 4-6 hrs (ACR 2). SETTING: A 17-bed general ICU in a university teaching hospital. PATIENTS: Unselected medical (206) and surgical (225) patients recruited prospectively. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Bedside urine ACR was measured by nurses using a Bayer DCA 2000 analyzer and expressed in mg/mmol (reference range <2.3). ACR 1 in medical and surgical patients was 15.5 (12.4-19.5) and 8.2 (5.9-11.1) mg/mmol, respectively (p = .0002), and ACR 2 was 9.0 (5.8-12.5) and 4.6 (3.6-5.3), respectively (p < .0001). For all patients, median (95% confidence interval) ACR fell from 11.2 (8.7-13.2) to 5.4 (4.7-6.8) mg/mmol 4-6 hrs after ICU admission (p < .0001). ACR 1 for nonsurvivors (n = 90) and survivors (n = 341) was 16.1 (11.2-21.3) and 8.8 (6.9-11.9), respectively (p = .0002) and ACR 2, 12.4 (8.2-18.9) and 4.8 (3.9-5.4), respectively (p < .0001). In both medical and surgical patients who died on the ICU, median ACR failed to decrease significantly following admission. ACR1 and ACR 2 were higher in patients who required inotropic or vasopressor support and correlated with duration of therapy. ACR 1 and 2 were inversely correlated with mean Po2/Fio2 ratio 48 hrs after ICU admission and positively correlated with duration of mechanical ventilation and ACR 1 with ICU stay. ACR 2 predicted mortality and ACR 1 inotrope requirement independent of clinical mortality risk assessment and APACHE II and SOFA scores. CONCLUSIONS: Urine albumin changes rapidly within the first 6 hrs following ICU admission and predicts ICU mortality and inotrope requirement as well as or better than APACHE II and SOFA scores. Serial urine albumin measurement may provide a means of monitoring the microvascular effects of systemic inflammation.

APACHE↗
PubMed2005

Pulmonary and renal function following cardiopulmonary bypass is associated with systemic capillary leak.

OBJECTIVE: The purpose of this study was to compare perioperative capillary permeability during cardiac surgery with subsequent pulmonary and renal function. DESIGN: An observational prospective comparison of capillary permeability (microalbuminuria) during and after cardiopulmonary bypass (CPB), with postoperative pulmonary and renal function. SETTING: A university teaching hospital. PARTICIPANTS: Forty patients, mean (range) age 67.8 (50-85) years, undergoing elective first-time coronary artery bypass grafting (CABG). INTERVENTIONS: Urine albumin concentration (AC) and albumin creatinine ratio (ACR) were compared with PO2 /FIO2 ratio, mechanical ventilation (intermittent positive-pressure ventilation [IPPV]) duration, and renal function. MEASUREMENTS AND MAIN RESULTS: Median (range) AC and ACR increased from 8.3 (1.6-184.2) mg/L and 0.65 (0.1-18.8) mg/mmol preoperatively to 13.6 (1.6-267.2) mg/L and 4.80 (0.3-54.2) mg/mmol 10 minutes postbypass (p = 0.003 for ACR Wilcoxon rank test: not significant for AC). AC 2 hours postbypass was associated with mean PO2 /FIO2 ratio 0 to 2 hours postbypass and AC 4 hours postbypass was associated with mean PO2 /FIO2 ratio 0 to 2 and 2 to 12 hours postbypass (p < 0.05 Spearman). ACR 2 hours postbypass was associated with mean PO2 /FIO2 ratio 0 to 2 and 2 to 12 hours postbypass (p < 0.05 Spearman). AC 10 minutes and 2 hours postbypass and ACR 2 hours postbypass were associated with the duration of IPPV (p < 0.03). Day 1 serum creatinine was associated with pre- and 4 hours postbypass AC and ACR (p < 0.05). Day 2 serum creatinine was associated with 2 and 4 hours postbypass ACR (p < 0.05). CONCLUSIONS: The magnitude of increase in capillary permeability during CABG is associated with later pulmonary and renal function.

Aged↗
PubMed2003

Mortality prediction at admission to intensive care: a comparison of microalbuminuria with acute physiology scores after 24 hours.

OBJECTIVE: To compare low level albumin excretion (microalbuminuria), a marker of systemic capillary permeability, with mortality, Acute Physiologic And Chronic Health Evaluation (APACHE II) score, the Simplified Acute Physiologic (SAP II) score, and their derived mortality probabilities in patients admitted to a general intensive care unit. DESIGN: Prospective observational study. SETTING: A 14-bed intensive care unit in a university teaching hospital. PATIENTS: A total of 140 consecutive patients (59 surgical, 48 medical, 22 trauma, and 11 burns). INTERVENTIONS: Urine collection within 15 mins of intensive care unit admission for assessment of microalbuminuria. MEASUREMENTS AND MAIN RESULTS: Microalbuminuria, expressed as the albumin-creatinine ratio (ACR: normal, <2.3 mg/mmol), was compared with mortality, APACHE II and SAP II scores and their derived mortality probabilities after 24 hrs, intensive care unit stay, and markers of organ function and inflammation. Median (95% confidence interval) ACR at admission for survivors (n = 115) and nonsurvivors (n = 25) were 4.2 (3.6-6.5) and 17.8 (8.0-40.8) mg/mmol, respectively (p =.0002 Mann Whitney). For 92 surgical, trauma, and burn patients, of whom 81 survived, ACR of >5.9 mg/mmol gave a sensitivity for death of 100%, specificity of 59%, positive predictive value of 25%, and negative predictive value of 100%. Mortality probability receiver operator characteristic curve areas for ACR, APACHE II, and SAP II were 0.843 (p <.0001), 0.793 (p =.0004), and 0.770 (p =.0017), respectively. ACR was associated with intensive care unit stay (p =.0021) and highest serum C-reactive protein (p =.0002), serum creatinine (p <.0001), and bilirubin (p =.0009). For 48 medical patients, of whom 34 survived, admission ACRs for survivors and nonsurvivors were 8.3 (5.7-10.8) and 10.7 (4.1-48.2) mg/mmol, respectively (p =.32). SAP II, but not APACHE II, score was significantly higher for nonsurvivors. CONCLUSIONS: For surgical, trauma, and burn patients, but not medical patients, microalbuminuria within 15 mins of intensive care unit admission predicted death as well as APACHE II and SAP II scores calculated after 24 hrs, and it shows promise as a predictor of outcome.

APACHE↗