Burden of acute kidney injury and 90-day mortality in critically ill patients

Show simple item record

dc.contributor.author Wiersema, Renske
dc.contributor.author Eck, Ruben J
dc.contributor.author Haapio, Mikko
dc.contributor.author Koeze, Jacqueline
dc.contributor.author Poukkanen, Meri
dc.contributor.author Keus, Frederik
dc.contributor.author van der Horst, Iwan C C
dc.contributor.author Pettilä, Ville
dc.contributor.author Vaara, Suvi T
dc.date.accessioned 2020-01-05T04:14:49Z
dc.date.available 2020-01-05T04:14:49Z
dc.date.issued 2019-12-31
dc.identifier.citation BMC Nephrology. 2019 Dec 31;21(1):1
dc.identifier.uri http://hdl.handle.net/10138/308995
dc.description.abstract Abstract Background Mortality rates associated with acute kidney injury (AKI) vary among critically ill patients. Outcomes are often not corrected for severity or duration of AKI. Our objective was to analyse whether a new variable, AKI burden, would outperform 1) presence of AKI, 2) highest AKI stage, or 3) AKI duration in predicting 90-day mortality. Methods Kidney Diseases: Improving Global Outcomes (KDIGO) criteria using creatinine, urine output and renal replacement therapy were used to diagnose AKI. AKI burden was defined as AKI stage multiplied with the number of days that each stage was present (maximum five), divided by the maximum possible score yielding a proportion. The AKI burden as a predictor of 90-day mortality was assessed in two independent cohorts (Finnish Acute Kidney Injury, FINNAKI and Simple Intensive Care Studies I, SICS-I) by comparing four multivariate logistic regression models that respectively incorporated either the presence of AKI, the highest AKI stage, the duration of AKI, or the AKI burden. Results In the FINNAKI cohort 1096 of 2809 patients (39%) had AKI and 90-day mortality of the cohort was 23%. Median AKI burden was 0.17 (IQR 0.07–0.50), 1.0 being the maximum. The model including AKI burden (area under the receiver operator curve (AUROC) 0.78, 0.76–0.80) outperformed the models using AKI presence (AUROC 0.77, 0.75–0.79, p = 0.026) or AKI severity (AUROC 0.77, 0.75–0.79, p = 0.012), but not AKI duration (AUROC 0.77, 0.75–0.79, p = 0.06). In the SICS-I, 603 of 1075 patients (56%) had AKI and 90-day mortality was 28%. Median AKI burden was 0.19 (IQR 0.08–0.46). The model using AKI burden performed better (AUROC 0.77, 0.74–0.80) than the models using AKI presence (AUROC 0.75, 0.71–0.78, p = 0.001), AKI severity (AUROC 0.76, 0.72–0.79. p = 0.008) or AKI duration (AUROC 0.76, 0.73–0.79, p = 0.009). Conclusion AKI burden, which appreciates both severity and duration of AKI, was superior to using only presence or the highest stage of AKI in predicting 90-day mortality. Using AKI burden or other more granular methods may be helpful in future epidemiological studies of AKI.
dc.publisher BioMed Central
dc.subject Acute kidney injury
dc.subject Burden
dc.subject Mortality
dc.subject Critically ill
dc.subject Prediction models
dc.title Burden of acute kidney injury and 90-day mortality in critically ill patients
dc.date.updated 2020-01-05T04:14:50Z
dc.language.rfc3066 en
dc.rights.holder The Author(s).
dc.type.uri http://purl.org/eprint/entityType/ScholarlyWork
dc.type.uri http://purl.org/eprint/entityType/Expression
dc.type.uri http://purl.org/eprint/type/JournalArticle

Files in this item

Total number of downloads: Loading...

Files Size Format View
12882_2019_Article_1645.pdf 613.1Kb PDF View/Open

This item appears in the following Collection(s)

Show simple item record