Clinical profile, precipitating factors & in-hospital mortality of acute kidney injury in cirrhosis of liver

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

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Serum lactate dehydrogenase level is associated with in-hospital mortality in critically Ill patients with acute kidney injury

International Urology and Nephrology ◽

10.1007/s11255-021-02792-z ◽

2021 ◽

Author(s):

Dan Zhang ◽

Lin Shi

Keyword(s):

Acute Kidney Injury ◽

Lactate Dehydrogenase ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Lactate Dehydrogenase Level ◽

Serum Lactate ◽

Serum Lactate Dehydrogenase ◽

Serum Lactate Dehydrogenase Level

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Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study

BMC Nephrology ◽

10.1186/s12882-021-02238-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Wen En Joseph Wong ◽

Siew Pang Chan ◽

Juin Keith Yong ◽

Yen Yu Sherlyn Tham ◽

Jie Rui Gerald Lim ◽

...

Keyword(s):

Acute Kidney Injury ◽

High Risk ◽

Hospital Mortality ◽

Structural Equation Model ◽

Structural Equation ◽

Injury Risk ◽

Kidney Injury ◽

Equation Model ◽

Surgical Icu ◽

One Year

Abstract Background Acute kidney injury is common in the surgical intensive care unit (ICU). It is associated with poor patient outcomes and high healthcare resource usage. This study’s primary objective is to help identify which ICU patients are at high risk for acute kidney injury. Its secondary objective is to examine the effect of acute kidney injury on a patient’s prognosis during and after the ICU admission. Methods A retrospective cohort of patients admitted to a Singaporean surgical ICU between 2015 to 2017 was collated. Patients undergoing chronic dialysis were excluded. The outcomes were occurrence of ICU acute kidney injury, hospital mortality and one-year mortality. Predictors were identified using decision tree algorithms. Confirmatory analysis was performed using a generalized structural equation model. Results A total of 201/940 (21.4%) patients suffered acute kidney injury in the ICU. Low ICU haemoglobin levels, low ICU bicarbonate levels, ICU sepsis, low pre-ICU estimated glomerular filtration rate (eGFR) and congestive heart failure was associated with the occurrence of ICU acute kidney injury. Acute kidney injury, together with old age (> 70 years), and low pre-ICU eGFR, was associated with hospital mortality, and one-year mortality. ICU haemoglobin level was discretized into 3 risk categories for acute kidney injury: high risk (haemoglobin ≤9.7 g/dL), moderate risk (haemoglobin between 9.8–12 g/dL), and low risk (haemoglobin > 12 g/dL). Conclusion The occurrence of acute kidney injury is common in the surgical ICU. It is associated with a higher risk for hospital and one-year mortality. These results, in particular the identified haemoglobin thresholds, are relevant for stratifying a patient’s acute kidney injury risk.

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Predictors of acute kidney injury in patients after extracorporeal cardiopulmonary resuscitation

Perfusion ◽

10.1177/02676591211049767 ◽

2021 ◽

pp. 026765912110497

Author(s):

Christopher Gaisendrees ◽

Borko Ivanov ◽

Stephen Gerfer ◽

Anton Sabashnikov ◽

Kaveh Eghbalzadeh ◽

...

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

High Risk ◽

Cardiopulmonary Resuscitation ◽

Hospital Mortality ◽

Hospital Stay ◽

Kidney Injury ◽

Dialysis Patients ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Outcome Parameters

Objectives: Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly used due to its beneficial outcomes and results compared with conventional CPR. Data after eCPR for acute kidney injury (AKI) are lacking. We sought to investigate factors predicting AKI in patients who underwent eCPR. Methods: From January 2016 until December 2020, patients who underwent eCPR at our institution were retrospectively analyzed and divided into two groups: patients who developed AKI ( n = 60) and patients who did not develop AKI ( n = 35) and analyzed for outcome parameters. Results: Overall, 63% of patients suffered AKI after eCPR and 45% of patients who developed AKI needed subsequent dialysis. Patients who developed AKI showed higher values of creatinine (1.1 mg/dL vs 1.5 mg/dL, p ⩽ 0.01), urea (34 mg/dL vs 42 mg/dL, p = 0.04), CK (creatine kinase) (923 U/L vs 1707 U/L, p = 0.07) on admission, and CK after 24 hours of ECMO support (1705 U/L vs 4430 U/L, p = 0.01). ECMO explantation was significantly more often performed in patients who suffered AKI (24% vs 48%, p = 0.01). In-hospital mortality (86% vs 70%; p = 0.07) did not differ significantly. Conclusion: Patients after eCPR are at high risk for AKI, comparable to those after conventional CPR. Baseline urea levels predict the development of AKI during the hospital stay.

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Association of Blood Type on Clinical Outcomes in Black/African Americans Hospitalized for COVID-19 Infection

Blood ◽

10.1182/blood-2020-137556 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 14-14

Author(s):

Yan Cheng ◽

Sharif Mohammed ◽

Alexis Okoh ◽

Ki (Steve) Lee ◽

Corinne Raczek ◽

...

Keyword(s):

Acute Kidney Injury ◽

African Americans ◽

Hospital Mortality ◽

Kidney Injury ◽

Type A ◽

Blood Type ◽

P Value ◽

Single Center ◽

Black African ◽

O 31

Introduction: Early studies from Wuhan, China have reported an association between blood type and outcomes in COVID-19 infected patients. Conflicting reports in literature have investigated the protective role of blood type O against worst outcomes associated with COVID-19 infections. Approximately 50% of Black/African Americans (AA) have blood group O. Our study is the only study to date looking at the association between Black/AA and blood type. We aimed to determine the association between blood type and Black/AA patients hospitalized for COVID-19. Methods: We retrospectively reviewed data on patients with known blood type, who were admitted for COVID-19 at a single center between March and April 2020. We excluded other races in our study because only about 2% of the population was Caucasian and 8% representing other races, representing a small subset of patients under study whereas Black/AA represented about 90% of our hospitalized patients. Patients were stratified into 4 groups based on their ABO blood type. Baseline demographic, clinical characteristics and clinical course of the disease were compared. The primary end point was in-hospital mortality. Secondary endpoints included admission to the intensive care unit (ICU), acute kidney injury requiring hemodialysis and length of stay (LOS). Results: During the study period, a total of 256 patients were reviewed. Distribution of ABO type was as follows; A: (N=65) 25%, B: (N=62) 24%, AB: (N=9) 4%, O: (N=120) 47%. Compared to blood types A, B and O, AB patients were younger (mean; yrs. 63 vs. 63 vs. 62 vs. 43 yrs. p=0.0242). Blood type B patients were more likely to present with nausea, than groups A, AB, and O. (27% vs. 10% vs. 0% vs. 5%; p=0.017). All other characteristics including baseline inflammatory markers were comparable. There was no difference among groups regarding in-hospital mortality (A: 39% B: 29% AB: 33% O: 31% p value: 0.676) or admission to the ICU (A:31% B: 28% AB: 33% O: 34% p value: 0.840). The incidence of acute kidney injury requiring hemodialysis was higher in blood type A patients compared to B, AB, and O. (31% vs. 0% vs. 23% vs. 19%; p=0.046). In hospital LOS was comparable among all groups. Conclusions: In this single center analysis of black/AA patients admitted for COVID-19, there was no association between blood type and in-hospital mortality or admission to ICU. Blood type A patients had a higher propensity of kidney injury, but this did not translate into worse in-hospital survival. Disclosures Cohen: GBT: Speakers Bureau.

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