A Nationwide Trend Analysis of Patients Admitted for Acute Pancreatitis: Ten Year Evaluation of in Hospital Mortality, Clinical Outcomes, and the Impact of Acute Kidney Injury

Background and Purpose: Clinical outcome and mortality after endovascular thrombectomy (EVT) in patients with ischemic stroke are commonly assessed after 3 months. In patients with acute kidney injury (AKI), unfavorable results for 3-month mortality have been reported. However, data on the in-hospital mortality after EVT in this population are sparse. In the present study, we assessed whether AKI impacts in-hospital and 3-month mortality in patients undergoing EVT.Materials and Methods: From a prospectively recruiting database, consecutive acute ischemic stroke patients receiving EVT between 2010 and 2018 due to acute large vessel occlusion were included. Post-contrast AKI (PC-AKI) was defined as an increase of baseline creatinine of ≥0.5 mg/dL or >25% within 48 h after the first measurement at admission. Adjusting for potential confounders, associations between PC-AKI and mortality after stroke were tested in univariate and multivariate logistic regression models.Results: One thousand one hundred sixty-nine patients were included; 166 of them (14.2%) died during the acute hospital stay. Criteria for PC-AKI were met by 29 patients (2.5%). Presence of PC-AKI was associated with a significantly higher risk of in-hospital mortality in multivariate analysis [odds ratio (OR) = 2.87, 95% confidence interval (CI) = 1.16–7.13, p = 0.023]. Furthermore, factors associated with in-hospital mortality encompassed higher age (OR = 1.03, 95% CI = 1.01–1.04, p = 0.002), stroke severity (OR = 1.05, 95% CI = 1.03–1.08, p < 0.001), symptomatic intracerebral hemorrhage (OR = 3.20, 95% CI = 1.69–6.04, p < 0.001), posterior circulation stroke (OR = 2.85, 95% CI = 1.72–4.71, p < 0.001), and failed recanalization (OR = 2.00, 95% CI = 1.35–3.00, p = 0.001).Conclusion: PC-AKI is rare after EVT but represents an important risk factor for in-hospital mortality and for mortality within 3 months after hospital discharge. Preventing PC-AKI after EVT may represent an important and potentially lifesaving effort in future daily clinical practice.

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The Impact of Blood Type O on Major Outcomes in Patients With Severe Burns

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa059 ◽

2020 ◽

Vol 41 (5) ◽

pp. 1111-1117 ◽

Cited By ~ 1

Author(s):

Renqi Yao ◽

Wenjia Hou ◽

Tuo Shen ◽

Shuo Zhao ◽

Xingfeng He ◽

...

Keyword(s):

Hospital Mortality ◽

Clinical Outcomes ◽

Poor Prognosis ◽

Kidney Injury ◽

Blood Type ◽

Blood Types ◽

Severe Burns ◽

Icu Length Of Stay ◽

Abo Blood Type ◽

The Impact

Abstract ABO blood type has been reported to be a predictor of poor prognosis in critically ill patients. Here, we aim to correlate different blood types with clinical outcomes in patients with severe burns. We conducted a single-center retrospective cohort study by enrolling patients with severe burn injuries (≥40% TBSA) between January 2012 and December 2017. Baseline characteristics and clinical outcomes were compared between disparate ABO blood types (type O vs non-O type). Multivariate logistic and linear regression analyses were performed to identify an association between ABO blood type and clinical outcomes, including in-hospital mortality, the development of acute kidney injury (AKI), and hospital or ICU length of stay. A total of 141 patients were finally enrolled in the current study. Mortality was significantly higher in patients with type O blood compared with those of other blood types. The development of AKI was significantly higher in patients with blood type O vs non-O blood type (P = .001). Multivariate analysis demonstrated that blood type O was independently associated with in-hospital mortality and AKI occurrence after adjusting for other potential confounders. Our findings indicated the blood type O was an independent risk factor of both increased mortality and the development of AKI postburn. More prudent and specific treatments are required in treating these patients to avoid poor prognosis.

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The impact of diabetes on outcomes, length of stay and costs in acute kidney injury patients: a cross-sectional multicenter study in China

10.21203/rs.3.rs-16071/v1 ◽

2020 ◽

Author(s):

Lishan Tan ◽

Li Chen ◽

Lingyan Li ◽

Jinwei Wang ◽

Xiaoyan Huang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Length Of Stay ◽

Hospital Mortality ◽

Hospital Stay ◽

Kidney Injury ◽

Renal Recovery ◽

Cross Sectional ◽

Patients With Diabetes ◽

The Impact ◽

Physician Diagnosis

Abstract Background : With the increasing worldwide prevalence and disease burden of diabetic mellitus, data on the impact of diabetes on acute kidney injury (AKI) patients in China are limited.Methods: A nationwide cross-sectional and retrospective study was conducted in China, which included 2,223,230 hospitalized adult patients and covered 82% of the country’s population. Diabetes was identified according to blood glucose, hemoglobin A1c levels, physician diagnosis and drug use. In total, 7604 AKI patients were identified, and 1404 and 6200 cases were defined as diabetic and non-diabetic respectively. Clinical characteristics, outcome, in-hospital stay, and costs of AKI patients with and without diabetes were compared. Multivariable logistic and linear regression analyses were conducted to evaluate the association of diabetes with mortality and renal recovery in the admitted AKI patients.Results: In this survey, AKI patients with diabetes were older, male-dominated (61.9%), with more comorbidities, and higher serum creatinine levels. Compared to patients without diabetes, a significant upswing in all-cause in-hospital mortality, hospital stay, and costs were found in those with diabetes ( p <0.05). After adjusted for relevant covariables, diabetes was independently associated with failed renal recovery (OR=1.13, p =0.04), rather than all-cause in-hospital mortality (OR=1.09, p =0.39). Also, diabetic status was positively associated with length of stay ( β =0.04, p =0.04) and costs ( β =0.09, p <0.01) in hospital after adjusted for possible confounders. Conclusions: Failed renal recovery, rather than all-cause in-hospital mortality, is independently associated with diabetes in hospitalized AKI patients. Moreover, diabetes is significantly correlated with in-hospital stay and expenditures in AKI.

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The impact of transient and persistent acute kidney injury in hospital mortality in COVID-19 patients

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2021-0123 ◽

2021 ◽

Author(s):

João Bernardo ◽

Joana Gonçalves ◽

Joana Gameiro ◽

João Oliveira ◽

Filipe Marques ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Hospital Admission ◽

Kidney Injury ◽

Baseline Serum ◽

Negative Prognostic Factor ◽

Long Term Follow Up ◽

Vasopressor Use ◽

The Impact

Abstract Introduction: Acute kidney injury (AKI) has been described in Coronavirus Disease 2019 (COVID-19) patients and is considered a marker of disease severity and a negative prognostic factor for survival. In this study, the authors aimed to study the impact of transient and persistent acute kidney injury (pAKI) on in-hospital mortality in COVID-19 patients. Methods: This was a retrospective observational study of patients hospitalized with COVID-19 in the Department of Medicine of the Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal, between March 2020 and August 2020. A multivariate analysis was performed to predict AKI development and in-hospital mortality. Results: Of 544 patients with COVID-19, 330 developed AKI: 166 persistent AKI (pAKI), 164 with transient AKI. AKI patients were older, had more previous comorbidities, had higher need to be medicated with RAAS inhibitors, had higher baseline serum creatine (SCr) (1.60 mg/dL vs 0.87 mg/dL), higher NL ratio, and more severe acidemia on hospital admission, and more frequently required admission in intensive care unit, mechanical ventilation, and vasopressor use. Patients with persistent AKI had higher SCr level (1.71 mg/dL vs 1.25 mg/dL) on hospital admission. In-hospital mortality was 14.0% and it was higher in AKI patients (18.5% vs 7.0%). CKD and serum ferritin were independent predictors of AKI. AKI did not predict mortality, but pAKI was an independent predictor of mortality, as was age and lactate level. Conclusion: pAKI was independently associated with in-hospital mortality in COVID-19 patients but its impact on long-term follow-up remains to be determined.

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Potential Prognostic Markers of Acute Kidney Injury in the Early Phase of Acute Pancreatitis

International Journal of Molecular Sciences ◽

10.3390/ijms20153714 ◽

2019 ◽

Vol 20 (15) ◽

pp. 3714 ◽

Cited By ~ 5

Author(s):

Justyna Wajda ◽

Paulina Dumnicka ◽

Małgorzata Maraj ◽

Piotr Ceranowicz ◽

Marek Kuźniewski ◽

...

Keyword(s):

Acute Kidney Injury ◽

Acute Pancreatitis ◽

Binding Protein ◽

Kidney Injury ◽

Current Evidence ◽

Serum Cystatin C ◽

Fatty Acid Binding ◽

Number Of Patients ◽

Kidney Injury Molecule 1 ◽

The Impact

Acute kidney injury (AKI) is a serious complication of acute pancreatitis (AP), which occurs in up to 70% of patients with severe AP and significantly increases the risk of mortality. At present, AKI is diagnosed based on dynamic increase in serum creatinine and decreased urine output; however, there is a need for earlier and more accurate biomarkers. The aim of the study was to review current evidence on the laboratory tests that were studied as the potential biomarkers of AKI in AP. We also briefly summarized the knowledge coming from the studies including sepsis or ICU patients since severe acute pancreatitis is associated with systemic inflammation and organ failure. Serum cystatin C and serum or urine NGAL have been shown to predict or diagnose AKI in AP; however, this evidence come from the single center studies of low number of patients. Other markers, such as urinary kidney injury molecule-1, cell cycle arrest biomarkers (tissue inhibitor metalloproteinase-2 and urine insulin-like growth factor-binding protein 7), interleukin-18, liver-type fatty acid-binding protein, or calprotectin have been studied in other populations suffering from systemic inflammatory states. In AP, the potential markers of AKI may be significantly influenced by either dehydration or inflammation, and the impact of these factors may be difficult to distinguish from kidney injury. The subject of AKI complicating AP is understudied. More studies are needed, for both exploratory (to choose the best markers) and clinical (to evaluate the diagnostic accuracy of the chosen markers in real clinical settings).

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Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm8070981 ◽

2019 ◽

Vol 8 (7) ◽

pp. 981 ◽

Cited By ~ 13

Author(s):

Charat Thongprayoon ◽

Wisit Cheungpasitporn ◽

Ploypin Lertjitbanjong ◽

Narothama Reddy Aeddula ◽

Tarun Bathini ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Meta Analysis ◽

Kidney Injury ◽

Incidence Rates ◽

Adult Patients ◽

Membrane Oxygenation ◽

The Impact

Background: Although acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. Methods: A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). Results: 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%–72.4%) and 44.9% (95%CI: 40.8%–49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87–4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21–4.99). There was no publication bias as evaluated by the funnel plot and Egger’s regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively. Conclusion: Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.

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Impact of acute kidney injury on in-hospital outcomes among patients hospitalized with acute heart failure: a propensity score matched analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1247 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Shetty ◽

H Malik ◽

A Abbas ◽

Y Ying ◽

W Aronow ◽

...

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Propensity Score ◽

Hospital Mortality ◽

Acute Heart Failure ◽

Kidney Injury ◽

Matched Cohort ◽

Hospital Outcomes ◽

Increased Risk ◽

The Impact

Abstract Background Acute kidney injury (AKI) is frequently present in patients admitted for acute heart failure (AHF). Several studies have evaluated the mortality risk and have concluded poor prognosis in any patient with AKI admitted for AHF. For the most part, the additional morbidity and mortality burden in AHF patients with AKI has been attributed to the concomitant comorbidities, and/or interventions. Purpose We sought to determine the impact of acute kidney injury (AKI) on in-hospital outcomes in patients presenting with acute heart failure (AHF). We identified isolated AKI patients after excluding other concomitant diagnoses and procedures, which may contribute to an increased risk of mortality and morbidity. Methods Data from the National Inpatient Sample (2012- 14) were used to identify patients with the principal diagnosis of AHF and the concomitant secondary diagnosis of AKI. Propensity score matching was performed on 30 baseline variables to identify a matched cohort. The outcome of interest was in-hospital mortality. We further evaluated in-hospital procedures and complications. Results Of 1,470,450 patients admitted with AHF, 24.3% had AKI. After propensity matching a matched cohort of 356,940 patients was identified. In this matched group, the AKI group had significantly higher in-hospital mortality (3.8% vs 1.7%, p<0.001). Complications such as sepsis and cardiac arrest were higher in the AKI group. Similarly, in-hospital procedures including CABG, mechanical ventilation and IABP were performed more in the AKI group. AHF patients with AKI had longer in-hospital stay of ∼1.7 days. Conclusions In a propensity score-matched cohort of AHF with and without AKI, the risk of in-hospital mortality was >2-fold in the AKI group. Healthcare utilization and burden of complications were higher in the AKI group. Funding Acknowledgement Type of funding source: None

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Epidemiology and the Impact of Acute Kidney Injury on Outcomes in Patients with Rhabdomyolysis

Journal of Clinical Medicine ◽

10.3390/jcm10091950 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1950

Author(s):

Chien-Wen Yang ◽

Si Li ◽

Yishan Dong ◽

Nitpriya Paliwal ◽

Yichen Wang

Keyword(s):

Acute Kidney Injury ◽

Clinical Outcomes ◽

Kidney Injury ◽

Wald Test ◽

Categorical Variables ◽

Charlson Comorbidity Index Score ◽

Care Utilization ◽

Chi Squared ◽

Hospital Stays ◽

The Impact

Background: Currently, no large, nationwide studies have been conducted to analyze the demographic factors, underlying comorbidities, clinical outcomes, and health care utilization in rhabdomyolysis patients with and without acute kidney injury (AKI). Methods: We queried the National Inpatient Sample of Healthcare Cost and Utilization Project (HCUP) with patients with rhabdomyolysis from 2016 to 2018. The chi-squared test was used to compare categorical variables, and the adjusted Wald test was employed to compare quantitative variables. The logistic regression model was applied to calculate adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) to estimate the impact of AKI on outcomes in patients with rhabdomyolysis. Results: Among 111,085 rhabdomyolysis-related hospitalizations, a higher prevalence of AKI was noticed in older patients (mean age ± SD, 58.2 ± 21.6 vs. 53.8 ± 22.2), Medicare insurance (48.5% vs. 43.2%,), and patients with a higher Charlson Comorbidity Index score (CCI 3–5, 15.1% vs. 5.5%). AKI was found to be independently associated with higher mortality (adjusted odds ratio [aOR].3.33, 95% CI 2.33–4.75), longer hospital stays (adjusted difference 1.17 days, 95% CI: 1.00−1.34), and higher cost of hospital stay (adjusted difference $11,315.05, 95% CI: $9493.02–$13,137.07). Conclusions: AKI in patients hospitalized with rhabdomyolysis is related to adverse clinical outcomes and significant economic and survival burden.

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Clinical impact of diabetes mellitus in patients hospitalized for myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1506 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V.H Schmitt ◽

L Hobohm ◽

T Munzel ◽

P Wenzel ◽

T Gori ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Acute Kidney Injury ◽

Cardiovascular Risk ◽

Hospital Mortality ◽

Kidney Injury ◽

Funding Source ◽

Federal States ◽

Artery Disease ◽

The Impact

Abstract Background Diabetes mellitus (DM) represents a major cardiovascular risk factor for coronary artery disease and myocardial infarction (MI). Purpose We aimed to assess in-hospital events and time trends in MI patients with and without DM between 2005 and 2016 in Germany. Methods The nationwide German inpatient sample 2005–2016 was used for statistical analysis (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2016, own calculations). Hospitalized MI patients were stratified for the presence of DM and the impact of DM on in-hospital events was investigated. Results A total of 3,307,703 patients with acute MI (37.6% females, 56.8% aged ≥70 years) were included in the present analysis. Of these, 1,007,326 (30.5%) patients were coded for additional DM. More MI patients with DM were female (41.2% vs. 36.0%, P<0.001) and aged 70 years or older (64.3% vs. 53.5%, P<0.001). Presence of most cardiovascular risk factors was increased in coprevalence with DM compared to non-diabetics (obesity: 14.1% vs. 7.2%, essential arterial hypertension: 60.9% vs. 52.4%, hyperlipidaemia 40.5% vs. 37.8%, P<0.001), only smoking was more frequent in people without DM (4.8% vs. 8.5%, P<0.001). Additionally, DM was associated with an elevated occurrence of comorbidities like peripheral artery disease (10.8% vs. 4.5%, P<0.001), atrial fibrillation/flutter (26.5% vs. 19.6%, P<0.001) and acute or chronic kidney disease (39.8% vs. 21.8%, P<0.001). Recurrent MI events during the first 4 weeks after previous MI were more common in MI patients with DM (0.8% vs. 0.6%, P<0.001). Pneumonia (14.9% vs. 10.2%, P<0.001), acute kidney injury (8.6% vs. 5.2%, P<0.001) and stroke (3.4% vs. 2.7%, P<0.001) were more prevalent in MI patients with DM. Mortality was significantly increased in patients with DM (13.2% vs. 12.1%, P<0.001). While the proportion of MI patients with DM increased slightly from 29.8% in 2005 to 30.7% in 2016 (β 7.04 [95% CI 4.13–9.94], P<0.001), the in-hospital mortality rate of MI patients with DM decreased substantially from 15.2% in 2005 to 11.5% in 2016 (β −0.36 [95% CI: −0.38 to −0.34], P<0.001). Confirming this results, the univariate logistic regression analyses demonstrated that DM was associated with a higher in-hospital mortality (OR 1.1 [95% CI: 1.1–1.1], P<0.001), higher risk for recurrent MI (OR 1.3 [95% CI: 1.3–1.4], P<0.001), and higher frequency of acute kidney injury (OR 1.7 [95% CI: 1.7–1.7], P<0.001). Conclusions While the proportion of MI patients with DM increased only slightly from 2005 to 2016, the in-hospital mortality decreased substantially in MI patients with DM. DM was associated with an aggravated cardiovascular risk profile, higher prevalence of comorbidities and increased in-hospital mortality during hospitalization. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503); institutional grant for the Center for Thrombosis and Hemostasis.

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Clinical Outcomes of Dialysis-Treated Acute Kidney Injury Patients at the University of Port Harcourt Teaching Hospital, Nigeria

ISRN Nephrology ◽

10.5402/2013/540526 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Pedro Chimezie Emem-Chioma ◽

Datonye Dennis Alasia ◽

Friday Samuel Wokoma

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Clinical Outcomes ◽

Teaching Hospital ◽

Kidney Injury ◽

Developed Countries ◽

High Morbidity ◽

Acute Glomerulonephritis ◽

Study Objective ◽

The University

Background. Acute kidney injury in adults is a common cause of hospitalization, associated with high morbidity and mortality especially in developing countries. In spite of RRT the in-hospital mortality rates remain high even in the developed countries. Though a proportion of our patients receive renal replacement therapy as part of their management, data on outcomes are sparse. Study Objective. To determine the clinical outcomes of dialysis-treated AKI in our hospital. Methods. A retrospective analysis of the clinical data of all adult AKI patients treated with haemodialysis at the University of Teaching Hospital during an interrupted six-year period was conducted. Analysis was done using SPSS version 17.0. Results. 34 males and 28 females with mean age of 41.3 ± 18.5 years were studied. The leading causes of AKI were sepsis (22.7%), acute glomerulonephritis (20.5%), acute gastroenteritis (15.9%), and toxic nephropathies (11.4%) and presented with mean e-GFR of 14.7±5.8 mls/min/1.73 m2. Of the 62 patients, 29 (46.8%) were discharged from the hospital, 27 (43.5%) died in hospital, while 6 (9.7%) absconded from treatment. Survivors had better Rifle grade than those who died (P<0.001). Conclusion. Hospital mortality rate of dialysis-treated AKI patients is high and the severity of renal damage at presentation may be an important factor.

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