scholarly journals Geospatial Distribution and Predictors of Mortality in Hospitalized Patients With COVID-19: A Cohort Study

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
◽  
S K Mallipattu ◽  
R Jawa ◽  
R Moffitt ◽  
J Hajagos ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Cohort Study ◽  
Length Of Stay ◽  
Regression Models ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Logistic Regression Models

Abstract Background The global coronavirus disease 2019 (COVID-19) pandemic offers the opportunity to assess how hospitals manage the care of hospitalized patients with varying demographics and clinical presentations. The goal of this study was to demonstrate the impact of densely populated residential areas on hospitalization and to identify predictors of length of stay and mortality in hospitalized patients with COVID-19 in one of the hardest hit counties internationally. Methods This was a single-center cohort study of 1325 sequentially hospitalized patients with COVID-19 in New York between March 2, 2020, to May 11, 2020. Geospatial distribution of study patients’ residences relative to population density in the region were mapped, and data analysis included hospital length of stay, need and duration of invasive mechanical ventilation (IMV), and mortality. Logistic regression models were constructed to predict discharge dispositions in the remaining active study patients. Results The median age of the study cohort (interquartile range [IQR]) was 62 (49–75) years, and more than half were male (57%) with history of hypertension (60%), obesity (41%), and diabetes (42%). Geographic residence of the study patients was disproportionately associated with areas of higher population density (rs = 0.235; P = .004), with noted “hot spots” in the region. Study patients were predominantly hypertensive (MAP > 90 mmHg; 670, 51%) on presentation with lymphopenia (590, 55%), hyponatremia (411, 31%), and kidney dysfunction (estimated glomerular filtration rate < 60 mL/min/1.73 m2; 381, 29%). Of the patients with a disposition (1188/1325), 15% (182/1188) required IMV and 21% (250/1188) developed acute kidney injury. In patients on IMV, the median (IQR) hospital length of stay in survivors (22 [16.5–29.5] days) was significantly longer than that of nonsurvivors (15 [10–23.75] days), but this was not due to prolonged time on the ventilator. The overall mortality in all hospitalized patients was 15%, and in patients receiving IMV it was 48%, which is predicted to minimally rise from 48% to 49% based on logistic regression models constructed to project disposition in the remaining patients on ventilators. Acute kidney injury during hospitalization (odds ratioE, 3.23) was the strongest predictor of mortality in patients requiring IMV. Conclusions This is the first study to collectively utilize the demographics, clinical characteristics, and hospital course of COVID-19 patients to identify predictors of poor outcomes that can be used for resource allocation in future waves of the pandemic.

Controlled Study of Decision-Making Algorithms for Kidney Replacement Therapy Initiation in Acute Kidney Injury

2021 ◽  
pp. CJN.02060221
Author(s):  
Yvelynne Kelly ◽  
Kavita Mistry ◽  
Salman Ahmed ◽  
Shimon Shaykevich ◽  
Sonali Desai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Controlled Study ◽  
Control Group ◽  
Inpatient Mortality ◽  
Icu Length Of Stay ◽  
Kidney Replacement Therapy

Background: Acute kidney injury (AKI) requiring kidney replacement therapy (KRT) is associated with high mortality and utilization. We evaluated the use of an AKI-Standardized Clinical Assessment and Management Plan (SCAMP) on patient outcomes including mortality, hospital and ICU length of stay. Methods: We conducted a 12-month controlled study in the ICUs of a large academic tertiary medical center. We alternated use of the AKI-SCAMP with use of a "sham" control form in 4-6-week blocks. The primary outcome was risk of inpatient mortality. Pre-specified secondary outcomes included 30-day mortality, 60-day mortality and hospital and ICU length of stay. Generalized estimating equations were used to estimate the impact of the AKI-SCAMP on mortality and length of stay. Results: There were 122 patients in the AKI-SCAMP group and 102 patients in the control group. There was no significant difference in inpatient mortality associated with AKI-SCAMP use (41% vs 47% control). AKI-SCAMP use was associated with significantly reduced ICU length of stay (mean 8 (95% CI 8-9) vs 12 (95% CI 10-13) days; p = <0.0001) and hospital length of stay (mean 25 (95% CI 22-29) vs 30 (95% CI 27-34) days; p = 0.02). Patients in the AKI-SCAMP group less likely to receive KRT in the context of physician-perceived treatment futility than those in the control group (2% vs 7%, p=0.003). Conclusions: Use of the AKI-SCAMP tool for AKI-KRT was not significantly associated with inpatient mortality but was associated with reduced ICU and hospital length of stay and use of KRT in cases of physician-perceived treatment futility.

Effect of acute kidney injury on hospital-based outcomes in patients with multiple myeloma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e20006-e20006
Author(s):  
Muhammad Usman Zafar ◽  
Zahid Tarar ◽  
Ghulam Ghous ◽  
Umer Farooq ◽  
Bradley Walter Lash
Keyword(s):  
Heart Failure ◽  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Teaching Hospitals ◽  
Inpatient Mortality ◽  
History Of

e20006 Background: Multiple Myeloma, a cancer of plasma cells, is treatable, but incurable. 5-year survival rate is about 54% depending upon the stage. Studies have suggested that up to 50% of the patients experience acute kidney injury or chronic kidney disease at some point in their disease course. Approximately 3% of the patients will end up on hemodialysis. In this study we utilize the National Inpatient Sample (NIS) to understand the effect of acute kidney injury (AKI) on inpatient mortality in multiple myeloma patients. Methods: This is a retrospective study utilizing the data obtained from the NIS for the year 2018. We queried this NIS database for ICD-10 codes for multiple myeloma or plasmacytoma that had not achieved remission or was in relapse. We also looked at codes for acute kidney injury as secondary diagnosis. Primary outcome was inpatient mortality. Secondary outcomes were hospital length of stay and cost utilization. We then ran multivariate logistic regression analysis in STATA MP 16.1. Various comorbidities were accounted for by adding them into the analysis. These included previous history of coronary artery disease, congestive heart failure, stroke, smoking, hyperlipidemia, stem cell transplant, neutropenia and chemotherapy. Results: The population of multiple myeloma patients under investigation were all adults more than 18 years of age and numbered in 3944 patients. The mean age was 65.71 years. Among these 45% were females. While examining inpatient mortality we see that for patients that had AKI the odds of inpatient mortality are higher (Odds Ratio (OR) 1.75, p = 0.003, 95% Confidence Interval (CI) 1.21 – 2.56). History of Heart Failure (OR 2.28, 95% CI 1.59 – 3.28), and increasing age (OR 1.02, 95% CI 1.01 – 1.04) also appear to contribute towards higher odds of mortality. The effect of other comorbidities was not statistically significant. Among demographical characteristics being of Native American heritage or not belonging to any descriptive race predicted higher odds of mortality. Mean LOS was 11 days. Patients with AKI stayed in the hospital longer by ̃1.4 days (Coef. 1.39, 95% CI 0.41 – 2.37). LOS was higher in patients with a history of heart failure (2.61, 95% CI 0.89 – 4.34 and in those with a history of neutropenia (5.52, 95% CI 4.42 – 6.62). LOS was lower in patients with a history of smoking by 1 day. Age lowered the LOS by a clinically insignificant amount. Teaching hospitals had higher LOS by ̃4 days. The total charge for hospitalizations from AKI is higher by $31019 (95% CI 14444.23 – 47594.37). Other factors incurring higher cost include history of neutropenia, and teaching hospitals. Hospitals in the Midwest had lower cost compared to hospitals in the Northeast. Conclusions: Among patients that present with a principal diagnosis of multiple myeloma, having acute kidney injury, adversely affects inpatient outcomes that include, mortality, hospital length of stay and total hospitalization cost.

Vancomycin Trough and Acute Kidney Injury: A Large Retrospective, Cohort Study

2016 ◽  
Vol 44 (6) ◽  
pp. 456-461 ◽  
Author(s):  
Kassem Hammoud ◽  
Michael Brimacombe ◽  
Alan Yu ◽  
Neil Goodloe ◽  
Wael Haidar ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Cohort Study ◽  
Reference Group ◽  
Kidney Injury ◽  
Logistic Regression Models ◽  
Vancomycin Trough ◽  
Observational Cohort ◽  
Baseline Characteristics ◽  
Retrospective Observational Cohort Study

Background: The association between vancomycin trough (VT) and acute kidney injury (AKI) at the recommended doses remains controversial. Methods: The authors conducted a retrospective, observational cohort study of 500 adult patients who received vancomycin for ≥72 h. Data collected included 2 main predictors: average VT (including only VTs before the occurrence of AKI), first VT and other possible risk factors for AKI. The baseline characteristics/variables between patients with AKI and patients with no AKI were compared. Logistic regression models were used to develop multivariate models. The authors divided the patients into 4 subgroups: (1) VT <10, (2) 10 ≤ VT < 15, (3) 15 ≤ VT < 20 and (4) VT ≥20 µg/ml. All subgroups were compared to subgroup 2 (reference group). Results: AKI occurred in 12.85% of patients while on vancomycin. The incidence of AKI in subgroups 1-4 was 8.02, 13.61, 13.70 and 31.82%, respectively, using the first VT, that is significantly higher in subgroup 4. Using average VT, AKI incidence was 5, 10.38, 19.01 and 25.58%, respectively, that is significantly higher in subgroups 3 and 4. On multivariate logistic regression, average VT, first VT, average VT >15, first VT >15, methicillin-resistant Staphylococcus aureus infection and morbid obesity were significantly associated with increased incidence of AKI. Conclusion: Clinicians should be careful when aiming for a VT >15 μg/ml as this is associated with increased incidence of AKI.

scholarly journals Catalytic iron and acute kidney injury

2016 ◽  
Vol 311 (5) ◽  
pp. F871-F876 ◽  
Author(s):  
David E. Leaf ◽  
Dorine W. Swinkels
Keyword(s):  
Acute Kidney Injury ◽  
Animal Models ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Redox Cycling ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Translational Studies ◽  
Labile Iron

Acute kidney injury (AKI) is a common and often devastating condition among hospitalized patients and is associated with markedly increased hospital length of stay, mortality, and cost. The pathogenesis of AKI is complex, but animal models support an important role for catalytic iron in causing AKI. Catalytic iron, also known as labile iron, is a transitional pool of non-transferrin-bound iron that is readily available to participate in redox cycling. Initial findings related to catalytic iron and animal models of kidney injury have only recently been extended to human AKI. In this review, we discuss the role of catalytic iron in human AKI, focusing on recent translational studies in humans, assay considerations, and potential therapeutic targets for future interventional studies.

scholarly journals In Nonagenarians, Acute Kidney Injury Predicts In-Hospital Mortality, while Heart Failure Predicts Hospital Length of Stay

PLoS ONE ◽  
2013 ◽  
Vol 8 (11) ◽  
pp. e77929 ◽  
Author(s):  
Chia-Ter Chao ◽  
Yu-Feng Lin ◽  
Hung-Bin Tsai ◽  
Nin-Chieh Hsu ◽  
Chia-Lin Tseng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay

The Importance of Duration of Acute Kidney Injury after Severe Trauma:  A Cohort Study

2020 ◽  
Author(s):  
Gabrielle Elise Hatton ◽  
John A Harvin ◽  
Charles E Wade ◽  
Lillian S Kao
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Kidney Injury ◽  
Severe Trauma ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Discharge Disposition ◽  
Prolonged Hospitalization ◽  
Post Traumatic ◽  
Poor Outcomes

Abstract Introduction: Acute kidney injury (AKI) is common after severe trauma. AKI incidence and AKI stage have previously been shown to be associated with poor outcomes after trauma. However, AKI duration may also be important for outcomes after trauma, given that it has been shown to be associated with long-term morbidity and mortality in general intensive care unit (ICU) and hospitalized patients. We hypothesized that duration of AKI is independently associated with poor outcomes after trauma. Methods: A cohort study was conducted at a single, level 1 trauma center. Patients admitted to the ICU between 2009 and 2018 were included. Data were extracted from the trauma registry and electronic medical records. AKI within 7 days from presentation was defined according to the Kidney Disease Improving Global Outcomes guidelines. Multivariable analyses were performed to assess the association between AKI incidence, AKI stage, and AKI duration with outcomes including prolonged ICU and hospital length-of-stay, discharge to home, and mortality. Collinearity was assessed using the variance inflation factor. Results: Of 7049 patients included, 72% were male, the median age was 41 years (IQR 27-58), and 10% expired. The AKI incidence was 45%, with 69% of these patients presenting with AKI on arrival. The majority (73%) of patients who suffered AKI recovered within 2 days. After adjustment in separate models, AKI incidence, AKI stage and AKI duration were each associated with prolonged hospitalization, an unfavorable discharge disposition, and mortality. AKI stage and duration were collinear and therefore not used in the same model. Conclusions: Post-traumatic AKI was common on arrival and frequently short-lasting. Duration was correlated with highest AKI stage, and both were separately associated with prolonged hospitalization, discharge destination other than home, and mortality on adjusted analyses. Given the high incidence of AKI on arrival, stage or duration may be better targets for future interventions and quality improvement initiatives to improve outcomes after post-traumatic AKI.

Can the simple clinical score usefully predict the mortality risk and length of stay for a recently admitted patient?

2015 ◽  
Vol 39 (5) ◽  
pp. 522
Author(s):  
Minh T. Nguyen ◽  
Richard J. Woodman ◽  
Paul Hakendorf ◽  
Campbell H. Thompson ◽  
Jeff Faunt
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Length Of Stay ◽  
General Medicine ◽  
Clinical Score ◽  
Accurate Method ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Emergency Department Care ◽  
Logistic Regression Models

Objectives The aim of the present study was to determine whether an aggregate simple clinical score (SCS) has a role in predicting the imminent mortality and in-hospital length of stay (LOS) of newly admitted, acutely unwell General Medical in-patients. Methods Data were collected prospectively from adult patients admitted through an Acute Medical Unit between February and August 2013. Using logistic regression analysis before and after adjustment for age, the SCS was assessed for its association with LOS and mortality, including 30-day mortality, just for those patients for full resuscitation. Changes in sensitivity and specificity after adding SCS to age as a predictor, as well as the change in the net reclassification index, were determined using the predicted probabilities from the logistic regression models. Results The SCS was superior to age in predicting mortality of any patient within 30 days. It did not assist in predicting 30-day mortality for those patients who were for full resuscitation. The ability of the SCS to predict long stay (>72 h) remained relatively low (64%) and was inferior to published rates achieved by bedside clinician assessment (74%–82%). Conclusion There was no useful prospective role for the SCS in predicting LOS and mortality of in-patients newly admitted to a General Medicine service. What is known about the topic? After their presentation to the emergency department, care efficiency is improved by the ‘streaming’ of patients according to their risk of imminent deterioration and their likelihood of being a long-stay patient. Although streaming is currently effected by bedside assessment of the patient, an accepted aggregate assessment score may assist disposition decisions. What does this paper add? Bedside assessment of each patient still offers the most accurate method for identifying the long-stay patient. The SCS, good at predicting 30-day mortality of all new admissions, is not useful for predicting the death of those admissions who are for full resuscitation. What are the implications for practitioners? When deciding admitted patients’ disposition on leaving the emergency department, a simple aggregate score based on patient physiology, comorbidity and functionality has little to offer practitioners beyond knowledge of each patient’s age.

scholarly journals An Association Between Hyperchloremia and Acute Kidney Injury in Patients With Acute Ischemic Stroke

2020 ◽  
Vol 10 (4) ◽  
pp. 250-256
Author(s):  
J. Tyler Haller ◽  
Keaton Smetana ◽  
Michael J. Erdman ◽  
Todd A. Miano ◽  
Heidi M. Riha ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Matched Cohort ◽  
Increased Risk ◽  
The Relationship

Background and Purpose: While an association between hyperchloremia and worse outcomes, such as acute kidney injury and increased mortality, has been demonstrated in hemorrhagic stroke, it is unclear whether the same relationship exists after acute ischemic stroke. This study aims to determine the relationship between moderate hyperchloremia (serum chloride ≥115 mmol/L) and acute kidney injury in patients with ischemic stroke. Methods: This is a multicenter, retrospective, propensity-matched cohort study of adults admitted for acute ischemic stroke. The primary objective was to determine the relationship between moderate hyperchloremia and acute kidney injury, as defined by the Acute Kidney Injury Network criteria. Secondary objectives included mortality and hospital length of stay. Results: A total of 407 patients were included in the unmatched cohort (332 nonhyperchloremia and 75 hyperchloremia) and 114 patients (57 in each group) were matched based upon propensity scores. In the matched cohort, hyperchloremia was associated with an increased risk of acute kidney injury (relative risk 1.91 [95% confidence interval 1.01-3.59]) and a longer hospital length of stay (16 vs 12 days; P = .03). Mortality was higher in the hyperchloremia group (19.3% vs 10.5%, P = .19), but this did not reach statistical significance. Conclusions: In this study, hyperchloremia after ischemic stroke was associated with increased rates of acute kidney injury and longer hospital length of stay. Further research is needed to determine which interventions may increase chloride levels in patients with acute ischemic stroke and the association between hyperchloremia and clinical outcomes.

scholarly journals Serum Creatine Kinase Levels are not Associated with an Increased Need for Continuous Renal Replacement Therapy in Patients with Acute Kidney Injury Following Rhabdomyolysis

2021 ◽  
Author(s):  
Luniu Xiao ◽  
Xiao Ran ◽  
Yanxia Zhong ◽  
Yue Le ◽  
Shusheng Li
Keyword(s):  
Acute Kidney Injury ◽  
Creatine Kinase ◽  
Renal Replacement Therapy ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Serum Creatine Kinase ◽  
Hospital Length Of Stay ◽  
Renal Functions ◽  
Experimental Group

Abstract BackgroudRhabdomyolysis is a syndrome caused by the breakdown and necrosis of skeletal muscle tissues. As a result, there is leakage of various intercellular myocyte contents into the circulating blood stream. Severe rhabdomyolysis can lead to acute kidney injury (AKI) and cause potentially permanent kidney damage. Previous studies have reported benefit from continuous renal replacement therapy (CRRT) for rhabdomyolysis-associated AKI. For patients with AKI, the termination of CRRT often depends on the patient’s renal functions. Here, we asked whether serum creatine kinase (CK) levels should be considered for CRRT termination in patients with AKI following rhabdomyolysis.MethodsWe compared different CK levels in patients after CRRT termination and we observed the correlation between CK levels and clinical outcomes. For a retrospective study, we collected 86 cases with confirmed rhabdomyolysis-associated AKI, who had received CRRT from January 1st of 2012 to December 31th of 2020 in Tongji Hospital. Patients’ renal functions were assessed within 24 hours of intermission, and patients with urine output ≥ 1,000 mL and serum creatinine ≤ 265 umol/L were considered for CRRT termination. Following CRRT termination, patients were divided into a CK > 5,000 U/L group (experimental group) and a CK < 5,000 U/L group (control group). The outcomes, such as in-hospital mortality and in-hospital length of stay, were compared between two groups.ResultsThirty-three (38.37%) patients were classified as having CK > 5,000 U/L, while 53 (61.63%) were categorized as having CK < 5,000 U/L. The majority of laboratory examinations were comparable between the two groups on admission. The higher CK levels, as well as worse renal functions, predicted the necessity of CRRT continuation for patients. After CRRT termination, the in-hospital mortality (27.27% vs 22.64, p = 0.389) and Multiple Organ Dysfunction Syndrome (MODS) incidence (51.52% vs 49.06%, p = 0.064) were similar between two groups, while the experimental group showed a significantly shorter in-hospital length of stay (11.88 ± 1.469 vs 16.42 ± 1.290, p = 0.026) and Intensive Care Unit (ICU) length of stay (7.545 ± 0.866 vs 10.11 ± 0.793, p = 0.038).ConclusionCRRT termination may be independent of s the CK levels for patients with rhabdomyolysis-associated acute kidney injure, providing their renal functions have recovered to an appropriate level. Prospective clinical trials would be needed to more thoroughly investigate the optimal CK range that could be used as a gauge to prevent recurrence of renal impairments after treatments.

Sign in / Sign up

Export Citation Format

Share Document