scholarly journals Body Mass Index Is Associated with the Severity and All-Cause Mortality of Acute Kidney Injury in Critically Ill Patients: An Analysis of a Large Critical Care Database

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Benji Wang ◽  
Diwen Li ◽  
Yuqiang Gong ◽  
Binyu Ying ◽  
Bihuan Cheng ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Proportional Hazards ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Overweight And Obesity ◽  
Obese Patients ◽  
Subgroup Analyses ◽  
All Cause Mortality ◽  
The Relationship

Background. Acute kidney injury (AKI) is a common clinical syndrome carrying high morbidity and mortality. Body mass index (BMI) is a common health indicator, and a high BMI value-obesity has been shown to be associated with the outcomes of several diseases. However, the relationship between different BMI categories and mortality in all critically ill patients with AKI is unclear and needs further investigation. Therefore, we evaluated the ability of BMI to predict the severity and all-cause mortality of AKI in critically ill patients. Methods. We extracted clinical data from the MIMIC-III v1.4 database. All adult patients with AKI were initially screened. The baseline data extracted within 24 hours after ICU admission were presented according to WHO BMI categories. Logistic regression models and the Cox proportional hazards models were, respectively, constructed to assess the relationship between BMI and the severity and all-cause mortality of AKI. The generalized additive model (GAM) was used to identify nonlinear relationships as BMI was a continuous variable. The subgroup analyses were performed to further analyze the stability of the association between BMI category and 365-day all-cause mortality of AKI. Result. A total of 15,174 patients were extracted and were divided into four groups according to BMI. Obese patients were more likely to be young and male. In the fully adjusted logistic regression model, we found that overweight and obesity were significant predictors of AKI stage III (OR, 95 CI: 1.17, 1.05–1.30; 1.32, 1.18–1.47). In the fully adjusted Cox proportional hazards model, overweight and obesity were associated with significantly lower 30-day, 90-day, and 365-day all-cause mortality. The corresponding adjusted HRs (95 CIs) for overweight patients were 0.87 (0.77, 0.99), 0.84 (0.76, 0.93), and 0.80 (0.74, 0.88), and for obese patients, they were 0.87 (0.77, 0.98), 0.79 (0.71, 0.88), and 0.73 (0.66, 0.80), respectively. The subgroup analyses further presented a stable relationship between BMI category and 365-day all-cause mortality. Conclusions. BMI was independently associated with the severity and all-cause mortality of AKI in critical illness. Overweight and obesity were associated with increased risk of AKI stage III; however, they were predictive of a relatively lower mortality risk in these patients.

scholarly journals Serum Anion Gap Predicts All-Cause Mortality in Critically Ill Patients with Acute Kidney Injury: Analysis of the MIMIC-III Database

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Bihuan Cheng ◽  
Diwen Li ◽  
Yuqiang Gong ◽  
Binyu Ying ◽  
Benji Wang
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Anion Gap ◽  
Increased Risk ◽  
All Cause Mortality ◽  
The Relationship ◽  
Mimic Iii

Background. No epidemiological study has investigated the effect of anion gap (AG) on the prognosis of critically ill patients with acute kidney injury (AKI). Therefore, we aimed to determine the association between serum AG and all-cause mortality in these patients. Methods. From MIMIC III, we extracted demographics, vital signs, laboratory tests, comorbidities, and scoring systems from the first 24 h after patient ICU admission. A generalized additive model was used to identify a nonlinear association between anion gap and 30-day all-cause mortality. We also used the Cox proportional hazards models to measure the association between AG levels and 30-day, 90-day, and 365-day mortality in patients with AKI. Results. A total of 11,573 eligible subjects were extracted from the MIMIC-III. The relationship between AG levels and 30-day all-cause mortality in patients with AKI was nonlinear, with a U-shaped curve. In multivariate analysis, after adjusting for potential confounders, higher AG was a significant predictor of 30-day, 90-day, and 365-day all-cause mortality compared with lower AG (HR, 95% CI: 1.54, 1.33–1.75; 1.55, 1.38–1.73; 1.46, 1.31–1.60). Conclusions. The relationship between AG levels and 30-day all-cause mortality described a U-shaped curve. High-AG levels were associated with increased risk 30-day, 90-day, and 365-day all-cause mortality in critically ill patients with AKI.

scholarly journals The Neutrophil Percentage-to-Albumin Ratio Is Associated with All-Cause Mortality in Critically Ill Patients with Acute Kidney Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Benji Wang ◽  
Diwen Li ◽  
Bihuan Cheng ◽  
Binyu Ying ◽  
Yuqiang Gong
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Proportional Hazards ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Albumin Ratio ◽  
Neutrophil Percentage ◽  
Increased Risk ◽  
All Cause Mortality

Background. There is no evidence to suggest the predictive power of neutrophil percentage-to-albumin ratio (NPAR) in patients with acute kidney injury (AKI). We hypothesized that NPAR would correlate with all-cause mortality in critically ill patients with AKI. Methods. From the MIMIC-III V1.4 database, we extracted demographics, vital signs, comorbidities, laboratory tests, and other clinical data. The clinical endpoints were 30-, 90- and 365-day all-cause mortality in critically ill patients with AKI. Cox proportional hazards models were used to evaluate the prognostic values of NPAR, and subgroup analyses were performed to measure mortality across various subgroups. Results. A total of 7,481 eligible subjects were enrolled. In multivariate analysis, after adjustments for age, ethnicity, gender, and other confounding factors, higher NPARs were associated with an increased risk of 30-, 90- and 365-day all-cause mortality in critically ill patients with AKI (tertile 3 versus tertile 1: adjusted HR, 95% CI: 1.48, 1.30–1.69; 1.47, 1.31–1.66; 1.46, 1.32–1.62, respectively; P trend <0.01). A similar trend was observed in the NPAR group division by quintiles. Subgroup analysis revealed no significant interactions in most strata. Conclusions. Increased NPAR correlates with increased risk of all-cause mortality in critically ill patients with AKI.

scholarly journals Association of FIB-4 index and clinical outcomes in critically ill patients with acute kidney injury: a cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi-Yi Shi ◽  
Rui Zheng ◽  
Jie-Jie Cai ◽  
Zheng-Dong Fang ◽  
Wen-Jing Chen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Proportional Hazards Model ◽  
Kidney Injury ◽  
Continuous Variable ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
The Relationship

Abstract Background The relationship between fibrosis-4 (FIB-4) index and clinical outcomes in patients with acute kidney injury (AKI) is unclear. We aimed to investigate the association between FIB-4 index and all-cause mortality in critically ill patients with AKI. Methods We used data from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database (v1.4). The FIB-4 score was calculated using the existing formulas. logistic regression model, and Cox proportional hazards model were used to assessed the relationship between the FIB-4 index and in-hospital,28-day and 90-day mortality, respectively. Results A total of 3592 patients with AKI included in the data analysis. 395 (10.99%) patients died during hospitalization and 458 (12.74%) patients died in 28-day. During the 90-day follow-up, 893 (22.54%) patients were dead. An elevated FIB-4 value was significantly associated with increased in-hospital mortality when used as a continuous variable (odds ratio [OR] 1.183, 95% confidence interval [CI] 1.072–1.305, P = 0.002) and as a quartile variable (OR of Q2 to Q4 1.216–1.744, with Q1 as reference). FIB-4 was positively associated with 28-day mortality of AKI patients with hazard ratio (HR) of 1.097 (95% CI 1.008, 1.194) and 1.098 (95% 1.032, 1.167) for 90-day mortality, respectively. Conclusion This study demonstrated the FIB-4 index is associated with clinical outcomes in critically ill patients with acute kidney injury.

scholarly journals Prognostic value of fibrinogen to albumin ratios among critically ill patients with acute kidney injury

2021 ◽  
Author(s):  
Wenkai Xia ◽  
Chenyu Li ◽  
Xiajuan Yao ◽  
Yan Chen ◽  
Yaoquan Zhang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Proportional Hazards ◽  
Predictive Accuracy ◽  
Prognostic Significance ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Increased Risk

AbstractFibrinogen to albumin ratios (FAR) have shown to be a promising prognostic factor for improving the predictive accuracy in various diseases. This study explores FAR's prognostic significance in critically ill patients with acute kidney injury (AKI). All clinical data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.4. All patients were divided into four groups based on FAR quartiles. The primary endpoint was in-hospital mortality. A generalized additive model was applied to explore a nonlinear association between FAR and in-hospital mortality. The Cox proportional hazards models were used to determine the association between FAR and in-hospital mortality. A total of 5001 eligible subjects were enrolled. Multivariate analysis demonstrated that higher FAR was an independent predictor of in-hospital mortality after adjusting for potential confounders (HR, 95% CI 1.23, 1.03–1.48, P = 0.025). A nonlinear relationship between FAR and in-hospital mortality was observed. FAR may serve as a potential prognostic biomarker in critically patients with AKI and higher FAR was associated with increased risk of in-hospital mortality among these patients.

scholarly journals Eosinophil count and mortality risk in incident hemodialysis patients

2020 ◽  
Vol 35 (6) ◽  
pp. 1032-1042
Author(s):  
Duk-Hee Kang ◽  
Yuji Lee ◽  
Carola Ellen Kleine ◽  
Yong Kyu Lee ◽  
Christina Park ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Eosinophil Count ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Time Varying ◽  
Cox Proportional Hazards Models ◽  
Lower Baseline ◽  
All Cause Mortality ◽  
Relationship Of ◽  
The Relationship

Abstract Background Eosinophils are traditionally known as moderators of allergic reactions; however, they have now emerged as one of the principal immune-regulating cells as well as predictors of vascular disease and mortality in the general population. Although eosinophilia has been demonstrated in hemodialysis (HD) patients, associations of eosinophil count (EOC) and its changes with mortality in HD patients are still unknown. Methods In 107 506 incident HD patients treated by a large dialysis organization during 2007–11, we examined the relationships of baseline and time-varying EOC and its changes (ΔEOC) over the first 3 months with all-cause mortality using Cox proportional hazards models with three levels of hierarchical adjustment. Results Baseline median EOC was 231 (interquartile range 155–339) cells/μL and eosinophilia (&gt;350 cells/μL) was observed in 23.4% of patients. There was a gradual increase in EOC over time after HD initiation with a median ΔEOC of 5.1 (IQR −53–199) cells/μL, which did not parallel the changes in white blood cell count. In fully adjusted models, mortality risk was highest in subjects with lower baseline and time-varying EOC (&lt;100 cells/μL) and was also slightly higher in patients with higher levels (≥550 cells/μL), resulting in a reverse J-shaped relationship. The relationship of ΔEOC with all-cause mortality risk was also a reverse J-shape where both an increase and decrease exhibited a higher mortality risk. Conclusions Both lower and higher EOCs and changes in EOC over the first 3 months after HD initiation were associated with higher all-cause mortality in incident HD patients.

scholarly journals Serum anion gap is associated with all-cause mortality among critically ill patients with congestive heart failure

2020 ◽  
Author(s):  
yiyang tang ◽  
wenchao lin ◽  
lihuang zha ◽  
xiaofang zeng ◽  
zhenghui liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Critically Ill ◽  
Subgroup Analysis ◽  
Critically Ill Patients ◽  
Demographic Data ◽  
Cox Proportional Hazards ◽  
Anion Gap ◽  
High Morbidity ◽  
All Cause Mortality

Background: Congestive heart failure (CHF) is a complex clinical syndrome, with high morbidity and mortality. Serum anion gap (SAG) has been known to be associated with the severity of various cardiovascular diseases. However, the role of SAG indicators in CHF is unclear. Methods and results: A retrospective analysis of data from MIMIC-III v1.4 was conducted in critically ill patients with CHF. Clinical information of each patient, including demographic data, comorbidities, vital signs, scores, and laboratory indicators, were successfully obtained. Cox proportional hazards models were performed to determine the relationship between SAG and mortality in CHF patient, the consistency of which was further verified by subgroup analysis. Results: A total of 7426 subjects met the inclusion criteria. In multivariate analysis, after adjusting for age, gender, ethnicity, and other potential confounders, higher SAG was significantly related to an increase in 30-day and 90-day all-cause mortality of critically ill patients with CHF compared with lower SAG (tertile3 vs tertile1: adjusted HR, 95% CI: 1.74, 1.46-2.08; 1.53, 1.32-1.77). In subgroup analysis, the association between SAG and all-cause mortality present similarities in most strata. Conclusion: SAG at admission can be a promising predictor of all-cause mortality in critically ill patients with CHF.

scholarly journals Outcomes in Critically Ill Patients Sedated with Intravenous Lormetazepam or Midazolam: A Retrospective Cohort Study

2021 ◽  
Vol 10 (18) ◽  
pp. 4091
Author(s):  
Björn Weiss ◽  
David Hilfrich ◽  
Gerald Vorderwülbecke ◽  
Maria Heinrich ◽  
Julius J. Grunow ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Medical Center ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model

The benzodiazepine, midazolam, is one of the most frequently used sedatives in intensive care medicine, but it has an unfavorable pharmacokinetic profile when continuously applied. As a consequence, patients are frequently prolonged and more deeply sedated than intended. Due to its distinct pharmacological features, including a cytochrome P450-independent metabolization, intravenous lormetazepam might be clinically advantageous compared to midazolam. In this retrospective cohort study, we compared patients who received either intravenous lormetazepam or midazolam with respect to their survival and sedation characteristics. The cohort included 3314 mechanically ventilated, critically ill patients that received one of the two drugs in a tertiary medical center in Germany between 2006 and 2018. A Cox proportional hazards model with mortality as outcome and APACHE II, age, gender, and admission mode as covariates revealed a hazard ratio of 1.75 [95% CI 1.46–2.09; p < 0.001] for in-hospital mortality associated with the use of midazolam. After additionally adjusting for sedation intensity, the HR became 1.04 [95% CI 0.83–1.31; p = 0.97]. Thus, we concluded that excessive sedation occurs more frequently in critically ill patients treated with midazolam than in patients treated with lormetazepam. These findings require further investigation in prospective trials to assess if lormetazepam, due to its ability to maintain light sedation, might be favorable over other benzodiazepines for sedation in the ICU.

scholarly journals Association between suicide, external-cause and all-cause mortality and irregular mental health discharge among the US veteran population

BJPsych Open ◽  
2021 ◽  
Vol 7 (5) ◽  
Author(s):  
Natalie B. Riblet ◽  
Daniel J. Gottlieb ◽  
Bradley V. Watts ◽  
Maxwell Levis ◽  
Brian Shiner
Keyword(s):  
Mental Health ◽  
Suicide Risk ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Post Discharge ◽  
Residential Settings ◽  
Increased Risk ◽  
The Us ◽  
All Cause Mortality ◽  
The Relationship

Background Irregular hospital discharge is highly prevalent among people admitted to hospital for mental health reasons. No study has examined the relationship between irregular discharge, post-discharge mortality and treatment setting (i.e. mortality after patients are discharged from acute in-patient or residential mental health settings). Aims To understand the relationship between irregular discharge and mortality among patients discharged from acute in-patient and residential settings. Method A retrospective study was conducted in members of the US veteran population discharged from acute in-patient or residential settings of the US Department of Veterans Affairs between 2003 and 2018. Multivariate Cox proportional hazards were used to evaluate associations between irregular discharge and suicide, external-cause (as defined by ICD-10 Codes: V01-Y98) and all-cause mortality in the first 30-, 90- and 180-days post-discharge. Results There were over 1.5 million mental health discharges between 2003 and 2018. Patients with an irregular discharge were at increased risk for suicide, external-cause and all-cause mortality in the first 180 days after discharge. In the first 30 days after discharge, patients with irregular discharge had more than three times greater suicide risk than patients with regular discharge (adjusted hazard ratio (HR) = 3.41, 95% CI 2.21–5.25). Suicide risk was higher among patients with irregular discharge in the first 30 days after acute in-patient discharge (adjusted HR = 1.55, 95% CI 1.11–2.16). In both settings, the mortality risk associated with irregular discharge attenuated but remained elevated within 90 and 180 days. Conclusions Irregular discharge after an acute in-patient or residential stay poses a large risk for mortality soon after discharge. Clinicians must identify effective interventions to mitigate harms associated with irregular discharge in these settings.

scholarly journals Pharmacokinetic/Toxicodynamic Analysis of Colistin-Associated Acute Kidney Injury in Critically Ill Patients

2017 ◽  
Vol 61 (11) ◽  
Author(s):  
Alan Forrest ◽  
Samira M. Garonzik ◽  
Visanu Thamlikitkul ◽  
Evangelos J. Giamarellos-Bourboulis ◽  
David L. Paterson ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Steady State ◽  
Renal Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Patient Factors ◽  
Potential Patient ◽  
Relationship Of ◽  
The Relationship

ABSTRACT Acute kidney injury (AKI) occurs in a substantial proportion of critically ill patients receiving intravenous colistin. In the pharmacokinetic/toxicodynamic analysis reported here, the relationship of the occurrence of AKI to exposure to colistin and a number of potential patient factors was explored in 153 critically ill patients, none of whom were receiving renal replacement therapy. Tree-based modeling revealed that the rates of AKI were substantially higher when the average steady-state plasma colistin concentration was greater than ∼2 mg/liter.

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