scholarly journals Construction and Validation of a Risk Prediction Model for Acute Kidney Injury in Patients Suffering from Septic Shock

2022 ◽  
Vol 2022 ◽  
pp. 1-12
Author(s):  
Suru Yue ◽  
Shasha Li ◽  
Xueying Huang ◽  
Jie Liu ◽  
Xuefei Hou ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Calibration Curve ◽  
Roc Curve ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Clinical Impact ◽  
Curve Analysis ◽  
Sufficient Information

Background. Acute kidney injury (AKI) is an important complication in critically ill patients, especially in sepsis and septic shock patients. Early prediction of AKI in septic shock can provide clinicians with sufficient information for timely intervention so that improve the patients’ survival rate and quality of life. The aim of this study was to establish a nomogram that predicts the risk of AKI in patients with septic shock in the intensive care unit (ICU). Methods. The data were collected from the Medical Information Mart for Intensive Care III (MIMIC-III) database between 2001 and 2012. The primary outcome was AKI in the 48 h following ICU admission. Univariate and multivariate logistic regression analyses were used to screen the independent risk factors of AKI. The performance of the nomogram was evaluated according to the calibration curve, receiver operating characteristic (ROC) curve, decision curve analysis, and clinical impact curve. Results. A total of 2415 patients with septic shock were included in this study. In the training and validation cohort, 1091 (64.48%) of 1690 patients and 475 (65.52%) of 725 patients developed AKI, respectively. The predictive factors for nomogram construction were gender, ethnicity, congestive heart failure, diabetes, obesity, Simplified Acute Physiology Score II (SAPS II), angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs), bilirubin, creatinine, blood urea nitrogen (BUN), and mechanical ventilation. The model had a good discrimination with the area under the ROC curve of 0.756 and 0.760 in the training and validation cohorts, respectively. The calibration curve for probability of AKI in septic shock showed optimal agreement between prediction by nomogram and actual observation. Decision curve and clinical impact curve analysis indicated that the nomogram conferred high clinical net benefit. Conclusion. The proposed nomogram can quickly and effectively predict the risk of AKI at an early stage in patients with septic shock in ICU, which can provide information for timely and efficient intervention in patients with septic shock in the ICU setting.

scholarly journals Circulating Proenkephalin, Acute Kidney Injury, and Its Improvement in Patients with Severe Sepsis or Shock

2018 ◽  
Vol 64 (9) ◽  
pp. 1361-1369 ◽  
Author(s):  
Pietro Caironi ◽  
Roberto Latini ◽  
Joachim Struck ◽  
Oliver Hartmann ◽  
Andreas Bergmann ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Kidney Injury ◽  
Baseline Serum

Abstract BACKGROUND Acute kidney injury (AKI) occurs in many critically ill patients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients. METHODS Plasma proenkephalin A 119–159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial to test its association with incident AKI, improvement of renal function, need for renal replacement therapy (RRT), and mortality. RESULTS Median [Q1–Q3] plasma penKid concentration on day 1 [84 (20–159) pmol/L[ was correlated with serum creatinine concentration (r = 0.74); it was higher in patients with chronic renal failure and rose progressively with the renal Sequential Organ Failure Assessment subscore. It predicted incident AKI within 48 h (adjusted odds ratio, 3.3; 95% CI, 2.1–5.1; P < 0.0001) or 1 week [adjusted hazard ratio, 2.1 (1.7–2.8); P < 0.0001] and future RRT during the intensive care unit stay [odds ratio, 4.0 (3.0–5.4)]. PenKid was also associated with improvements in renal function in patients with baseline serum creatinine >2 mg/dL, both within the next 48 h [adjusted odds ratio, 0.31 (0.18–0.54), P < 0.0001] and 1 week [0.23 (0.12–0.45)]. The time course of penKid concentrations predicted AKI and 90-day mortality. CONCLUSIONS Early measurement and the trajectory of penKid predict incident AKI, improvement of renal function, and the need for RRT in the acute phase after intensive care unit admission during sepsis or septic shock. PenKid measurement may be a valuable tool to test early therapies aimed at preventing the risk of AKI in sepsis.

scholarly journals A novel risk-predicted nomogram for sepsis associated-acute kidney injury among critically ill patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shanglin Yang ◽  
Tingting Su ◽  
Lina Huang ◽  
Lu-Huai Feng ◽  
Tianbao Liao
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Validation Cohort ◽  
Kidney Injury ◽  
Curve Analysis ◽  
High Morbidity ◽  
Baseline Serum ◽  
Decision Curve Analysis

Abstract Background Acute kidney injury (AKI) is a prevalent and severe complication of sepsis contributing to high morbidity and mortality among critically ill patients. In this retrospective study, we develop a novel risk-predicted nomogram of sepsis associated-AKI (SA-AKI). Methods A total of 2,871 patients from the Medical Information Mart for Intensive Care III (MIMIC-III) critical care database were randomly assigned to primary (2,012 patients) and validation (859 patients) cohorts. A risk-predicted nomogram for SA-AKI was developed through multivariate logistic regression analysis in the primary cohort while the nomogram was evaluated in the validation cohort. Nomogram discrimination and calibration were assessed using C-index and calibration curves in the primary and external validation cohorts. The clinical utility of the final nomogram was evaluated using decision curve analysis. Results Risk predictors included in the prediction nomogram included length of stay in intensive care unit (LOS in ICU), baseline serum creatinine (SCr), glucose, anemia, and vasoactive drugs. Nomogram revealed moderate discrimination and calibration in estimating the risk of SA-AKI, with an unadjusted C-index of 0.752, 95 %Cl (0.730–0.774), and a bootstrap-corrected C index of 0.749. Application of the nomogram in the validation cohort provided moderate discrimination (C-index, 0.757 [95 % CI, 0.724–0.790]) and good calibration. Besides, the decision curve analysis (DCA) confirmed the clinical usefulness of the nomogram. Conclusions This study developed and validated an AKI risk prediction nomogram applied to critically ill patients with sepsis, which may help identify reasonable risk judgments and treatment strategies to a certain extent. Nevertheless, further verification using external data is essential to enhance its applicability in clinical practice.

scholarly journals Characteristics of Acute Kidney Injury in the Intensive Care Unit of Dr. Soetomo General Hospital, Surabaya

2021 ◽  
Vol 5 (3) ◽  
pp. 96-99
Author(s):  
Putu Laksmi Febriyani ◽  
Bambang Pujo Semedi ◽  
Widodo Widodo
Keyword(s):  
Diabetes Mellitus ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Injury ◽  
Developed Countries ◽  
Primary Diagnosis ◽  
Exposure Factor ◽  
Age Range

Acute Kidney Injury (AKI) is one of the causes of morbidity and mortality among people in both developing and developed countries in the intensive care unit (ICU). In Indonesia, the incidence rate is 0.2% while for the Surabaya, AKI research has not been widely carried out and published. This study aims to determine the characteristics of AKI patients in ICU of Dr. Soetomo hospital covers the data distribution of sociodemographic, risk factors, and mortality. This descriptive study involving 23 inpatients at the ICU with AKI as the sample. Samples were selected using total sampling method. Data were collected from medical records with data collection sheets. The results were then analyzed descriptively and tested bivariate using logistic regression. The results showed that 82.6% of the patients were male with the highest age range of 50-56 years old (30.43%). AKI mortality rate in the intensive care unit was 30.43%. The primary diagnosis was diabetes mellitus (34.78%) and the highest exposure factor was a septic shock (38.70%). Factors associated with AKI mortality were diabetes mellitus (p = 0.000) and exposure to septic shock (p = 0.005). Keywords: acute kidney injury; intensive care unit

scholarly journals Acute Kidney Injury and Septic Shock—Defined by Updated Sepsis-3 Criteria in Critically Ill Patients

2019 ◽  
Vol 8 (10) ◽  
pp. 1731 ◽  
Author(s):  
Vin-Cent Wu ◽  
Shih-Chieh Jeff Chueh ◽  
Jui-Ting Chang ◽  
Bang-Gee Hsu ◽  
Marlies Ostermann ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Risk Factor ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Acute Dialysis ◽  
Sepsis And Septic Shock

Sepsis is commonly associated with acute kidney injury (AKI), particularly in those requiring dialysis (AKI-D). To date, Sepsis-3 criteria have not been applied to AKI-D patients. We investigated sepsis prevalence defined by Sepsis-3 criteria and evaluated the outcomes of septic-associated AKI-D among critically ill patients. Using the data collected from a prospective multi-center observational study, we applied the Sepsis-3 criteria to critically ill AKI-D patients treated in intensive care units (ICUs) in 30 hospitals between September 2014 and December 2015. We described the prevalence, outcomes, and characteristics of sepsis as defined by the screening Sepsis-3 criteria among AKI-D patients, and compared the outcomes of AKI-D patients with or without sepsis using the Sepsis-3 criteria. A total of 1078 patients (median 70 years; 673 (62.4%) men) with AKI-D were analyzed. The main etiology of AKI was sepsis (71.43%) and the most frequent indication for acute dialysis was oliguria (64.4%). A total of 577 (53.3% of 1078 patients) met the Sepsis-3 criteria, and 206 among the 577 patients (19.1%) had septic shock. Having sepsis and septic shock were independently associated with 90-day mortality among these ICU AKI-D patients (hazard ratio (HR) 1.23 (p = 0.027) and 1.39 (p = 0.004), respectively). Taking mortality as a competing risk factor, AKI-D patients with septic shock had a significantly reduced chance of weaning from dialysis at 90 days than those without sepsis (HR 0.65, p = 0.026). The combination of the Sepsis-3 criteria with the AKI risk score led to better performance in forecasting 90-day mortality. Sepsis affects more than 50% of ICU AKI patients requiring dialysis, and one-fifth of these patients had septic shock. In AKI-D patients, coexistent with or induced by sepsis (as screened by the Sepsis-3 criteria), there is a significantly higher mortality and reduced chance of recovering sufficient renal function, when compared to those without sepsis.

scholarly journals Plasma neutrophil gelatinase-associated lipocalin at intensive care unit admission as a predictor of acute kidney injury progression

2020 ◽  
Vol 13 (6) ◽  
pp. 994-1002 ◽  
Author(s):  
Jacqueline Koeze ◽  
Iwan C C van der Horst ◽  
Frederik Keus ◽  
Renske Wiersema ◽  
Wim Dieperink ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Roc Curve ◽  
Kidney Injury ◽  
Operating Characteristics ◽  
Icu Admission ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Plasma Ngal ◽  
Neutrophil Gelatinase

Abstract Background Acute kidney injury (AKI) is a common complication in patients during intensive care unit (ICU) admission. AKI is defined as an increase in serum creatinine (SCr) and/or a reduction in urine output. SCr is a marker of renal function with several limitations, which led to the search for biomarkers for earlier AKI detection. Our aim was to study the predictive value of plasma neutrophil gelatinase-associated lipocalin (NGAL) at admission as a biomarker for AKI progression during the first 48 h of ICU admission in an unselected, heterogeneous ICU patient population. Methods We conducted a prospective observational study in an academic tertiary referral ICU population. We recorded AKI progression in all ICU patients during the first 48 h of ICU admission in a 6-week period. Plasma NGAL was measured at admission but levels were not reported to the attending clinicians. As possible predictors of AKI progression, pre-existing AKI risk factors were recorded. We examined the association of clinical parameters and plasma NGAL levels at ICU admission with the incidence and progression of AKI within the first 48 h of the ICU stay. Results A total of 361 patients were included. Patients without AKI progression during the first 48 h of ICU admission had median NGAL levels at admission of 115 ng/mL [interquartile range (IQR) 81–201]. Patients with AKI progression during the first 48 h of ICU admission had median NGAL levels at admission of 156 ng/mL (IQR 97–267). To predict AKI progression, a multivariant model with age, sex, diabetes mellitus, body mass index, admission type, Acute Physiology and Chronic Health Evaluation score and SCr at admission had an area under the receiver operating characteristics (ROC) curve of 0.765. Adding NGAL to this model showed a small increase in the area under the ROC curve to 0.783 (95% confidence interval 0.714–0.853). Conclusions NGAL levels at admission were higher in patients with progression of AKI during the first 48 h of ICU admission, but adding NGAL levels at admission to a model predicting this AKI progression showed no significant additive value.

scholarly journals The epidemiology of acute kidney injury in critically ill patients in the Gansu Province: the EACG Study

2020 ◽  
Author(s):  
Yu Chen ◽  
Fang Feng ◽  
Xueni Chang ◽  
Dong Liu ◽  
Yuan Yuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Cardiac Output ◽  
Intensive Care ◽  
Kidney Injury ◽  
Gansu Province ◽  
Sepsis And Septic Shock

Abstract Objective: To investigate the epidemiology of acute kidney injury and to clarify the risk factors associated with the prognosis of acute kidney injury in critically ill patients in the Gansu Province.Methods : This was a multicenter, retrospective study. The clinical data of all patients from January 1, 2017, to December 31, 2019, in the intensive care unit of the selected hospitals were screened. Descriptive statistical analysis was performed first, and then the patients were divided into a survival group and a nonsurvival group based on survival status at discharge. Logistic regression analyses were used to determine the risk factors for in-hospital mortality in patients with acute kidney injury. RESULTS : (1) Among the 8106 patients admitted, a total of 3019 patients were excluded according to the exclusion criteria. Among the included patients, 890 patients met the diagnostic criteria for AKI, with an incidence of 17.5% and mortality of 41.3%. The etiology of acute kidney injury was 64% prerenal, 33% renal, and 2.7% postrenal. Prerenal AKI was the most common, among which cases caused by sepsis and septic shock accounted for 44.7%. Among the selected AKI patients, AKI stage I accounted for 22.02%, AKI stage II accounted for 31.01%, AKI stage III accounted for 46.97%, and 35.8% of the AKI patients received renal replacement therapy. (2) Logistic regression analysis showed that sex , age, AKI stage, RRT, infection, cardio-pulmonary resuscitation, cardiac output, mechanical ventilation, diuretics, white blood cells, platelets, blood urea nitrogen, prothrombin time and activated partial thromboplastin time were significantly associated with the prognosis of acute kidney injury (P <0.05). Further analysis showed that male sex, old age, high AKI stage, RRT treatment, low cardiac output, mechanical ventilation, elevated leukocyte count, reduced platelet count and reduced serum albumin were independent risk factors for a poor prognosis of acute kidney injury.Conclusions : Large-scale epidemiological data from several representative general hospitals in the Gansu Province showed that the incidence and mortality of acute kidney injury in intensive care units were still very high. Sepsis and septic shock are the main causes of AKI.

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