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

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.

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

Disease Markers ◽

10.1155/2020/6501272 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10 ◽

Cited By ~ 2

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.

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Effects of Dexmedetomidine Administration on Outcomes in Critically Ill Patients with Acute Kidney Injury: A Propensity Score-Matching Analysis

10.21203/rs.3.rs-609595/v1 ◽

2021 ◽

Author(s):

Aixiang Yang ◽

Jing Yang ◽

Biying Zhou ◽

Jinxian Qian ◽

Liyang Jiang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Length Of Stay ◽

Propensity Score ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Medical Information ◽

Kidney Injury ◽

Cox Proportional Hazards Model

Abstract Background Dexmedetomidine (DEX) had organ protection effects and could decrease mortality in animal models, but its association with mortality and length of stay (LOS) in ICU and hospital in critically ill patients was conflicting. Whether acute kidney injury (AKI) subgroup of critically ill patients could benefit from DEX was unknown. The present study aimed to evaluate the effects of DEX on clinical outcomes of critically ill patients with AKI. Methods Data were extracted from the Medical Information Mart for Intensive Care Ⅲ database (MIMIC Ⅲ). Propensity score matching (PSM) analysis (1:3), cox proportional hazards model, linear regression and logistic regression model were used to assess the effect of DEX on clinical outcomes. Results After PSM, 324 pairs of patients were matched between the patients with DEX administration and those without. DEX administration was associated with decreased in-hospital mortality [hazard ratio (HR) 0.287; 95% CI 0.151–0.542; P < 0.001] and 90-day mortality [HR 0.344; 95% CI 0.221–0.534; P < 0.001], and it was also associated with reduced length of stay (LOS) in ICU [4.54(3.13,7.72) versus 5.24(3.15,10.91), P < 0.001] and LOS in hospital [11.63(8.02,16.79) versus 12.09(7.83,20.44), P = 0.002]. Subgroup analysis showed the above associations existed only in mild and moderate AKI subgroups, but not in severe AKI subgroup. Nevertheless, DEX administration was not associated with the recovery of renal function [HR 1.199; 95% CI 0.851–1.688; P = 0.300]. Conclusions DEX administration improved outcomes in critically ill patients with mild and moderate AKI and could be a good choice of sedation.

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Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury

Journal of Critical Care ◽

10.1016/j.jcrc.2007.12.017 ◽

2009 ◽

Vol 24 (1) ◽

pp. 129-140 ◽

Cited By ~ 204

Author(s):

Sean M. Bagshaw ◽

Shigehiko Uchino ◽

Rinaldo Bellomo ◽

Hiroshi Morimatsu ◽

Stanislao Morgera ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury

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Association Between Base Excess and Mortality Among Patients in ICU with Acute Kidney Injury

10.21203/rs.3.rs-746329/v1 ◽

2021 ◽

Author(s):

Yi Cheng ◽

Yuanjun Tang ◽

Boxiang Tu ◽

Xin Cheng ◽

Ran Qi ◽

...

Keyword(s):

Acute Kidney Injury ◽

Medical Information ◽

Proportional Hazards ◽

Base Excess ◽

Proportional Hazards Model ◽

Kidney Injury ◽

Prognostic Indicator ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Icu Patients

Abstract Objective This study aimed to explore the association between base excess (BE) and risk of 30-day mortality among patients with acute kidney injury (AKI) in ICU.Methods This retrospective study including ICU patients with AKI from Medical Information Mart for Intensive Care (MIMIC)-IV database. We used multivariate Cox proportional-hazards model to calculate the hazard ratio (HR) for risk of 30-day mortality among patients with AKI. Furthermore, we utilized Cox proportional-hazard model with restrict cubic splines (RCS) to explore the potential no-linear association. Results Of all the 14238 ICU patients with AKI, BE showed U-shaped relationship with risk of 30-day mortality for patients with AKI, and higher or lower BE value could increase the risk. Compared with normal base excess (-3~3 mmol/L), patients with difference groups (BE ≤ -9mmol/L, -9 mmol/L <BE≤-3 mmol/L, 3 mmol/L <BE≤9 mmol/L and BE＞9 mmol/L) had different HR for mortality: 1.57(1.40,1.76), 1.26(1.14,1.39), 0.97(0.83,1.12), 1.53(1.17,2.02) respectively. And the RCS analyses also showed U-shaped curve between BE and 30-day mortality risk.Conclusion Our results suggest both higher and lower BE in patients with AKI would increase the risk of 30-day mortality. BE measured at administration could be a critical prognostic indicator for ICU patients with AIK and provide guidance for clinicians.

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

Journal of Clinical Medicine ◽

10.3390/jcm10184091 ◽

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.

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

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01367-17 ◽

2017 ◽

Vol 61 (11) ◽

Cited By ~ 29

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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Corticosteroid therapy in critically ill patients with COVID-19: a multicenter, retrospective study

Critical Care ◽

10.1186/s13054-020-03429-w ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Yiming Li ◽

Qinghe Meng ◽

Xin Rao ◽

Binbin Wang ◽

Xingguo Zhang ◽

...

Keyword(s):

Logistic Regression ◽

Critically Ill ◽

Critically Ill Patients ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Corticosteroid Treatment ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Initiation Time ◽

Icu Admission

Abstract Background Corticoid therapy has been recommended in the treatment of critically ill patients with COVID-19, yet its efficacy is currently still under evaluation. We investigated the effect of corticosteroid treatment on 90-day mortality and SARS-CoV-2 RNA clearance in severe patients with COVID-19. Methods 294 critically ill patients with COVID-19 were recruited between December 30, 2019 and February 19, 2020. Logistic regression, Cox proportional-hazards model and marginal structural modeling (MSM) were applied to evaluate the associations between corticosteroid use and corresponding outcome variables. Results Out of the 294 critically ill patients affected by COVID-19, 183 (62.2%) received corticosteroids, with methylprednisolone as the most frequently administered corticosteroid (175 accounting for 96%). Of those treated with corticosteroids, 69.4% received corticosteroid prior to ICU admission. When adjustments and subgroup analysis were not performed, no significant associations between corticosteroids use and 90-day mortality or SARS-CoV-2 RNA clearance were found. However, when stratified analysis based on corticosteroid initiation time was performed, there was a significant correlation between corticosteroid use (≤ 3 day after ICU admission) and 90-day mortality (logistic regression adjusted for baseline: OR 4.49, 95% CI 1.17–17.25, p = 0.025; Cox adjusted for baseline and time varying variables: HR 3.89, 95% CI 1.94–7.82, p < 0.001; MSM adjusted for baseline and time-dependent variants: OR 2.32, 95% CI 1.16–4.65, p = 0.017). No association was found between corticosteroid use and SARS-CoV-2 RNA clearance even after stratification by initiation time of corticosteroids and adjustments for confounding factors (corticosteroids use ≤ 3 days initiation vs no corticosteroids use) using MSM were performed. Conclusions Early initiation of corticosteroid use (≤ 3 days after ICU admission) was associated with an increased 90-day mortality. Early use of methylprednisolone in the ICU is therefore not recommended in patients with severe COVID-19.

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Impact of Downtime on Clinical Outcomes in Critically Ill Patients with Acute Kidney Injury Receiving Continuous Renal Replacement Therapy

ASAIO Journal ◽

10.1097/mat.0000000000001549 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Jungho Shin ◽

Hyun Chul Song ◽

Jin Ho Hwang ◽

Su Hyun Kim

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury

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Risk of acute kidney injury in patients with HIV receiving proton pump inhibitors

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2019-0017 ◽

2019 ◽

Vol 8 (10) ◽

pp. 781-790

Author(s):

S Scott Sutton ◽

Joseph Magagnoli ◽

Tammy H Cummings ◽

James W Hardin

Keyword(s):

Acute Kidney Injury ◽

Cohort Study ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Kidney Injury ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Increased Risk

Aims/patients & methods: To evaluate the risk of acute kidney injury (AKI) in patients with HIV receiving proton pump inhibitors (PPI) a cohort study was conducted utilizing the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database. Patients were followed from the index date until the earliest date of AKI, 120 days or end of study period, or death. Statistical analyses utilized a Cox proportional hazards model. Results: A total of 21,643 patients (6000 PPI and 15,643 non-PPI) met all study criteria. The PPI cohort had twice the risk of AKI compared with controls (2.12, hazard ratio: 1.46–3.1). Conclusion: A nationwide cohort study supported the relationship of an increased risk of AKI in patients receiving PPIs.

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