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

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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Risk Factors and Outcomes of Acute Kidney Injury in Critically Ill Patients with Coronavirus Disease 2019

Kidney Diseases ◽

10.1159/000512270 ◽

2020 ◽

pp. 1-9

Author(s):

Yichun Cheng ◽

Nanhui Zhang ◽

Ran Luo ◽

Meng Zhang ◽

Zhixiang Wang ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Regression Analysis ◽

Intensive Care ◽

Hospital Mortality ◽

Kidney Injury ◽

Stage 1

Background: Coronavirus disease 2019 (COVID-19) has emerged as a major global health threat with a great number of deaths worldwide. Acute kidney injury (AKI) is a common complication in patients admitted to the intensive care unit. We aimed to assess the incidence, risk factors and in-hospital outcomes of AKI in COVID-19 patients admitted to the intensive care unit. Methods: We conducted a retrospective observational study in the intensive care unit of Tongji Hospital, which was assigned responsibility for the treatments of severe COVID-19 patients by the Wuhan government. AKI was defined and staged based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Mild AKI was defined as stage 1, and severe AKI was defined as stage 2 or stage 3. Logistic regression analysis was used to evaluate AKI risk factors, and Cox proportional hazards model was used to assess the association between AKI and in-hospital mortality. Results: A total of 119 patients with COVID-19 were included in our study. The median patient age was 70 years (interquartile range, 59–77) and 61.3% were male. Fifty-one (42.8%) patients developed AKI during hospitalization, corresponding to 14.3% in stage 1, 28.6% in stage 2 and 18.5% in stage 3, respectively. Compared to patients without AKI, patients with AKI had a higher proportion of mechanical ventilation mortality and higher in-hospital mortality. A total of 97.1% of patients with severe AKI received mechanical ventilation and in-hospital mortality was up to 79.4%. Severe AKI was independently associated with high in-hospital mortality (OR: 1.82; 95% CI: 1.06–3.13). Logistic regression analysis demonstrated that high serum interleukin-8 (OR: 4.21; 95% CI: 1.23–14.38), interleukin-10 (OR: 3.32; 95% CI: 1.04–10.59) and interleukin-2 receptor (OR: 4.50; 95% CI: 0.73–6.78) were risk factors for severe AKI development. Conclusions: Severe AKI was associated with high in-hospital mortality, and inflammatory response may play a role in AKI development in critically ill patients with COVID-19.

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The epidemiology of acute kidney injury in critically ill patients in the Gansu Province: The EACG study

Science Progress ◽

10.1177/00368504211018057 ◽

2021 ◽

Vol 104 (2) ◽

pp. 003685042110180

Author(s):

Yu Chen ◽

Fang Feng ◽

Xue-ni Chang ◽

Dong Liu ◽

Yuan Yuan ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

White Blood Cells ◽

Kidney Injury ◽

Gansu Province ◽

Incidence And Mortality

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. 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. Univariate and multivariate logistic regression analyses were used to determine the risk factors for in-hospital mortality in patients with acute kidney injury. (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%. (2) Logistic regression analysis showed that sex, age, AKI stage, 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). 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. Trial registration: the Chinese Clinical Trial Registry number is ChiCTR1800016945. Date of registration: 4 July 2018.

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Risk Factors and Outcomes of Acute Kidney Injury in Critically Ill Patients With Coronavirus Disease 2019

10.21203/rs.3.rs-32532/v1 ◽

2020 ◽

Author(s):

Yichun Cheng ◽

Nanhui Zhang ◽

Ran Luo ◽

Meng Zhang ◽

Zhixiang Wang ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Regression Analysis ◽

Intensive Care ◽

Hospital Mortality ◽

Kidney Injury ◽

Stage 1

Abstract Background: Coronavirus disease 2019 (COVID-19) has emerged as a major global health threat with a great number of deaths worldwide. Acute kidney injury (AKI) is a common complication in patients admitted to the intensive care unit. We aimed toassess the incidence, risk factors and in-hospital outcomes of AKI in COVID-19 patients admitted to intensive care unitMethods: we conducted a retrospective observational study in intensive care unit of Tongji hospital, which was assigned responsibility for the treatments of severe COVID-19 patients by Wuhan government. The AKI was defined and staged based onKidney Disease: Improving Global Outcomes (KDIGO) criteria. Mild AKI was defined as stage 1, and severe AKI was defined as stage 2 or stage 3. We used logistic regression analysis to evaluate AKI risk factors and the association between AKI and in-hospital mortality.Results: A total of 150 patients with COVID-19 were included in our study. The median age of patients was 70 (interquartile range, 60-80) years and 62.7% were male. 70 (46.7%) patients developed AKI during hospitalization, corresponding to the 17.3% in stage 1 and 9.3% in stage 2 and 20.0% in stage 3, respectively. Compared to patients without AKI, patients with AKI had higher proportion of mechanical ventilation mortality and higher in-hospital mortality. 95.5% patients with severe AKI received mechanical ventilation and in-hospital mortality was up to 79.5%. Severe AKI was independently associated with high in-hospital mortality (OR: 4.30; 95% CI: 1.83-10.10). Logistic regression analysis demonstrated that high serum interleukin-6 (OR: 2.54; 95%CI: 1.00-6.42) and interleukin-10 (OR: 3.02; 95%CI: 1.17-7.82) were risk factors for severe AKI development.Conclusions: severe AKI was associated with high in-hospital mortality and inflammatory response may play a role in AKI development in critically ill patients with COVID-19.

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Risk factors for 28-day mortality in patients with sepsis-related myocardial injury in intensive care units

Journal of International Medical Research ◽

10.1177/03000605211004759 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052110047

Author(s):

Meng Zhang ◽

Meili Duan ◽

Deyuan Zhi ◽

Jin Lin ◽

Pei Liu ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Intensive Care ◽

Myocardial Injury ◽

Kidney Injury ◽

Oxygenation Index ◽

Multivariate Logistic Regression ◽

Norepinephrine Dose

Objective This study aimed to identify the risk factors for death in patients with sepsis-related myocardial injury. Methods A retrospective study was conducted in 158 patients with sepsis-related myocardial injury in a mixed medical intensive care unit from January 2009 to March 2020. The patients were divided into those who survived and those who died on the basis of whether they survived after 28 days. Demographic and clinical parameters were collected. Multivariate logistic regression was performed. Results Sixty-nine (43.7%) patients died within 28 days after admission to the intensive care unit. Multivariate logistic regression analysis showed that the oxygenation index (odds ratio [OR]: 0.979, 95% confidence interval [CI]: 0.970–0.989), acute kidney injury (OR: 4.787, 95% CI: 1.674–13.693), norepinephrine dose (OR: 1.706, 95% CI: 1.375–2.117), and abdominopelvic cavity infection (OR: 0.257, 95% CI: 0.076–0.866) were significantly associated with mortality within 28 days after admission in patients with sepsis-related myocardial injury. Conclusions Patients with sepsis-related myocardial injury have a high mortality rate. A high oxygenation index, occurrence of acute kidney injury, high norepinephrine dose, and occurrence of abdominopelvic cavity infection are independent risk factors for 28-day mortality in patients with sepsis-related myocardial injury.

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

Journal of Clinical Medicine ◽

10.3390/jcm8101731 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1731 ◽

Cited By ~ 1

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.

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Acute Kidney Injury in Patients with Sepsis and Septic Shock: Risk Factors and Clinical Outcomes

Yonsei Medical Journal ◽

10.3349/ymj.2013.54.4.965 ◽

2013 ◽

Vol 54 (4) ◽

pp. 965 ◽

Cited By ~ 34

Author(s):

Sang Heon Suh ◽

Chang Seong Kim ◽

Joon Seok Choi ◽

Eun Hui Bae ◽

Seong Kwon Ma ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Acute Kidney Injury ◽

Clinical Outcomes ◽

Kidney Injury ◽

Sepsis And Septic Shock

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Outcome of patients with acute kidney injury in severe sepsis and septic shock treated with early goal-directed therapy in an intensive care unit

Saudi Journal of Kidney Diseases and Transplantation ◽

10.4103/1319-2442.132171 ◽

2014 ◽

Vol 25 (3) ◽

pp. 544 ◽

Cited By ~ 14

Author(s):

Wasim Ahmed ◽

JavedI Memon ◽

Rifat Rehmani ◽

Abdulmajeed Al Juhaiman

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Acute Kidney Injury ◽

Severe Sepsis ◽

Intensive Care ◽

Kidney Injury ◽

Goal Directed Therapy ◽

Early Goal Directed Therapy ◽

Sepsis And Septic Shock

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Association between Procalcitonin and Acute Kidney Injury in Patients with Bacterial Septic Shock

Blood Purification ◽

10.1159/000512351 ◽

2021 ◽

pp. 1-10

Author(s):

Guang Fu ◽

Hai-chao Zhan ◽

Hao-li Li ◽

Jun-fu Lu ◽

Yan-hong Chen ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Piecewise Linear ◽

Kidney Injury ◽

Multiple Logistic Regression ◽

Primary Analysis ◽

Female Patients ◽

Potential Biomarker ◽

The Relationship

Objective: The objective of this study was to assess the relationship between serum procalcitonin (PCT) and acute kidney injury (AKI) induced by bacterial septic shock. Methods: A retrospective study was designed which included patients who were admitted to the ICU from January 2015 to October 2018. Multiple logistic regression and receiver operating characteristic (ROC) as well as smooth curve fitting analysis were used to assess the relationship between the PCT level and AKI. Results: Of the 1,631 patients screened, 157 patients were included in the primary analysis in which 84 (53.5%) patients were with AKI. Multiple logistic regression results showed that PCT (odds ratio [OR] = 1.017, 95% confidence interval [CI] 1.009–1.025, p < 0.001) was associated with AKI induced by septic shock. The ROC analysis showed that the cutoff point for PCT to predict AKI development was 14 ng/mL, with a sensitivity of 63% and specificity 67%. Specifically, in multivariate piecewise linear regression, the occurrence of AKI decreased with the elevation of PCT when PCT was between 25 ng/mL and 120 ng/mL (OR 0.963, 95% CI 0.929–0.999; p = 0.042). The AKI increased with the elevation of PCT when PCT was either <25 ng/mL (OR 1.077, 95% CI 1.022–1.136; p = 0.006) or >120 ng/mL (OR 1.042, 95% CI 1.009–1.076; p = 0.013). Moreover, the PCT level was significantly higher in the AKI group only in female patients aged ≤75 years (p = 0.001). Conclusions: Our data revealed a nonlinear relationship between PCT and AKI in septic shock patients, and PCT could be used as a potential biomarker of AKI in female patients younger than 75 years with bacterial septic shock.

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