Elevated serum iron level is a predictor of prognosis in severe patients with acute kidney injury

Abstract Background: Accumulation of iron is associated with oxidative stress (OS), inflammation and regulated cell death. The above three reactions contribute to the development of acute kidney injury (AKI). Here we aimed to investigate the association between the serum iron level and prognosis in severe patients with AKI.Methods: A total of 483 patients with AKI defined by Kidney Disease: Improving Global Guidelines (KIDGO) were included in this retrospective study. The data was extracted from the single-center Medical Information Mart for Intensive Care Ⅲ (MIMIC-Ⅲ) database. The max serum iron concentration measured after Intensive Care Unit (ICU) admission was defined as the serum iron in the study and divided into three groups (Low group, Middle group, High group). We plotted boxplots and Kaplan–Meier curves and used cox regression analysis to analyze data.Results: In univariable Cox regression analysis, serum iron levels were significantly correlated to the prognosis of AKI patients. After adjusting for confounding variables, higher serum iron level was remained to associate with the increase in 90-day mortality in the multivariable Cox regression analysis. Moreover, the risk of 90-day mortality stepwise increased as the groups of serum iron levels increased in AKI patients.Conclusions: From our study, we investigated that high serum iron level was associated with the increased mortality in severe patients with AKI. Serum iron levels on admission can be a predictor for predicting the prognosis of AKI patients.

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Elevated serum iron level is a predictor of prognosis in ICU patients with acute kidney injury

10.21203/rs.3.rs-23349/v2 ◽

2020 ◽

Author(s):

Jie Shu ◽

Yufeng HU ◽

Xueshu Yu ◽

Jiaxiu Chen ◽

Wenwei Xu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Regression Analysis ◽

Intensive Care ◽

Serum Iron ◽

Cox Regression ◽

Elevated Serum ◽

Kidney Injury ◽

Iron Level ◽

Serum Iron Level ◽

Cox Regression Analysis

Abstract Background Accumulation of iron is associated with oxidative stress (OS), inflammation and regulated cell death. The above three reactions contribute to the development of acute kidney injury (AKI). Here we aimed to investigate the association between the serum iron level and prognosis in severe patients with AKI. Methods A total of 483 patients with AKI defined by Kidney Disease: Improving Global Guidelines (KIDGO) were included in this retrospective study. The data was extracted from the single-center Medical Information Mart for Intensive Care III (MIMIC-III) database. The max serum iron concentration measured after Intensive Care Unit (ICU) admission was defined as the serum iron in the study and divided into three groups (Low group, Middle group, High group). We plotted boxplots and Kaplan–Meier curves and used cox regression analysis to analyze data. Results In univariable Cox regression analysis, serum iron levels were significantly correlated to the prognosis of AKI patients. After adjusting for confounding variables, higher serum iron level was remained to associate with the increase in 90-day mortality in the multivariable Cox regression analysis. Moreover, the risk of 90-day mortality stepwise increased as the groups of serum iron levels increased in AKI patients. Conclusions From our study, we investigated that high serum iron level was associated with the increased mortality in severe patients with AKI. Serum iron levels on admission can be a predictor for predicting the prognosis of AKI patients.

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Elevated serum iron level is a predictor of prognosis in ICU patients with acute kidney injury

BMC Nephrology ◽

10.1186/s12882-020-01965-9 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Jie Shu ◽

Yufeng Hu ◽

Xueshu Yu ◽

Jiaxiu Chen ◽

Wenwei Xu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Serum Iron ◽

Elevated Serum ◽

Kidney Injury ◽

Iron Level ◽

Serum Iron Level ◽

Icu Patients

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Kidney function on admission predicts in-hospital mortality in COVID-19

10.1101/2020.06.18.20134627 ◽

2020 ◽

Cited By ~ 1

Author(s):

Sinan Trabulus ◽

Cebrail Karaca ◽

İlker İnanç Balkan ◽

Mevlüt Tamer Dincer ◽

Ahmet Murt ◽

...

Keyword(s):

Acute Kidney Injury ◽

Logistic Regression ◽

Regression Analysis ◽

Mortality Rate ◽

Hospital Mortality ◽

Kidney Function ◽

Cox Regression ◽

Kidney Injury ◽

Reciprocal Relationship ◽

Cox Regression Analysis

AbstractBackgroundRecent data have reinforced the concept of a reciprocal relationship between COVID-19 and kidney function. However, most studies have focused on the effect of COVID-19 on kidney function, whereas data regarding kidney function on the COVID-19 prognosis is scarce. Therefore, in this study, we aimed to investigate the association between eGFR on admission and the mortality rate of COVID-19.MethodsWe recruited 336 adult consecutive patients (male 57.1%, mean age 55.0±15.9) that were hospitalized with the diagnosis of COVID-19 in the tertiary care university hospital. Data were collected from the electronic health records of the hospital. On admission, eGFR was calculated using the CKD-EPI formula. Acute kidney injury was defined according to the KDIGO criteria. Binary logistic regression and Cox regression analyses were used to assess the relationship between eGFR on admission and in-hospital mortality of COVID-19.ResultsBaseline eGFR was under 60 mL/min/1.73m2 in 61 patients (18.2%). Acute kidney injury occurred in 29.1% of the patients. In-hospital mortality was calculated as 12.8%. Age-adjusted and multivariate logistic regression analysis (p:0.005, odds ratio:0.974, CI:0.956-0.992) showed that baseline eGFR was independently associated with mortality. Additionally, age-adjusted Cox regression analysis revealed a higher mortality rate in patients with an eGFR under 60 mL/min/1.73m2.ConclusionsOn admission eGFR seems to be a prognostic marker for mortality in patients with COVID-19; We recommend to determine eGFR in all patients on admission and use it as an additional tool for risk stratification. Close follow-up should be warranted in patients with reduced eGFR.

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Role of cystatin C as a biomarker of acute kidney injury and as an independent long-term predictor of cardiovascular events, mortality and functional outcome

Italian Journal of Medicine ◽

10.4081/itjm.2012.195 ◽

2012 ◽

Author(s):

Carolina Marrani ◽

Teuta Zenjelaj ◽

Daniela Bartoli ◽

Francesco Corradi ◽

Rinaldo Innocenti

Keyword(s):

Acute Kidney Injury ◽

Cystatin C ◽

Cardiovascular Events ◽

Cox Regression ◽

Elevated Serum ◽

Kidney Injury ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Long Term Mortality

Introduction Serum cystatin C measurements as an early biomarker of acute kidney injury (AKI) is gaining acceptance as studies confirm and define its usefulness. The aim of this study is to determine whether increase in serum cystatin C has an impact on long-term mortality, independently from the presence of the kidney injury itself.Materials and methods A retrospective study (20-month follow-up) was conducted in 173 not selected hospitalized patients. According to serum cystatin C concentrations, patients were stratified in risk classes by quartiles (≥0.55 and <1 mg/L; ≥1 and <1.17 mg/L; ≥1.17 and 1.57 mg/L; ≥1.57 and ≤5.29 mg/L). We compared the association of cystatin C levels with the risk for long-term mortality, after adjustment for age, sex, race and heart failure risk factors.Results A relationship with higher serum levels of cystatin C and mortality was found in patients with and without AKI, being stronger in patients without AKI. After multivariate adjustment, the highest quartile of cystatin C (>1.5 mg/L) was associated with a lower risk for long-term mortality. The statistical analysis (Cox regression) of the independent variables as far as mortality is concerned confirmed the significance of our result (RR 3.60; IC 1.73–7.48; p = 0.001).Conclusions In summary, elevated serum cystatin C level (>1.5 mg/L) was strongly and independently associated with negative clinical outcomes such as mortality and cardiovascular events, independently from the kidney injury itself. The dosage of cystatin C might play an important role in clinical practice for the assessment of cardiovascular risk stratification.

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MO179ACUTE KIDNEY INJURY IN ELDERLY- PROGNOSTIC VALUES OF COMORBIDITY AND THE AGE FOR THE SHORT AND THE LONG TERM OUTCOME

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab092.0057 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Zvezdana Petronijevikj ◽

Gjulsen Selim ◽

Biljana Gerasimovska ◽

Lada Trajceska

Keyword(s):

Regression Analysis ◽

Risk Factor ◽

Heart Disease ◽

High Risk ◽

Mortality Rate ◽

Elderly Patients ◽

Cox Regression ◽

Kidney Injury ◽

Comorbid Conditions ◽

Cox Regression Analysis

Abstract Background and Aims Acute kidney injury (AKI) is defined by a rapid decline in glomerular filtration rate (GFR), resulting in disturbance of renal physiological functions including impairment of nitrogenous waste product excretion, loss of water and electrolyte regulation and loss of acid-base regulation. Coexisting disease and the structural and functional changes that occur during the aging process are disposing factors that increase the risk of AKI in elderly population. Method 101 elderly patients (≥ 65) who filling out one of the criteria of definition of AKI according to Kidney Disease Improving Global Outcome (KDIGO), were included in the study. Patients were divided into 2 groups by age, group <75 and group> 75 years old. In terms of outcome they were divided in group with short and 90-day survival. The burden of the simultaneous presence of comorbid conditions was estimated through the Charles Comorbid Index. (CHI) Results The mortality rate for the 90-day follow-up period after the AKI event was 45.5%. The intra-hospital mortality rate in adult patients with AKI was 22.8%.In our study the age was not confirmed as a risk factor for intra-hospital and 3-month outcome in elderly patients with AKI. The presence of comorbid conditions estimated through the Charles Comorbid Index (CHI), differed un-significantly between survivors and deceased patients with AKI (p = 0.39, p = 0.28 consecutive). Cox regression analysis confirmed the CCI score as a significant factor in survival in patients with ABO. (p = 0.036).The risk of letal outcome increases by 16.3% with each increase in this unit score. Cox regression analysis confirmed heart diseases as a significant prognostic factor for survival, increasing the risk of fatal outcome by about 2 times higher than patients without heart disease. Statistical analysis showed a significant difference in survival time, depending on the presence of heart disease as a comorbidity (p =0.037). Conducted Cox regression analysis showed that HR - for heart disease, as a comorbidity, is 1.837 95% CI (1.020 - 3.306) and p = 0.043. The death rate for patients with heart disease is about 2 times higher than patients without heart disease. Cumulative survival was higher in the group of patients without cardiomyopathy - 64.2% (0.07) compared to the group of patients with cardiomyopathy- 43.8% (0.07). Multivariate Cox regression analysis as significant independent predictors of survival in patients with ABO confirmed the diuresis (p = 0.029) and albumin (p = 0.006). Conclusion AKI survivors with high burden of comorbidities are at high risk for postdischarge death. Cardiomyopathy, as a risk factor, for two times increases the risk of death. CCI score is significant independent high-risk prognostic factors for poor outcome in elderly patients with AKI. Remain the recommendation for individual clinical approach, assessment and selection for the application of treatment taking into account the overall condition in adult patients with acute renal injury.

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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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Association of Preoperative Prognostic Nutritional Index and Postoperative Acute Kidney Injury in Patients Who Underwent Hepatectomy for Hepatocellular Carcinoma

Journal of Personalized Medicine ◽

10.3390/jpm11050428 ◽

2021 ◽

Vol 11 (5) ◽

pp. 428

Author(s):

Ji Hoon Sim ◽

In-Gu Jun ◽

Young-Jin Moon ◽

A Rom Jeon ◽

Sung-Hoon Kim ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Regression Analysis ◽

Cox Regression ◽

Kidney Injury ◽

Prognostic Nutritional Index ◽

Cox Regression Analysis ◽

Nutritional Index ◽

Open Hepatectomy ◽

One Year ◽

Postoperative Aki

Various biological indicators are reportedly associated with postoperative acute kidney injury (AKI) in the surgical treatment of hepatocellular carcinoma (HCC). However, only a few studies have evaluated the association between the preoperative prognostic nutritional index (PNI) and postoperative AKI. This study evaluated the association of the preoperative PNI and postoperative AKI in HCC patients. We retrospectively analyzed 817 patients who underwent open hepatectomy between December 2007 and December 2015. Multivariate regression analysis was performed to evaluate the association between the PNI and postoperative AKI. Additionally, we evaluated the association between the PNI and outcomes such as postoperative renal replacement therapy (RRT) and mortality. Cox regression analysis was performed to assess the risk factors for one-year and five-year mortality. In the multivariate analysis, high preoperative PNI was significantly associated with a lower incidence of postoperative AKI (odds ratio (OR): 0.92, 95% confidence interval (CI): 0.85 to 0.99, p = 0.021). Additionally, diabetes mellitus and the use of synthetic colloids were significantly associated with postoperative AKI. PNI was associated with postoperative RRT (OR: 0.76, 95% CI: 0.60 to 0.98, p = 0.032) even after adjusting for other potential confounding variables. In the Cox regression analysis, high PNI was significantly associated with low one-year mortality (Hazard ratio (HR): 0.87, 95% CI: 0.81 to 0.94, p < 0.001), and five-year mortality (HR: 0.93, 95% CI: 0.90–0.97, p < 0.001). High preoperative PNI was significantly associated with a lower incidence of postoperative AKI and low mortality. These results suggest that the preoperative PNI might be a predictor of postoperative AKI and surgical prognosis in HCC patients undergoing open hepatectomy.

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Duration of Acute Kidney Injury and in-hospital Mortality in Elder Patients With Severe COVID-19: a Retrospective Cohort Study

10.21203/rs.3.rs-580679/v1 ◽

2021 ◽

Author(s):

Yue Cai ◽

Qinglin Li ◽

Shanshan Guo ◽

Yanyan Chen ◽

Fang Wang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Cox Regression ◽

Kidney Injury ◽

Final Analysis ◽

Prognostic Impact ◽

Cox Regression Analysis ◽

Elder Patients ◽

Kaplan Meier ◽

Transient Aki

Abstract Background Patients with severe coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality. This study evaluated the prognostic impact of AKI duration on in-hospital mortality in elder patients.Methods We performed a retrospective study of 126 patients with confirmed COVID-19 with severe or critical disease who treated in the ICU from February 4, 2020, to April 16, 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes serum creatinine (Scr) criteria. AKI patients were divided into transient AKI and persistent AKI groups based on whether Scr level returned to baseline within 48 h post-AKI.Results In total, 107 patients were included in the final analysis. The mean age was 70 (64–78) years, and 69 (64.5%) patients were men. AKI occurred in 48 (44.9%) during their ICU stay. Of these, 11 (22.9%) had transient AKI, 37 (77.9%) had persistent AKI. In-hospital mortality was 18.6% (n =11) for patients without AKI, 72.7% (n=8) for patients with transient AKI, and 86.5% (n=32) for patients with persistent AKI (P<0.001). Kaplan–Meier curve analysis revealed that patients with both transient AKI and persistent AKI had significantly higher death rates than those without AKI (log-rank P<0.001). Multivariate Cox regression analysis revealed that transient and persistent AKI were an important risk factor for in-hospital mortality in older patients with severe COVID-19 even after adjustment for variables (hazard ratio [HR]=2.582; 95% CI: 1.025–6.505; P=0.044; and HR=6.974; 95% CI: 3.334–14.588; P<0.001).Conclusions AKI duration is a useful parameter to predict of worse clinical outcomes in elder patients with COVID-19 in the ICU. Among AKI patients, those persistent AKI have a lower in-hospital survival rate than those transient AKI, emphasizing the importance of identifying an appropriate treatment window for early intervention.

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Incidence, Risk Factors and Mortality Outcome in Patients with Acute Kidney Injury in COVID-19: A Single-Center Observational Study

10.1101/2020.06.24.20138230 ◽

2020 ◽

Cited By ~ 1

Author(s):

Alfano Gaetano ◽

Ferrari Annachiara ◽

Fontana Francesco ◽

Mori Giacomo ◽

Magistroni Riccardo ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cox Regression ◽

Case Fatality ◽

Kidney Injury ◽

Serum Levels ◽

University Hospital ◽

Hospital Death ◽

Cox Regression Analysis ◽

Incidence Risk

AbstractBackgroundAcute kidney injury (AKI) is a recently recognized complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate the incidence, risk factors and case-fatality rate of AKI in patients with documented COVID-19.MethodsWe reviewed the health medical records of 307 consecutive patients hospitalized for symptoms of COVID-19 at the University Hospital of Modena, Italy.ResultsAKI was diagnosed in 69 out of 307 (22.4%) patients. The stages of AKI were stage 1 in 57.9%, stage 2 in 24.6% and stage 3 in 17.3%. Hemodialysis was performed in 7.2% of the subjects. AKI patients had a mean age of 74.7±9.9 years and higher serum levels of the main marker of inflammation and organ involvement (lung, liver, hearth and liver) than non-AKI patients. AKI events were more frequent in subjects with severe lung comprise. Two peaks of AKI events coincided with in-hospital admission and death of the patients. Kidney injury was associate with a higher rate of urinary abnormalities including proteinuria (0.448±0.85 vs 0.18±0.29; P=<0.0001) and hematuria (P=0.032) compared to non-AKI patients. At the end of follow-up, 65.2% of the patients did not recover their renal function after AKI. Risk factors for kidney injury were age, male sex, CKD and non-renal SOFA. Adjusted Cox regression analysis revealed that AKI was independently associated with in-hospital death (hazard ratio [HR]=3.74; CI 95%, 1.34-10.46) compared to non-AKI patients. Groups of patients with AKI stage 2-3 and failure to recover kidney function were associated with the highest risk of in-hospital mortality. Lastly, long-hospitalization was positively associated with a decrease of serum creatinine, likely due to muscle depletion occurred with prolonged bed rest.ConclusionsAKI was a dire consequence of patients with COVID-19. Identification of patients at high-risk for AKI and prevention of kidney injury by avoiding dehydration and nephrotoxic agents is imperative in this vulnerable cohort of patients.

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Colistin-Induced Acute Kidney Injury and the Effect on Survival in Patients with Multidrug-Resistant Gram-Negative Infections: Significance of Drug Doses Adjusted to Ideal Body Weight

International Journal of Nephrology ◽

10.1155/2021/7795096 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Nittha Arrayasillapatorn ◽

Palinee Promsen ◽

Kittrawee Kritmetapak ◽

Siriluck Anunnatsiri ◽

Wijittra Chotmongkol ◽

...

Keyword(s):

Acute Kidney Injury ◽

Body Weight ◽

Total Dose ◽

Cox Regression ◽

Kidney Injury ◽

Ideal Body Weight ◽

Multidrug Resistant ◽

Gram Negative ◽

Cox Regression Analysis ◽

Ideal Body

Background. Colistin is a lifesaving treatment for multidrug-resistant Gram-negative bacterial (MDR-GNB) infections along with its well-known nephrotoxicity. The controversy of colistin-induced acute kidney injury (AKI) on mortality is noted. This study aimed to determine the risk factors and impact of AKI on the survival and significance of colistin dosage. Methods. A retrospective cohort study was performed in adult patients who received intravenous colistin for MDR-GNB treatment between June 2015 and June 2017. Factors influencing colistin-induced AKI and survival were evaluated by Cox regression analysis. Cut-off levels of the colistin dose per ideal body weight (IBW) that significantly affected clinical outcomes were assessed with linearity trends and receiver operating characteristic analyses. Results. AKI occurred in 68.5% of 412 enrolled patients with an incidence rate of 10.6 per 100 patients-days and a median time was 6 (3–13) days. Stages I–III of AKI were 38.3, 24.5, and 37.2%. Factors associated with colistin-induced AKI were advanced age, high serum bilirubin, AKI presented before colistin administration, increased daily colistin doses per IBW, and concomitant use of nephrotoxic drugs. Colistin-induced AKI was related to mortality (HR 1.74, 95% CI 1.06–2.86, p = 0.028 ). In the non-AKI before colistin usage subgroup, the total dose and total dose/IBW were >1,500–2,000 mg and 30–35 mg/kg to benefit mortality reduction but were <2,500–3,000 mg and 45–50 mg/kg for risk reduction of AKI. A daily colistin dose/IBW >4.5 mg/kg/day also increased the risk of AKI. In the AKI developed before colistin subgroup, the cut-off values of total colistin dose >1250–1350 mg and total dose/IBW >23.5–24 mg/kg demonstrated significant risks of AKI. Conclusion. The incidence of AKI after colistin administration was high and impacted mortality. Prevention and early correction of these related factors are mandatory. Careful use of colistin was also both beneficial in mortality and AKI reductions.

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