Impact of Prior to Intensive Care Unit Statin use on Patients with Acute Kidney Injury

Abstract Purpose: To evaluate if prior to intensive care unit (ICU) statin use improve the clinical outcomes, for critically ill patients with acute kidney injury (AKI).Materials and Methods: Patients with AKI were selected from the Medical Information Mart for Intensive Care IV v1.0 database for this retrospective observational study. The primary outcome was 30-day ICU mortality. 30-day in-hospital mortality and ICU length of stay (LOS) were considered as secondary outcomes. Comparison of mortality between pre-ICU statin users with non-users was conducted by multivariable cox proportional hazards model. Comparison of ICU LOS between two groups was implemented by multivariable linear model. Three propensity score methods were used to verify the results as sensitivity analyses. Stratification analyses were conducted to explore whether the association between pre-ICU statin use and mortality differed across various subgroups classified by sex and different AKI stages.Results: 3821 pre-ICU statin users and 9690 non-users were identified. In multivariable model, pre-ICU statin use was associated with reduced 30-day ICU mortality rate [Hazara ratio (HR) 0.68 (0.59,0.79); P<0.001], 30-day in-hospital mortality rate [HR 0.64 (0.57, 0.72); P<0.001] and ICU LOS [Mean Difference -0.51(-0.79, -0.24); P<0.001]. The conclusions were consistent in three propensity score methods. In Subgroup analyses, pre-ICU statin use was associated with decreased 30-day ICU mortality and 30-day in-hospital mortality in both sexes and AKI stages, only except for 30-day ICU mortality in AKI stage 1.Conclusions: Patients with AKI who were administered statins prior to ICU admission might have lower mortality rate during ICU or hospital stay and shorter ICU LOS.

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Association of Prior to Intensive Care Unit Statin Use With Outcomes on Patients With Acute Kidney Injury

Frontiers in Medicine ◽

10.3389/fmed.2021.810651 ◽

2021 ◽

Vol 8 ◽

Author(s):

Boxiang Tu ◽

Yuanjun Tang ◽

Yi Cheng ◽

Yuanyuan Yang ◽

Cheng Wu ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Mortality Rate ◽

Propensity Score ◽

Hospital Mortality ◽

Kidney Injury ◽

Icu Mortality ◽

Propensity Score Methods ◽

Statin Use

Purpose: To evaluate the association of prior to intensive care unit (ICU) statin use with the clinical outcomes in critically ill patients with acute kidney injury (AKI).Materials and Methods: Patients with AKI were selected from the Medical Information Mart for Intensive Care IV (version 1.0) database for this retrospective observational study. The primary outcome was 30-day intensive care unit (ICU) mortality. A 30-day in-hospital mortality and ICU length of stay (LOS) were considered as secondary outcomes. Comparison of mortality between pre-ICU statin users with non-users was conducted by the multivariate Cox proportional hazards model. Comparison of ICU LOS between two groups was implemented by multivariate linear model. Three propensity score methods were used to verify the results as sensitivity analyses. Stratification analyses were conducted to explore whether the association between pre-ICU statin use and mortality differed across various subgroups classified by sex and different AKI stages.Results: We identified 3,821 pre-ICU statin users and 9,690 non-users. In multivariate model, pre-ICU statin use was associated with reduced 30-day ICU mortality rate [hazard ratio (HR) 0.68 (0.59, 0.79); p < 0.001], 30-day in-hospital mortality rate [HR 0.64 (0.57, 0.72); p < 0.001] and ICU LOS [mean difference −0.51(−0.79, −0.24); p < 0.001]. The results were consistent in three propensity score methods. In subgroup analyses, pre-ICU statin use was associated with decreased 30-day ICU mortality and 30-day in-hospital mortality in both sexes and AKI stages, except for 30-day ICU mortality in AKI stage 1.Conclusion: Patients with AKI who were administered statins prior to ICU admission might have lower mortality during ICU and hospital stay and shorter ICU LOS.

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Acute Kidney Injury Outcomes of Elderly and Nonelderly Patients in the Medical Intensive Care Unit of a University Hospital in a Developing Country

Critical Care Research and Practice ◽

10.1155/2020/2391683 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Wanjak Pongsittisak ◽

Kashane Phonsawang ◽

Solos Jaturapisanukul ◽

Surazee Prommool ◽

Sathit Kurathong

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Mortality Rate ◽

Hospital Mortality ◽

Medical Intensive Care Unit ◽

Kidney Injury ◽

The Elderly ◽

University Hospital ◽

Medical Intensive Care

Background. Aging is associated with a high risk of acute kidney injury (AKI), and the elderly with AKI show a higher mortality rate than those without AKI. In this study, we compared AKI outcomes between elderly and nonelderly patients in a university hospital in a developing country. Materials and Methods. This retrospective cohort study included patients with AKI who were admitted to the medical intensive care unit (ICU) between January 1, 2012, and December 31, 2017. The patients were divided into the elderly (eAKI; age ≥65 years; n = 158) and nonelderly (nAKI; n = 142) groups. Baseline characteristics, comorbidities, principle diagnosis, renal replacement therapy (RRT) requirement, hospital course, and in-hospital mortality were recorded. The primary outcome was in-hospital mortality. Results. The eAKI group included more females, patients with higher Acute Physiology and Chronic Health Evaluation II scores, and patients with more comorbidities than the nAKI group. The etiology and staging of AKI were similar between the two groups. There were no significant differences in in-hospital mortality (p=0.338) and RRT requirement (p=0.802) between the two groups. After adjusting for covariates, the 28-day mortality rate was similar between the two groups (p=0.654), but the 28-day RRT requirement was higher in the eAKI group than in the nAKI group (p=0.042). Conclusion. Elderly and nonelderly ICU patients showed similar survival outcomes of AKI, although the elderly were at a higher risk of requiring RRT.

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Impact of End-Stage Renal Disease and Acute Kidney Injury on ICU Outcomes in Patients With Sepsis

Journal of Intensive Care Medicine ◽

10.1177/0885066616645308 ◽

2016 ◽

Vol 32 (7) ◽

pp. 444-450 ◽

Cited By ~ 5

Author(s):

Niranjan Jeganathan ◽

Neha Ahuja ◽

Stephen Yau ◽

Dara Otu ◽

Brian Stein ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Renal Disease ◽

Hospital Mortality ◽

End Stage Renal Disease ◽

Kidney Injury ◽

Icu Mortality ◽

Stage Renal Disease ◽

End Stage

Purpose: To report the characteristics and outcomes of patients with sepsis in the intensive care unit (ICU) with end-stage renal disease (ESRD) and acute kidney injury (AKI) compared to patients with nonkidney injury (non-KI). Methods: Retrospective study of all patients with sepsis admitted to the ICU of a university hospital within a 12-month time period. Data were obtained from the University Health Consortium database and a chart review of the electronic medical records. Results: We identified 39 cases of ESRD, 106 cases of AKI, and 103 cases of non-KI. Intensive care unit mortality was 15.4% for ESRD, 30.2% for AKI, and 13.6% for non-KI ( P < .01). Hospital mortality was 20.5% for ESRD, 32.1% for AKI, and 13.6% for non-KI ( P < .01). Early AKI and late AKI had an ICU mortality of 24.4% versus 50% ( P <.01), hospital mortality of 26.8% versus 50% ( P = .03), ICU length of stay (LOS) of 3 and 6 days ( P = .04), and hospital LOS of 7 and 12.5 days ( P <.01), respectively. Conclusion: Patients with sepsis having AKI have a higher mortality rate than those with ESRD and non-KI. Hospital and ICU mortality rates for patients with ESRD were similar to non-KI patients. Late AKI compared to early AKI had a higher mortality and longer LOS.

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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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Using Score for Neonatal Acute Physiology Perinatal Extension II (SNAPPE II) in Neonates with Acute Kidney Injury

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.762 ◽

2019 ◽

Vol 7 (21) ◽

pp. 3559-3563

Author(s):

Silvana Naunova-Timovska ◽

Olivera Jordanova ◽

Zoja Babinkostova

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Mortality Rate ◽

Newborn Infants ◽

Kidney Injury ◽

Control Group ◽

Lethal Outcome ◽

Pathological Conditions ◽

The Mean

BACKGROUND: Acute kidney injury is a severe clinical condition. It is common in neonates in intensive care unit. It is defined as a sudden deterioration in kidney function resulting in derangements in fluid balance, electrolytes, and waste products. The score for neonatal acute physiology perinatal extension in critically sick neonates with kidney injury is a useful tool for assessing the severity of the disease. AIM: This study aimed to determine the incidence of AKI and the role of SNAPPE 2 score in predicting mortality and morbidity of kidney injury in neonates. METHODS: The study was designed as a prospective clinical investigation performed in the period of three years, which included 100 neonates (50 with AKI and 50 without AKI) hospitalised in intensive care unit of University Clinic of Children Diseases in Skopje. The severity of the illness of hospitalised newborn infants was estimated with SNAPPE 2 score realised in the first 12 hours of admission to NICU. Medical data records of admitted neonates with AKI were analysed. The material was statistically processed using methods of descriptive statistics. RESULTS: During the study period, 770 new born's were hospitalised in the intensive care unit due to various pathological conditions and 50 new born's were selected with AKI. The control group consisted of 50 neonates with comparable associated pathological conditions, but without kidney injury. The calculated prevalence of AKI in neonates was 6.4%. Most of the involved neonates in the study in both groups (AKI and non-AKI) were born at term (64% and 54%) with a predominance of male neonates (68% and 60%). The mortality rate was significantly higher in newborns with AKI than in the control group (36% vs 24%) (p < 0.01). The mean SNAPPE 2 score value in neonates with AKI was higher than in the control group (58.72 vs 40.0), and the difference was significant (p = 0.00001). Difficult score level predominated in half (50%) of newborn infants with AKI, while median score level predominated in control group (42%). There was a significant difference between the mean score value in neonates with AKI and lethal outcome compared to neonates with AKI without lethal outcome (70.73 ± 18.6 vs 40.2 ± 16.6) (p < 0.0001). CONCLUSION: Acute kidney injury is a life-threatening condition with still high mortality rate. The severity of the illness of hospitalised neonates in an intensive care unit is estimated by SNAPPE 2 score. Also, the risk of mortality is estimated too, taking into consideration the fact that higher values of the score are associated with higher mortality. Appropriate treatment of neonates with severe kidney injury improves the outcome and reduces the mortality of the disease.

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The Attributable Mortality of Sepsis for Acute Kidney Injury: A Propensity Score Matched Study

10.21203/rs.3.rs-699907/v1 ◽

2021 ◽

Author(s):

Huimiao Jia ◽

Yijia Jiang ◽

Xi Zheng ◽

Wen Li ◽

Meiping Wang ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Mortality Rate ◽

Propensity Score ◽

Hospital Mortality ◽

Excess Mortality ◽

Kidney Injury ◽

Attributable Mortality ◽

Hospital Death ◽

Significant Difference

Abstract Background: Both sepsis and AKI are diseases of major concern in intensive care unit (ICU). This study aimed to evaluate the excess mortality attributable to sepsis for acute kidney injury (AKI).Methods: A propensity score-matched analysis of a prospective cohort study about sepsis epidemiology in 18 Chinese ICUs (January 2014-August 2015) was performed (registration number: ChiCTR-ECH-13003934). Propensity score model was sequentially conducted to match AKI patients with and without sepsis on day 1, day 2, and day 3-5. The primary outcome was hospital death of AKI patients. Propensity score-matched analyses were conducted to estimate the excess mortality attributable to sepsis for AKI. Results: A total of 2008 AKI patients (40.9%) were eligible for the study. Of the 1010 AKI patients with sepsis, 619 (61.3%) were matched to 619 AKI patients in whom sepsis did not develop during the screening period of the study. The hospital mortality rate of matched AKI patients with sepsis was 205 of 619 (33.1%) compared with 150 of 619 (24.0%) for their matched AKI controls without sepsis (p = 0.001). The attributable mortality of total sepsis for AKI patients was 9.1% (95% CI 4.8-13.3%). Matched AKI patients with and without sepsis were subgrouped according to the severity of sepsis (sepsis, septic shock). Of the matched patients with sepsis, 328 (53.0%) diagnosed septic shock. The mortality rate showed remarkably higher in matched AKI patients with septic shock (43.9%) than their controls of patients without sepsis (27.7%). The attributable mortality of septic shock for AKI was 16.2% (95% CI 11.3-20.8%, p < 0.001). Further, the attributable mortality of sepsis for AKI was 1.4% (95% CI 4.1-5.9%, p = 0.825), although there was no significant difference of mortality rate observed between matched AKI patients with and without sepsis (21.0% vs. 19.6%).Conclusions: The attributable hospital mortality of total sepsis for AKI were 9.1%. Septic shock contributes to major excess mortality rate for AKI than sepsis.

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Abstract 15752: Acute Kidney Injury and Shock Severity for Mortality Risk Stratification in Cardiac Intensive Care Unit Patients

Circulation ◽

10.1161/circ.142.suppl_3.15752 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mitchell R Padkins ◽

Thomas Breen ◽

Gregory W Barsness ◽

Kianoush Kashani ◽

Jacob C Jentzer

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Hospital Mortality ◽

Mortality Risk ◽

Kidney Injury ◽

Cardiac Intensive Care Unit ◽

Severe Stage ◽

Cardiac Intensive Care ◽

One Year

Introduction: Acute kidney injury (AKI) is a highly prevalent risk factor for mortality among patients with cardiogenic shock (CS). We sought to assess the incidence and prognostic relevance of AKI as a function of shock severity in unselected Cardiac Intensive Care Unit (CICU) patients, as measured by the Society for the Cardiovascular Angiography and Interventions (SCAI) shock stage. Methods: We retrospectively reviewed admissions to the Mayo Clinic from 2007 to 2015 and stratified patients by the SCAI shock stage. AKI was defined and staged based on changes in serum creatinine during hospitalization as per KDIGO guidelines. Predictors of in-hospital mortality were analyzed using Kaplan-Meier survival analysis, and one-year mortality was analyzed using Cox proportional-hazards analysis. Results: The final study population included 10,004 unique patients with a mean age of 67 years and 37% females. The percentage of patients with SCAI shock stages A, B, C, D, and E were 47%, 30%, 15%, 7%, and 1%, respectively. AKI of any severity occurred in 51% of patients during hospitalization, including severe (stage 2/3) AKI in 16%. The incidence of AKI and severe AKI increased with the SCAI shock stage. Hospital mortality occurred in 8% of patients and increased as a function of the AKI stage and SCAI shock stage. AKI was associated with increased hospital mortality after multivariable adjustment (adjusted OR per AKI stage 1.17, 95% CI 1.05-1.30, p=0.005). Twenty-one percent of patients died within one year of CICU admission, and worse AKI was associated with increased one-year mortality (adjusted HR per AKI stage 1.11, 95% CI 1.05-1.18, p=<0.001). Hospital survivors with AKI of any severity had higher mortality compared with patients who did not have AKI (p<0.001). Conclusions: AKI was increasingly common in CICU patients with higher shock severity. In-hospital and one-year mortality risk increased as a function of the severity of AKI and the SCAI shock stage. This analysis emphasizes the importance of AKI as a complication of shock and as a predictor of adverse outcomes in CICU patients.

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Acute Kidney Injury in Newborns

PRILOZI ◽

10.1515/prilozi-2015-0082 ◽

2015 ◽

Vol 36 (3) ◽

pp. 83-89

Author(s):

Silvana Naunova Timovska ◽

Svetlana Cekovska ◽

Katerina Tosheska-Trajkovska

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Mortality Rate ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Heart Diseases ◽

Kidney Injury ◽

Female Ratio

Abstract Objective: Acute kidney injury is common condition in the neonatal intensive care unit and it is associated with poor outcome. The incidence of neonatal AKI is the highest one followed by adults and children, depending on different factors such as the gestational age, birth weight, contributing conditions and the facilities of the neonatal intensive care unit. The aim of the study was to determine the incidence, risk factors and the outcome of the neonatal acute kidney injury. Subjects and Methods: This was a clinical, prospective study that was performed in a referent NICU at the University Children′s Hospital in Skopje. All neonates admitted from January 2012 to December 20014 with documented acute kidney injury were included. The medical data records of the admitted neonates with AKI were analyzed. The material was statistically processed using methods of the descriptive statistics. Results: During the study period 770 newborn infants were admitted to the NICU and 50 (6.5%) infants developed acute kidney injury. The male to female ratio was 2.1:1. Most of the neonates involved in the study were neonates born at term (62%). Oliguric AKI was found in 28 cases (56%) and no oliguric in 22 cases (44%). The prevalence of prerenal, renal and post renal AKI were 78.5%, 19.5% and 2.0% respectively. Perinatal asphyxia was the most common predisposing factor for AKI and was evaluated in 38% of the cases with predominance of term infants and male. The mortality rate was 32% and was significantly higher in the group of patients with congenital heart diseases. Conclusion: AKI is a life threatening condition with still high mortality rate. Early recognition of the risk factors and the rapid effective treatment of the contributing conditions will reduce AKI in the neonatal period.

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Acute Kidney Injury and COVID-19: A Picture from an Intensive Care Unit

Blood Purification ◽

10.1159/000513153 ◽

2021 ◽

pp. 1-5

Author(s):

Francesco Alessandri ◽

Valentina Pistolesi ◽

Chiara Manganelli ◽

Franco Ruberto ◽

Giancarlo Ceccarelli ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Renal Function ◽

Intensive Care ◽

Respiratory Failure ◽

Kidney Injury ◽

Icu Mortality ◽

Icu Stay ◽

Renal Function Recovery ◽

Tertiary Teaching

Introduction: Acute kidney injury (AKI) is a frequent complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care unit (ICU) for severe respiratory failure. The aim is to evaluate the rate of AKI, defined according to Kidney Disease: Improving Global Outcome guidelines, in a series of critical COVID-19 patients admitted to the ICU of a single tertiary teaching hospital. Methods: From April to May 2020, all consecutive critically ill COVID-19 patients admitted to the ICU who did not meet exclusion criteria (length of ICU stay <48 h, ESRD requiring dialysis, and patients still hospitalized in ICU at the time of data analysis) were enrolled in this study. Patients were stratified according to the highest AKI stage attained during ICU stay. Results: Sixty-one patients were included in the analysis. AKI was observed in 35/61 patients (57.4%): 25/35 episodes (71.4%) were observed within the first 7 days. AKI was classified as follows: 17.1% stage 1, 25.7% stage 2, and 57.2% stage 3. Fourteen out of 20 stage-3 patients required continuous renal replacement therapy (CRRT), mostly related to persistent oliguria. The overall ICU mortality was 68.9%, and it was higher in patients developing AKI if compared to no-AKI patients (p = 0.006). Renal function recovery of any grade was observed in 14 out of 35 AKI patients (40%). Among patients undergoing CRRT, 13 patients were still dialysis dependent at the time of death. Conclusion: In critical COVID-19 patients, ICU mortality is particularly high, especially in patients developing AKI. An accurate monitoring of renal function in early phases of respiratory failure should be ensured in order to timely apply any strategy aimed at limiting renal complications during ICU stay.

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