scholarly journals In-hospital and one-year mortality among patients with acute kidney injury and hematological malignancies

2021 ◽  
Vol 35 (1) ◽  
pp. 11-17
Author(s):  
Inês Coelho ◽  
◽  
Teresa Chuva ◽  
Hugo Ferreira ◽  
Ana Paiva ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Hematological Malignancies ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Hospital Death ◽  
Non Hodgkin Lymphoma ◽  
Hospital Patients ◽  
Observational Cohort ◽  
One Year

Hematological malignancies (HM) confer a high risk of acute kidney injury (AKI), which is associated with elevated morbi-mortality. The aim of this study was to identify the prognostic factors for in-hospital mortality and one-year mortality in this population. We conducted a single center, retrospective, observational cohort study of 101 in-hospital patients with AKI and HM between January 2015 and December 2019. Multiple myeloma was present in 30.7% of the patients, followed by non-Hodgkin lymphoma (NHL) in 27.7%. Renal support therapy (RST) was needed in 60.4% of the cases. Independent predictors for in-hospital mortality were invasive mechanical ventilation (IMV) (OR 49.53; 95% CI:9.17 – 267.57; P<0.001) and infection during in-hospital stay (IDHS) (OR 5.09; 95% CI:1.18 – 21.89; P=0.029). Predictors for one-year mortality were NHL (HR 2.88; 95% CI:1.54 – 5.39; P=0.001), tumor progression (HR 2.36; 95% CI:1.29 – 4.32; P=0.006) and IMV (HR 6.38; 95% CI:3.50 – 11.64; P<0.001). Higher albumin levels at AKI diagnosis conferred a better prognosis (HR 0.57; 95% CI:0.35 – 0.91; P=0.020). Our model showed that patients with HM and AKI who were submitted to IMV and had IDHS had a probability of in-hospital death of 96%. Albumin at the time of AKI influenced one-year mortality.

scholarly journals Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wen En Joseph Wong ◽  
Siew Pang Chan ◽  
Juin Keith Yong ◽  
Yen Yu Sherlyn Tham ◽  
Jie Rui Gerald Lim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Hospital Mortality ◽  
Structural Equation Model ◽  
Structural Equation ◽  
Injury Risk ◽  
Kidney Injury ◽  
Equation Model ◽  
Surgical Icu ◽  
One Year

Abstract Background Acute kidney injury is common in the surgical intensive care unit (ICU). It is associated with poor patient outcomes and high healthcare resource usage. This study’s primary objective is to help identify which ICU patients are at high risk for acute kidney injury. Its secondary objective is to examine the effect of acute kidney injury on a patient’s prognosis during and after the ICU admission. Methods A retrospective cohort of patients admitted to a Singaporean surgical ICU between 2015 to 2017 was collated. Patients undergoing chronic dialysis were excluded. The outcomes were occurrence of ICU acute kidney injury, hospital mortality and one-year mortality. Predictors were identified using decision tree algorithms. Confirmatory analysis was performed using a generalized structural equation model. Results A total of 201/940 (21.4%) patients suffered acute kidney injury in the ICU. Low ICU haemoglobin levels, low ICU bicarbonate levels, ICU sepsis, low pre-ICU estimated glomerular filtration rate (eGFR) and congestive heart failure was associated with the occurrence of ICU acute kidney injury. Acute kidney injury, together with old age (> 70 years), and low pre-ICU eGFR, was associated with hospital mortality, and one-year mortality. ICU haemoglobin level was discretized into 3 risk categories for acute kidney injury: high risk (haemoglobin ≤9.7 g/dL), moderate risk (haemoglobin between 9.8–12 g/dL), and low risk (haemoglobin > 12 g/dL). Conclusion The occurrence of acute kidney injury is common in the surgical ICU. It is associated with a higher risk for hospital and one-year mortality. These results, in particular the identified haemoglobin thresholds, are relevant for stratifying a patient’s acute kidney injury risk.

scholarly journals Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19

2020 ◽  
Vol 45 (6) ◽  
pp. 1018-1032
Author(s):  
Imran Chaudhri ◽  
Richard Moffitt ◽  
Erin Taub ◽  
Raji R. Annadi ◽  
Minh Hoai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Hospital Death ◽  
Study Cohort ◽  
Icu Admission ◽  
Risk Of Death ◽  
Increased Risk

<b><i>Introduction:</i></b> Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. <b><i>Methods:</i></b> This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, <i>t</i> test, χ<sup>2</sup> test, and Fisher’s exact test for bivariate analyses and logistic regression for multivariable analysis. <b><i>Results:</i></b> Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28–17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12–18.64), IMV (OR 8.79, 95% CI 2.08–37.00), and death (OR 18.03, 95% CI 2.84–114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19–114.4, <i>p</i> = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44–240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001–0.06). <b><i>Conclusion:</i></b> Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

scholarly journals High dose intravenous vitamin C treatment in Sepsis: associations with acute kidney injury and mortality

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thomas R. McCune ◽  
Angela J. Toepp ◽  
Brynn E. Sheehan ◽  
Muhammad Shaheer K. Sherani ◽  
Stephen T. Petr ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
High Dose ◽  
Clinical Covariates ◽  
Observational Cohort ◽  
Intravenous Vitamin

Abstract Background The effects of vitamin C on clinical outcomes in critically ill patients remain controversial due to inconclusive studies. This retrospective observational cohort study evaluated the effects of vitamin C therapy on acute kidney injury (AKI) and mortality among septic patients. Methods Electronic medical records of 1390 patients from an academic hospital who were categorized as Treatment (received at least one dose of 1.5 g IV vitamin C, n = 212) or Comparison (received no, or less than 1.5 g IV vitamin C, n = 1178) were reviewed. Propensity score matching was conducted to balance a number of covariates between groups. Multivariate logistic regressions were conducted predicting AKI and in-hospital mortality among the full sample and a sub-sample of patients seen in the ICU. Results Data revealed that vitamin C therapy was associated with increases in AKI (OR = 2.07 95% CI [1.46–2.93]) and in-hospital mortality (OR = 1.67 95% CI [1.003–2.78]) after adjusting for demographic and clinical covariates. When stratified to examine ICU patients, vitamin C therapy remained a significant risk factor of AKI (OR = 1.61 95% CI [1.09–2.39]) and provided no protective benefit against mortality (OR = 0.79 95% CI [0.48–1.31]). Conclusion Ongoing use of high dose vitamin C in sepsis should be appraised due to observed associations with AKI and death.

scholarly journals High Dose Intravenous Vitamin C Treatment in Sepsis: Associations with Acute Kidney Injury and Mortality Running Title Vitamin C associated AKI and mortality

2021 ◽  
Author(s):  
Thomas McCune ◽  
Brynn E Sheehan ◽  
Muhammad Shaheer K Sherani ◽  
Stephan T Petr ◽  
Angela J Toepp ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
High Dose ◽  
Clinical Covariates ◽  
Observational Cohort ◽  
Intravenous Vitamin

Abstract The effects of vitamin C on clinical outcomes in critically ill patients remain controversial due to inconclusive studies. This retrospective observational cohort study evaluated the effects of vitamin C therapy on acute kidney injury (AKI) and mortality among septic patients. Participants were 1390 patients from an academic hospital who were categorized as Treatment (received at least one dose of 1.5g IV vitamin C, n = 212) or Comparison (received no, or less than 1.5g IV vitamin C, n = 1178). Propensity score matching was conducted to balance a number of covariates between groups. Multivariate logistic regressions were conducted predicting AKI and in-hospital mortality among the full sample and a sub-sample of patients seen in the ICU. Results revealed that vitamin C therapy was associated with increases in AKI (OR = 2.07 95% CI [1.46–2.93]) and in-hospital mortality (OR = 1.67 95% CI [1.003–2.78]) after adjusting for demographic and clinical covariates. When stratified to examine ICU patients, vitamin C therapy remained a significant risk factor of AKI (OR = 1.61 95% CI [1.09–2.39]) and provided no protective benefit against mortality (OR = 0.79 95% CI [0.48–1.31]). Ongoing use of high dose vitamin C in sepsis should be appraised due to observed associations with AKI and death.

Outcome of dialysis-requiring acute kidney injury in patients with infective endocarditis: A nationwide study

2020 ◽  
Author(s):  
Jeppe Kofoed Petersen ◽  
Andreas Dalsgaard Jensen ◽  
Niels Eske Bruun ◽  
Anne-Lise Kamper ◽  
Jawad Haider Butt ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Valve Surgery ◽  
Cardiac Valve ◽  
Post Discharge ◽  
Dialysis Treatment ◽  
Cardiac Valve Surgery ◽  
One Year

Abstract Background Infective endocarditis (IE) may be complicated by acute kidney injury, yet data on the use of dialysis and subsequent reversibility are sparse. Methods Using Danish nationwide registries, we identified patients with first-time IE from 2000 to 2017. Dialysis naïve patients were grouped into: those with and those without dialysis during admission with IE. Continuation of dialysis was followed one year post-discharge. Multivariable adjusted Cox proportional hazard analysis was used to examine one-year mortality for patients surviving IE according to use of dialysis. Results We included 7,307 patients with IE; 416 patients (5.7%) initiated dialysis treatment during admission with IE and these were younger, had more comorbidities and more often underwent cardiac valve surgery compared with non-dialysis patients (47.4% vs. 20.9%). In patients with both cardiac valve surgery and dialysis treatment (n=197), 153 (77.7%) initiated dialysis on- or after the date of surgery. The in-hospital mortality was 40.4% and 19.0% for patients with and without dialysis, respectively (p&lt;0.0001). Of those who started dialysis and survived hospitalization, 21.6% continued dialysis treatment within one year after discharge. In multivariable adjusted analysis, dialysis during admission with IE was associated with an increased one-year mortality from IE discharge, HR=1.64 (95% CI: 1.21-2.23). Conclusion In dialysis-naïve patients with IE, approximately 1 in 20 patients initiated dialysis treatment during admission with IE. Dialysis identified a high-risk group with an in-hospital mortality of 40% and an approximately 20% risk of continued dialysis. Those with dialysis during admission with IE showed worse long-term outcomes than those without.

scholarly journals Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Charuhas V. Thakar ◽  
Annette Christianson ◽  
Peter Almenoff ◽  
Ron Freyberg ◽  
Marta L. Render
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Fold Increase ◽  
Mortality Rates ◽  
Dialysis Initiation ◽  
Icu Patients ◽  
Mortality Model ◽  
Electrolyte Disturbances ◽  
Observational Cohort

In a multicenter observational cohort of patients-admitted to intensive care units (ICU), we assessed whether creatinine elevation prior to dialysis initiation in acute kidney injury (AKI-D) further discriminates risk-adjusted mortality. AKI-D was categorized into four groups (Grp) based on creatinine elevation after ICU admission but before dialysis initiation: Grp I  > 0.3 mg/dL to <2-fold increase, Grp II ≥2 times but <3 times increase, Grp III ≥3-fold increase in creatinine, and Grp IV none or <0.3 mg/dl increase. Standardized mortality rates (SMR) were calculated by using a validated risk-adjusted mortality model and expressed with 95% confidence intervals (CI). 2,744 patients developed AKI-D during ICU stay; 36.7%, 20.9%, 31.2%, and 11.2% belonged to groups I, II, III, and IV, respectively. SMR showed a graded increase in Grp I, II, and III (1.40 (95% CI, 1.29–1.42), 1.84 (1.66–2.04), and 2.25 (2.07–2.45)) and was 0.98 (0.78–1.20) in Grp IV. In ICU patients with AKI-D, degree of creatinine elevation prior to dialysis initiation is independently associated with hospital mortality. It is the lowest in those experiencing minor or no elevations in creatinine and may represent reversible fluid-electrolyte disturbances.

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

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.

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

Circulation ◽  
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.

scholarly journals NGAL/hepcidin-25 ratio and AKI subtypes in patients following cardiac surgery: a prospective observational study

2021 ◽  
Author(s):  
Saban Elitok ◽  
Prasad Devarajan ◽  
Rinaldo Bellomo ◽  
Berend Isermann ◽  
Michael Haase ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Hospital Death ◽  
Urinary Ngal ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Abstract Background Acute kidney injury (AKI) subtypes combining kidney functional parameters and injury biomarkers may have prognostic value. We aimed to determine whether neutrophil gelatinase-associated lipocalin (NGAL)/hepcidin-25 ratio (urinary concentrations of NGAL divided by that of hepcidin-25) defined subtypes are of prognostic relevance in cardiac surgery patients. Methods We studied 198 higher-risk cardiac surgery patients. We allocated patients to four groups: Kidney Disease Improving Global Outcomes (KDIGO)-AKI-negative and NGAL/hepcidin-25 ratio-negative (no AKI), KDIGO AKI-negative and NGAL/hepcidin-25 ratio-positive (subclinical AKI), KDIGO AKI-positive and NGAL/hepcidin-25 ratio-negative (clinical AKI), KDIGO AKI-positive and NGAL/hepcidin-25 ratio-positive (combined AKI). Outcomes included in-hospital mortality (primary) and long-term mortality (secondary). Results We identified 127 (61.6%) patients with no AKI, 13 (6.6%) with subclinical, 40 (20.2%) with clinical and 18 (9.1%) with combined AKI. Subclinical AKI patients had a 23-fold greater in-hospital mortality than no AKI patients. For combined AKI vs. no AKI or clinical AKI, findings were stronger (odds ratios (ORs): 126 and 39, respectively). After adjusting for EuroScore, volume of intraoperative packed red blood cells, and aortic cross-clamp time, subclinical and combined AKI remained associated with greater in-hospital mortality than no AKI and clinical AKI (adjusted ORs: 28.118, 95% CI 1.465–539.703; 3.737, 95% CI 1.746–7.998). Cox proportional hazard models found a significant association of biomarker-informed AKI subtypes with long-term survival compared with no AKI (adjusted ORs: pooled subclinical and clinical AKI: 1.885, 95% CI 1.003–3.542; combined AKI: 1.792, 95% CI 1.367–2.350). Conclusions In the presence or absence of KDIGO clinical criteria for AKI, the urinary NGAL/hepcidin-25-ratio appears to detect prognostically relevant AKI subtypes. Trial registration number NCT00672334, clinicaltrials.gov, date of registration: 6th May 2008, https://clinicaltrials.gov/ct2/show/NCT00672334. Graphic abstract Definition of AKI subtypes: subclinical AKI (KDIGO negative AND Ratio-positive), clinical AKI (KDIGO positive AND Ratio-negative) and combined AKI (KDIGO positive AND Ratio-positive) with urinary NGAL/hepcidin-25 ratio-positive cut-off at 85% specificity for in-hospital death. AKI, acute kidney injury. AUC, area under the curve. NGAL, neutrophil gelatinase-associated lipocalin. KDIGO, Kidney Disease Improving Global Outcomes Initiative AKI definition.

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