Hyperglycemia is an independent predictor of in-hospital mortality in critically ill patients with acute kidney injury-a cohort study

Introduction: The association of hyperglycemia with poor outcomes has been described in several settings, including in generalintensive care unit (ICU) patients. However, it is not clear whether this relationship is consistent for all critically ill patients. Ourstudy assessed the association of blood glucose (BG) with in-hospital mortality in critically ill patients with acute kidney injury(AKI).Methods: A cohort of critical care patients with AKI was followed up until death or hospital discharge. The associationof BG level with in-hospital mortality was analyzed with multivariate logistic regression analysis adjusted for demographic,socioeconomic, laboratory and clinical variables. Receiver-operating characteristics (ROC) analysis was used to assess the abilityof various levels of BG to predict in-hospital mortality.Results: One hundred patients were followed, with a mean age of 62.2 years, 49 male, 41 surgical, 34 diabetics and 63 withsepsis. Nineteen patients needed renal replacement therapy and 67 died during hospital stay. In the final multivariate model, age,glucose level and sepsis had an independent association with the outcome death. The threshold level of BG that maximized thecombined sensitivity and specificity for the prediction of in-hospital mortality by ROC analysis was 109 mg/dl. In the stratifiedanalysis, BG was an independent predictor of death only among non-diabetic patients.Conclusions: To the best of our knowledge, this is the first study to describe an association between hyperglycemia and in-hospitalmortality in critically ill patients with AKI. Further studies are needed to confirm this finding and to assess the potential impact oftighter glucose control in this subpopulation.

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Serum lactate dehydrogenase level is associated with in-hospital mortality in critically Ill patients with acute kidney injury

International Urology and Nephrology ◽

10.1007/s11255-021-02792-z ◽

2021 ◽

Author(s):

Dan Zhang ◽

Lin Shi

Keyword(s):

Acute Kidney Injury ◽

Lactate Dehydrogenase ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Lactate Dehydrogenase Level ◽

Serum Lactate ◽

Serum Lactate Dehydrogenase ◽

Serum Lactate Dehydrogenase Level

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Incidence Evaluation of Acute Kidney Injury and Pharmacoeconomic Analysis Among Critically Ill Patients With Use of Antipseudomonal β-Lactams and Vancomycin

10.21203/rs.3.rs-298013/v1 ◽

2021 ◽

Author(s):

Yalin Dong ◽

Ying Zhang ◽

Yan Wang ◽

Jiangping Lian ◽

Ruixia Yang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Treatment Cost ◽

Independent Predictor ◽

Pharmacoeconomic Analysis ◽

Kidney Injury ◽

Decision Analytic Model ◽

Combination Therapies ◽

Matched Study

Abstract Background: Whether vancomycin (VAN) plus piperacillin-tazobactam (PTZ) could increase the risk of acute kidney injury (AKI) is still controversial in critically ill patients. The purpose of this study was to compare the risk of developing AKI and risk of developing AKI and treatment cost among this population receiving VAN/PTZ to a matched group receiving VAN/other antipseudomonal β-lactams. Methods: This multicenter, retrospective, matched study included 700 critically ill patients who received ≥48 hours of VAN/PTZ or VAN/other antipseudomonal β-lactams. The risk of developing AKI was compared between these two combination therapies using propensity-adjusted analysis. Furthermore, a pharmacoeconomic decision-analytic model was performed.Results: According to three AKI-defined criteria, VAN/PTZ was associated with significantly higher incidence of than VAN/other antipseudomonal β-lactams (all P < 0.001). In multivariate analysis, regardless of any VAN/other antipseudomonal β-lactams, VAN/PTZ was an independent predictor for stage 2 or 3 AKI. In the empiric treatment, the incremental cost-effectiveness ratios per additional nephrotoxic episode of 1147.35$, 1845.11$, and 3989.95$ were found for VAN/PTZ relative to, vancomycin plus imipenem-cilastatin, vancomycin plus meropenem, and vancomycin plus cefoperazone-sulbactam, respectively. Conclusion: In critically ill patients, VAN/PTZ was associated with both higher AKI risk and treatment cost when considering AKI occurence compared to VAN/other antipseudomonal β-lactams.Trial registration: retrospectively registered, ClinicalTrials.gov number: NCT03776409.

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Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin-Tazobactam, Cefepime, or Meropenem

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02658-18 ◽

2019 ◽

Vol 63 (5) ◽

Cited By ~ 16

Author(s):

Adam M. Blevins ◽

Jennifer N. Lashinsky ◽

Craig McCammon ◽

Marin Kollef ◽

Scott Micek ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Primary Outcome ◽

Independent Predictor ◽

Kidney Injury ◽

University Hospital ◽

Increased Risk ◽

Kdigo Guidelines

ABSTRACT Critically ill patients are frequently treated with empirical antibiotic therapy, including vancomycin and β-lactams. Recent evidence suggests an increased risk of acute kidney injury (AKI) in patients who received a combination of vancomycin and piperacillin-tazobactam (VPT) compared with patients who received vancomycin alone or vancomycin in combination with cefepime (VC) or meropenem (VM), but most studies were conducted predominately in the non-critically ill population. A retrospective cohort study that included 2,492 patients was conducted in the intensive care units of a large university hospital with the primary outcome being the development of any AKI. The rates of any AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, were 39.3% for VPT patients, 24.2% for VC patients, and 23.5% for VM patients (P < 0.0001 for both comparisons). Similarly, the incidences of stage 2 and stage 3 AKI were also significantly higher for VPT patients than for the patients in the other groups. The rates of stage 2 and stage 3 AKI, respectively, were 15% and 6.6% for VPT patients, 5.8% and 1.8% for VC patients, and 6.6% and 1.3% for VM patients (P < 0.0001 for both comparisons). In multivariate analysis, the use of vancomycin in combination with piperacillin-tazobactam was found to be an independent predictor of AKI (odds ratio [OR], 2.161; 95% confidence interval [CI], 1.620 to 2.883). In conclusion, critically ill patients receiving the combination of VPT had the highest incidence of AKI compared to critically ill patients receiving either VC or VM.

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High-dose versus low-dose haemofiltration for the treatment of critically ill patients with acute kidney injury: an updated systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2016-014171 ◽

2017 ◽

Vol 7 (10) ◽

pp. e014171 ◽

Cited By ~ 7

Author(s):

Peng Li ◽

Li-ping Qu ◽

Dong Qi ◽

Bo Shen ◽

Yi-mei Wang ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Hospital Mortality ◽

Hospital Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Low Dose ◽

Meta Analysis ◽

Kidney Injury ◽

High Dose

ObjectiveThe purpose of this study was to perform a systematic review and meta-analysis to evaluate the effect of high-dose versus low-dose haemofiltration on the survival of critically ill patients with acute kidney injury (AKI). We hypothesised that high-dose treatments are not associated with a higher risk of mortality.DesignMeta-analysis.SettingRandomised controlled trials and two-arm prospective and retrospective studies were included.ParticipantsCritically ill patients with AKI.InterventionsContinuous renal replacement therapy.Primary and secondary outcome measuresPrimary outcomes: 90-day mortality, intensive care unit (ICU) mortality, hospital mortality; secondary outcomes: length of ICU and hospital stay.ResultEight studies including 2970 patients were included in the analysis. Pooled results showed no significant difference in the 90-mortality rate between patients treated with high-dose or low-dose haemofiltration (pooled OR=0.90, 95% CI 0.73 to 1.11, p=0.32). Findings were similar for ICU (pooled OR=1.12, 95% CI 0.94 to 1.34, p=0.21) and hospital mortality (pooled OR=1.03, 95% CI 0.81 to 1.30, p=0.84). Length of ICU and hospital stay were similar between high-dose and low-dose groups. Pooled results are not overly influenced by any one study, different cut-off points of prescribed dose or different cut-off points of delivered dose. Meta-regression analysis indicated that the results were not affected by the percentage of patients with sepsis or septic shock.ConclusionHigh-dose and low-dose haemofiltration produce similar outcomes with respect to mortality and length of ICU and hospital stay in critically ill patients with AKI.This study was not registered at the time the data were collected and analysed. It has since been registered on 17 February 2017 athttp://www.researchregistry.com/, registration number: reviewregistry211.

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Variation in Risk and Mortality of Acute Kidney Injury in Critically Ill Patients: A Multicenter Study

American Journal of Nephrology ◽

10.1159/000371748 ◽

2015 ◽

Vol 41 (1) ◽

pp. 81-88 ◽

Cited By ~ 47

Author(s):

Nattachai Srisawat ◽

Florentina E. Sileanu ◽

Raghavan Murugan ◽

Rinaldo Bellomo ◽

Paolo Calzavacca ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Odds Ratio ◽

Disease Incidence ◽

Kidney Injury ◽

Severity Of Illness ◽

Process Of Care ◽

Residual Confounding

Background: Despite standardized definitions of acute kidney injury (AKI), there is wide variation in the reported rates of AKI and hospital mortality for patients with AKI. Variation could be due to actual differences in disease incidence, clinical course, or a function of data ascertainment and application of diagnostic criteria. Using standard criteria may help determine and compare the risk and outcomes of AKI across centers. Methods: In this cohort study of critically ill patients admitted to the intensive care units at six hospitals in four countries, we used KDIGO criteria to define AKI. The main outcomes were the occurrence of AKI and hospital mortality. Results: Of the 15,132 critically ill patients, 32% developed AKI based on serum creatinine criteria. After adjusting for differences in age, sex, and severity of illness, the odds ratio for AKI continued to vary across centers (odds ratio (OR), 2.57-6.04, p < 0.001). The overall, crude hospital mortality of patients with AKI was 27%, which also varied across centers after adjusting for KDIGO stage, differences in age, sex, and severity of illness (OR, 1.13-2.20, p < 0.001). The severity of AKI was associated with incremental mortality risk across centers. Conclusions: In this study, the absolute and severity-adjusted rates of AKI and hospital mortality rates for AKI varied across centers. Future studies should examine whether variation in the risk of AKI among centers is due to differences in clinical practice or process of care or residual confounding due to unmeasured factors.

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Investigate predictive capacity of in-hospital mortality of four severity score systems on critically ill patients with acute kidney injury

Journal of Investigative Medicine ◽

10.1136/jim-2019-001003 ◽

2019 ◽

Vol 67 (8) ◽

pp. 1103-1109 ◽

Cited By ~ 4

Author(s):

Yu Gong ◽

Feng Ding ◽

Fen Zhang ◽

Yong Gu

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Mortality Prediction ◽

Apache Ii ◽

University Teaching ◽

Predictive Capacity ◽

Saps Ii

Although significant improvements have been achieved in the renal replacement therapy of acute kidney injury (AKI), the mortality of patients with AKI remains high. The aim of this study is to prospectively investigate the capacity of Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II), Sepsis-related Organ Failure Assessment (SOFA) and Acute Tubular Necrosis Individual Severity Index (ATN-ISI) to predict in-hospital mortality of critically ill patients with AKI. A prospective observational study was conducted in a university teaching hospital. 189 consecutive critically ill patients with AKI were selected according Risk, Injury, Failure, Loss, or End-stage kidney disease criteria. APACHE II, SAPS II, SOFA and ATN-ISI counts were obtained within the first 24 hours following admission. Receiver operating characteristic analyses (ROCs) were applied. Area under the ROC curve (AUC) was calculated. Sensitivity and specificity of in-hospital mortality prediction were calculated. In this study, the in-hospital mortality of critically ill patients with AKI was 37.04% (70/189). AUC of APACHE II, SAPS II, SOFA and ATN-ISI was 0.903 (95% CI 0.856 to 0.950), 0.893 (95% CI 0.847 to 0.940), 0.908 (95% CI 0.866 to 0.950) and 0.889 (95% CI 0.841 to 0.937) and sensitivity was 90.76%, 89.92%, 90.76% and 89.08% and specificity was 77.14%, 70.00%, 71.43% and 71.43%, respectively. In this study, it was found APACHE II, SAPS II, SOFA and ATN-ISI are reliable in-hospital mortality predictors of critically ill patients with AKI. Trial registration number: NCT00953992.

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The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

Renal Failure ◽

10.3109/0886022x.2015.1044755 ◽

2015 ◽

Vol 37 (6) ◽

pp. 985-993 ◽

Cited By ~ 15

Author(s):

Hung-Chieh Wu ◽

Wei-Jie Wang ◽

Yu-Wei Chen ◽

Han-Hsiang Chen

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cohort Study ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Observational Cohort Study ◽

Observational Cohort

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The predictive value of red blood cell distribution width and platelet-to -lymphocyte ratio for acute kidney injury in critically ill patients

10.21203/rs.3.rs-1006561/v1 ◽

2021 ◽

Author(s):

Yan Tang ◽

Fen Jiang ◽

Li Zhang ◽

Jiaxuan Xiang ◽

Jie Lei ◽

...

Keyword(s):

Acute Kidney Injury ◽

Blood Cell ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Cell Distribution ◽

Platelet To Lymphocyte Ratio ◽

Distribution Width ◽

Red Blood Cell Distribution

Abstract Background Red blood cell distribution width (RDW) and the platelet-to-lymphocyte ratio (PLR) are associated with different types of prognoses in critically ill patients. But, the value of RDW and PLR in predicting the occurrence of acute kidney injury (AKI) in critically ill patients are unknown. The purpose of the study was to explore the associations of RDW and PLR with AKI incidence. Methods Among 1500 adult patients in the intensive care unit (ICU) between January 2016 and December 2019 were enrolled, we examined the associations of baseline RDW and PLR with the risk of AKI development using logistical analysis. In addition, we explored the value of RDW and PLR in predicting in-hospital mortality. Results The study participants included 951 men and 549 women, aged 60.1±16.14 years. The subjects had a mean RDW of 14.65±2.14% and a mean PLR of 188.16±129.2. Overall, 615 (41%) patients were diagnosed with AKI. There were remarkable differences in RDW and the PLR between the AKI and non-AKI groups (P<0.001). After adjustment, the association of RDW with AKI development risk strengthened (OR: 1.28, 95% CI: 1.19-1.36). Moreover, we divided the groups into two subgroups each; the high-RDW (≥14.045%) group had a high risk of developing AKI (OR=5.189, 95% CI: 4.088-6.588), while the high-PLR(≥172.067)group had a risk of developing AKI (OR=9.11,95% CI:7.09-11.71). The areas under the receiver operating characteristic curves (AUCs) for the prediction of AKI incidence based on RDW and PLR were 0.780 (95% CI: 0.755-0.804) and 0.728 (95% CI:0.702-0.754) (all P< 0.001), with cut-off values of 14.045 and 172.067, respectively. Moreover, a higher RDW was associated with a higher rate of hospital mortality (OR: 2.907, 2.190-3.858), and the risk of in-hospital mortality related to PLR was 1.534 (95%CI: 1.179-1.995). The AUC for in-hospital mortality based on RDW was 0.663 (95%CI:0.628-0.698), while the AUC for in-hospital mortality based on the PLR was 0.552 (0.514-0.589). Conclusions A higher RDW related to a higher risk of the occurrence of AKI and in-hospital mortality in ICU.The PLR also showed predictive value for the occurrence of AKI but did not show any clear prediction value of in-hospital mortality.

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