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Risk factors for mortality in patients with septic acute kidney injury in intensive care units in Beijing, China: a multicenter prospective observational study.

Wang X, Jiang L, Wen Y, Wang MP, Li W, Li ZQ, Xi XM - Biomed Res Int (2014)

Bottom Line: Twenty-one risk factors were found, and six independent risk factors were identified: age, APACHE II score, duration of mechanical ventilation, duration of MAP <65 mmHg, time until RRT started, and progressive KIDGO stage.Admission KDIGO stages were not associated with mortality, while worst KDIGO stages were.Progressive KIDGO stage is better than admission or the worst KIDGO for prediction of mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing 100038, China ; Department of Surgical Intensive Care Units, Hepatobiliary Surgery and Liver Transplant Center, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China.

ABSTRACT

Objective: To discover risk factors for mortality of patients with septic AKI in ICU via a multicenter study.

Background: Septic AKI is a serious threat to patients in ICU, but there are a few clinical studies focusing on this.

Methods: This was a prospective, observational, and multicenter study conducted in 30 ICUs of 28 major hospitals in Beijing. 3,107 patients were admitted consecutively, among which 361 patients were with septic AKI. Patient clinical data were recorded daily for 10 days after admission. Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define and stage AKI. Of the involved patients, 201 survived and 160 died.

Results: The rate of septic AKI was 11.6%. Twenty-one risk factors were found, and six independent risk factors were identified: age, APACHE II score, duration of mechanical ventilation, duration of MAP <65 mmHg, time until RRT started, and progressive KIDGO stage. Admission KDIGO stages were not associated with mortality, while worst KDIGO stages were. Only progressive KIDGO stage was an independent risk factor.

Conclusions: Six independent risk factors for mortality for septic AKI were identified. Progressive KIDGO stage is better than admission or the worst KIDGO for prediction of mortality. This trial is registered with ChiCTR-ONC-11001875.

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fig1: Study protocol flowchart.

Mentions: Septic AKI was defined as sepsis-associated AKI [20, 28, 29], which meant that sepsis was associated with development and progression of AKI, so the patients (n = 235) with sepsis whose sepsis was not associated with AKI were excluded (Figure 1). We defined sepsis according to the American College of Chest Physicians and the Society of Critical Care Medicine(ACCP/SCCM) consensus [24, 30]. Based on this consensus, SIRS is defined as temperature >38°C or <36°C, heart rate >90/min, respiratory rate >20/min or PaCO2 <32 mmHg, and white blood cell count >12,000/mm3 or <4,000/mm3 or with >10% bands. Sepsis was defined as a condition in which the patient met the criteria for SIRS and presented with either a documented or suspected infection. Admission KDIGO refers to the KDIGO stage on the first day of admission, while worst KDIGO refers to the worst KDIGO stage reached by a patient during their ICU stay. ICU-acquired AKI was defined as the development of AKI at 24 hours or more after admission, with the absence of AKI prior to admission. Progressive AKI was defined as patients reaching a higher KDIGO stage compared with the admission KDIGO stage at any time during their ICU stay. Vasoactive agents used in this study included epinephrine, norepinephrine, dopamine, and dobutamine. Large-dose vasopressor was defined as norepinephrine or epinephrine administered at a dose of >0.1 μg/kg/min, or dopamine or dobutamine administered at a dose of >15 μg/kg/min, or any two or more drugs in combination. Hospital acquired infection was defined as the development of an infection within 48 hours after hospital admission, which was not presented or incubating at the time of admission to the hospital.


Risk factors for mortality in patients with septic acute kidney injury in intensive care units in Beijing, China: a multicenter prospective observational study.

Wang X, Jiang L, Wen Y, Wang MP, Li W, Li ZQ, Xi XM - Biomed Res Int (2014)

Study protocol flowchart.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109370&req=5

fig1: Study protocol flowchart.
Mentions: Septic AKI was defined as sepsis-associated AKI [20, 28, 29], which meant that sepsis was associated with development and progression of AKI, so the patients (n = 235) with sepsis whose sepsis was not associated with AKI were excluded (Figure 1). We defined sepsis according to the American College of Chest Physicians and the Society of Critical Care Medicine(ACCP/SCCM) consensus [24, 30]. Based on this consensus, SIRS is defined as temperature >38°C or <36°C, heart rate >90/min, respiratory rate >20/min or PaCO2 <32 mmHg, and white blood cell count >12,000/mm3 or <4,000/mm3 or with >10% bands. Sepsis was defined as a condition in which the patient met the criteria for SIRS and presented with either a documented or suspected infection. Admission KDIGO refers to the KDIGO stage on the first day of admission, while worst KDIGO refers to the worst KDIGO stage reached by a patient during their ICU stay. ICU-acquired AKI was defined as the development of AKI at 24 hours or more after admission, with the absence of AKI prior to admission. Progressive AKI was defined as patients reaching a higher KDIGO stage compared with the admission KDIGO stage at any time during their ICU stay. Vasoactive agents used in this study included epinephrine, norepinephrine, dopamine, and dobutamine. Large-dose vasopressor was defined as norepinephrine or epinephrine administered at a dose of >0.1 μg/kg/min, or dopamine or dobutamine administered at a dose of >15 μg/kg/min, or any two or more drugs in combination. Hospital acquired infection was defined as the development of an infection within 48 hours after hospital admission, which was not presented or incubating at the time of admission to the hospital.

Bottom Line: Twenty-one risk factors were found, and six independent risk factors were identified: age, APACHE II score, duration of mechanical ventilation, duration of MAP <65 mmHg, time until RRT started, and progressive KIDGO stage.Admission KDIGO stages were not associated with mortality, while worst KDIGO stages were.Progressive KIDGO stage is better than admission or the worst KIDGO for prediction of mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing 100038, China ; Department of Surgical Intensive Care Units, Hepatobiliary Surgery and Liver Transplant Center, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China.

ABSTRACT

Objective: To discover risk factors for mortality of patients with septic AKI in ICU via a multicenter study.

Background: Septic AKI is a serious threat to patients in ICU, but there are a few clinical studies focusing on this.

Methods: This was a prospective, observational, and multicenter study conducted in 30 ICUs of 28 major hospitals in Beijing. 3,107 patients were admitted consecutively, among which 361 patients were with septic AKI. Patient clinical data were recorded daily for 10 days after admission. Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define and stage AKI. Of the involved patients, 201 survived and 160 died.

Results: The rate of septic AKI was 11.6%. Twenty-one risk factors were found, and six independent risk factors were identified: age, APACHE II score, duration of mechanical ventilation, duration of MAP <65 mmHg, time until RRT started, and progressive KIDGO stage. Admission KDIGO stages were not associated with mortality, while worst KDIGO stages were. Only progressive KIDGO stage was an independent risk factor.

Conclusions: Six independent risk factors for mortality for septic AKI were identified. Progressive KIDGO stage is better than admission or the worst KIDGO for prediction of mortality. This trial is registered with ChiCTR-ONC-11001875.

Show MeSH
Related in: MedlinePlus