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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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Progression of AKI in ICUs measured by KDIGO stages.
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fig2: Progression of AKI in ICUs measured by KDIGO stages.

Mentions: During the first 10 days of ICU care, renal function of the patients was evaluated once a day according to KDIGO stage in this study. A flowchart of the progression of AKI in the ICU measured by KDIGO stages is shown in Figure 2. On admission, 27.7% (100/361) of all patients were at KDIGO stage 0, 29.9% (108/361) were at stage 1, 17.2% (62/361) were at stage 2, and 25.2% (91/361) were at stage 3. For the worst KDIGO stages, none of the patients were at stage 0, 20.8% (75/361) of patients were at stage 1, 25.5% (92/361) were at stage 2, and 53.7% (194/361) were at stage 3. Admission KDIGO stages were not linked to patient outcome, while the worst KDIGO stages were. According to our data, patients categorized into KDIGO stages 1, 2, and 3 by the worst KDIGO stages were strongly associated with patient outcome (P < 0.001, P = 0.038, and P < 0.001, resp.). ICU-acquired AKI was not linked to disease outcome (P = 0.110). Progressive AKI was associated with mortality (P < 0.001) (Table 3). Mortality rates for patients at different admission and the worst KDIGO stages are shown in Figure 3.


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)

Progression of AKI in ICUs measured by KDIGO stages.
© Copyright Policy
Related In: Results  -  Collection

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

fig2: Progression of AKI in ICUs measured by KDIGO stages.
Mentions: During the first 10 days of ICU care, renal function of the patients was evaluated once a day according to KDIGO stage in this study. A flowchart of the progression of AKI in the ICU measured by KDIGO stages is shown in Figure 2. On admission, 27.7% (100/361) of all patients were at KDIGO stage 0, 29.9% (108/361) were at stage 1, 17.2% (62/361) were at stage 2, and 25.2% (91/361) were at stage 3. For the worst KDIGO stages, none of the patients were at stage 0, 20.8% (75/361) of patients were at stage 1, 25.5% (92/361) were at stage 2, and 53.7% (194/361) were at stage 3. Admission KDIGO stages were not linked to patient outcome, while the worst KDIGO stages were. According to our data, patients categorized into KDIGO stages 1, 2, and 3 by the worst KDIGO stages were strongly associated with patient outcome (P < 0.001, P = 0.038, and P < 0.001, resp.). ICU-acquired AKI was not linked to disease outcome (P = 0.110). Progressive AKI was associated with mortality (P < 0.001) (Table 3). Mortality rates for patients at different admission and the worst KDIGO stages are shown in Figure 3.

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