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ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients
BACKGROUND: Transient and persistent acute kidney injury (AKI) could share similar physiopathological mechanisms. The objective of our study was to assess prognostic impact of AKI duration on ICU mortality. DESIGN: Retrospective analysis of a prospective database via cause-specific model, with 28-da...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297118/ https://www.ncbi.nlm.nih.gov/pubmed/30560526 http://dx.doi.org/10.1186/s13613-018-0467-6 |
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author | Truche, A. S. Ragey, S. Perinel Souweine, B. Bailly, S. Zafrani, L. Bouadma, L. Clec’h, C. Garrouste-Orgeas, M. Lacave, G. Schwebel, C. Guebre-Egziabher, F. Adrie, C. Dumenil, A. S. Zaoui, Ph. Argaud, L. Jamali, S. Goldran Toledano, D. Marcotte, G. Timsit, J. F. Darmon, M. |
author_facet | Truche, A. S. Ragey, S. Perinel Souweine, B. Bailly, S. Zafrani, L. Bouadma, L. Clec’h, C. Garrouste-Orgeas, M. Lacave, G. Schwebel, C. Guebre-Egziabher, F. Adrie, C. Dumenil, A. S. Zaoui, Ph. Argaud, L. Jamali, S. Goldran Toledano, D. Marcotte, G. Timsit, J. F. Darmon, M. |
author_sort | Truche, A. S. |
collection | PubMed |
description | BACKGROUND: Transient and persistent acute kidney injury (AKI) could share similar physiopathological mechanisms. The objective of our study was to assess prognostic impact of AKI duration on ICU mortality. DESIGN: Retrospective analysis of a prospective database via cause-specific model, with 28-day ICU mortality as primary end point, considering discharge alive as a competing event and taking into account time-dependent nature of renal recovery. Renal recovery was defined as a decrease of at least one KDIGO class compared to the previous day. SETTING: 23 French ICUs. PATIENTS: Patients of a French multicentric observational cohort were included if they suffered from AKI at ICU admission between 1996 and 2015. INTERVENTION: None. RESULTS: A total of 5242 patients were included. Initial severity according to KDIGO creatinine definition was AKI stage 1 for 2458 patients (46.89%), AKI stage 2 for 1181 (22.53%) and AKI stage 3 for 1603 (30.58%). Crude 28-day ICU mortality according to AKI severity was 22.74% (n = 559), 27.69% (n = 327) and 26.26% (n = 421), respectively. Renal recovery was experienced by 3085 patients (58.85%), and its rate was significantly different between AKI severity stages (P < 0.01). Twenty-eight-day ICU mortality was independently lower in patients experiencing renal recovery [CSHR 0.54 (95% CI 0.46–0.63), P < 0.01]. Lastly, RRT requirement was strongly associated with persistent AKI whichever threshold was chosen between day 2 and 7 to delineate transient from persistent AKI. CONCLUSIONS: Short-term renal recovery, according to several definitions, was independently associated with higher mortality and RRT requirement. Moreover, distinction between transient and persistent AKI is consequently a clinically relevant surrogate outcome variable for diagnostic testing in critically ill patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-018-0467-6) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6297118 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-62971182019-01-03 ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients Truche, A. S. Ragey, S. Perinel Souweine, B. Bailly, S. Zafrani, L. Bouadma, L. Clec’h, C. Garrouste-Orgeas, M. Lacave, G. Schwebel, C. Guebre-Egziabher, F. Adrie, C. Dumenil, A. S. Zaoui, Ph. Argaud, L. Jamali, S. Goldran Toledano, D. Marcotte, G. Timsit, J. F. Darmon, M. Ann Intensive Care Research BACKGROUND: Transient and persistent acute kidney injury (AKI) could share similar physiopathological mechanisms. The objective of our study was to assess prognostic impact of AKI duration on ICU mortality. DESIGN: Retrospective analysis of a prospective database via cause-specific model, with 28-day ICU mortality as primary end point, considering discharge alive as a competing event and taking into account time-dependent nature of renal recovery. Renal recovery was defined as a decrease of at least one KDIGO class compared to the previous day. SETTING: 23 French ICUs. PATIENTS: Patients of a French multicentric observational cohort were included if they suffered from AKI at ICU admission between 1996 and 2015. INTERVENTION: None. RESULTS: A total of 5242 patients were included. Initial severity according to KDIGO creatinine definition was AKI stage 1 for 2458 patients (46.89%), AKI stage 2 for 1181 (22.53%) and AKI stage 3 for 1603 (30.58%). Crude 28-day ICU mortality according to AKI severity was 22.74% (n = 559), 27.69% (n = 327) and 26.26% (n = 421), respectively. Renal recovery was experienced by 3085 patients (58.85%), and its rate was significantly different between AKI severity stages (P < 0.01). Twenty-eight-day ICU mortality was independently lower in patients experiencing renal recovery [CSHR 0.54 (95% CI 0.46–0.63), P < 0.01]. Lastly, RRT requirement was strongly associated with persistent AKI whichever threshold was chosen between day 2 and 7 to delineate transient from persistent AKI. CONCLUSIONS: Short-term renal recovery, according to several definitions, was independently associated with higher mortality and RRT requirement. Moreover, distinction between transient and persistent AKI is consequently a clinically relevant surrogate outcome variable for diagnostic testing in critically ill patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-018-0467-6) contains supplementary material, which is available to authorized users. Springer International Publishing 2018-12-17 /pmc/articles/PMC6297118/ /pubmed/30560526 http://dx.doi.org/10.1186/s13613-018-0467-6 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Research Truche, A. S. Ragey, S. Perinel Souweine, B. Bailly, S. Zafrani, L. Bouadma, L. Clec’h, C. Garrouste-Orgeas, M. Lacave, G. Schwebel, C. Guebre-Egziabher, F. Adrie, C. Dumenil, A. S. Zaoui, Ph. Argaud, L. Jamali, S. Goldran Toledano, D. Marcotte, G. Timsit, J. F. Darmon, M. ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients |
title | ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients |
title_full | ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients |
title_fullStr | ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients |
title_full_unstemmed | ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients |
title_short | ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients |
title_sort | icu survival and need of renal replacement therapy with respect to aki duration in critically ill patients |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297118/ https://www.ncbi.nlm.nih.gov/pubmed/30560526 http://dx.doi.org/10.1186/s13613-018-0467-6 |
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