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Utilizing reclassification to explore characteristics and prognosis of KDIGO(SCr) AKI subgroups: a retrospective analysis of a multicenter prospective cohort study
BACKGROUND: Acute kidney injury (AKI) is widespread in the intensive care unit (ICU) and affects patient prognosis. According to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, the absolute and relative increases of serum creatinine (Scr) are classified into the same stage. Whether the...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Taylor & Francis
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8648037/ https://www.ncbi.nlm.nih.gov/pubmed/34860139 http://dx.doi.org/10.1080/0886022X.2021.1997761 |
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author | Dong, Gui-Ying Qin, Jun-Ping An, Youzhong Kang, Yan Yu, Xiangyou Zhao, Mingyan Ma, Xiaochun Ai, Yuhang Xu, Yuan Xi, Xiuming Qian, Chuanyun Wu, Dawei Sun, Renhua Li, Shusheng Hu, Zhenjie Cao, Xiangyuan Zhou, Fachun Jiang, Li Lin, Jiandong Chen, Erzhen Qin, Tiehe He, Zhenyang Zhu, Jihong Du, Bin |
author_facet | Dong, Gui-Ying Qin, Jun-Ping An, Youzhong Kang, Yan Yu, Xiangyou Zhao, Mingyan Ma, Xiaochun Ai, Yuhang Xu, Yuan Xi, Xiuming Qian, Chuanyun Wu, Dawei Sun, Renhua Li, Shusheng Hu, Zhenjie Cao, Xiangyuan Zhou, Fachun Jiang, Li Lin, Jiandong Chen, Erzhen Qin, Tiehe He, Zhenyang Zhu, Jihong Du, Bin |
author_sort | Dong, Gui-Ying |
collection | PubMed |
description | BACKGROUND: Acute kidney injury (AKI) is widespread in the intensive care unit (ICU) and affects patient prognosis. According to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, the absolute and relative increases of serum creatinine (Scr) are classified into the same stage. Whether the prognosis of the two types of patients is similar in the ICU remains unclear. METHODS: According to the absolute and relative increase of Scr, AKI stage 1 and stage 3 patients were divided into stage 1a and 1b, stage 3a and 3b groups, respectively. Their demographics, laboratory results, clinical characteristics, and outcomes were analyzed retrospectively. RESULTS: Of the 345 eligible cases, we analyzed stage 1 because stage 3a group had only one patient. Using 53 or 61.88 µmol/L as the reference Scr (Scr(ref)), no significant differences were observed in ICU mortality (P(53)=0.076, P(61.88)=0.070) or renal replacement therapy (RRT) ratio, (P(53)=0.356, P(61.88)=0.471) between stage 1a and 1b, but stage 1b had longer ICU length of stay (LOS) than stage 1a (P(53)<0.001, P(61.88)=0.032). In the Kaplan-Meier survival analysis, no differences were observed in ICU mortality between stage 1a and 1b (P(53)=0.378, P(61.88)=0.255). In a multivariate analysis, respiratory failure [HR = 4.462 (95% CI 1.144–17.401), p = 0.031] and vasoactive drug therapy [HR = 4.023 (95% CI 1.584–10.216), p = 0.003] were found to be independently associated with increased risk of death. CONCLUSION: ICU LOS benefit was more prominent in KDIGO(SCr) AKI stage 1a patients than in stage 1 b. Further prospective studies with a larger sample size are necessary to confirm the effectiveness of reclassification. |
format | Online Article Text |
id | pubmed-8648037 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Taylor & Francis |
record_format | MEDLINE/PubMed |
spelling | pubmed-86480372021-12-07 Utilizing reclassification to explore characteristics and prognosis of KDIGO(SCr) AKI subgroups: a retrospective analysis of a multicenter prospective cohort study Dong, Gui-Ying Qin, Jun-Ping An, Youzhong Kang, Yan Yu, Xiangyou Zhao, Mingyan Ma, Xiaochun Ai, Yuhang Xu, Yuan Xi, Xiuming Qian, Chuanyun Wu, Dawei Sun, Renhua Li, Shusheng Hu, Zhenjie Cao, Xiangyuan Zhou, Fachun Jiang, Li Lin, Jiandong Chen, Erzhen Qin, Tiehe He, Zhenyang Zhu, Jihong Du, Bin Ren Fail Clinical Study BACKGROUND: Acute kidney injury (AKI) is widespread in the intensive care unit (ICU) and affects patient prognosis. According to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, the absolute and relative increases of serum creatinine (Scr) are classified into the same stage. Whether the prognosis of the two types of patients is similar in the ICU remains unclear. METHODS: According to the absolute and relative increase of Scr, AKI stage 1 and stage 3 patients were divided into stage 1a and 1b, stage 3a and 3b groups, respectively. Their demographics, laboratory results, clinical characteristics, and outcomes were analyzed retrospectively. RESULTS: Of the 345 eligible cases, we analyzed stage 1 because stage 3a group had only one patient. Using 53 or 61.88 µmol/L as the reference Scr (Scr(ref)), no significant differences were observed in ICU mortality (P(53)=0.076, P(61.88)=0.070) or renal replacement therapy (RRT) ratio, (P(53)=0.356, P(61.88)=0.471) between stage 1a and 1b, but stage 1b had longer ICU length of stay (LOS) than stage 1a (P(53)<0.001, P(61.88)=0.032). In the Kaplan-Meier survival analysis, no differences were observed in ICU mortality between stage 1a and 1b (P(53)=0.378, P(61.88)=0.255). In a multivariate analysis, respiratory failure [HR = 4.462 (95% CI 1.144–17.401), p = 0.031] and vasoactive drug therapy [HR = 4.023 (95% CI 1.584–10.216), p = 0.003] were found to be independently associated with increased risk of death. CONCLUSION: ICU LOS benefit was more prominent in KDIGO(SCr) AKI stage 1a patients than in stage 1 b. Further prospective studies with a larger sample size are necessary to confirm the effectiveness of reclassification. Taylor & Francis 2021-12-03 /pmc/articles/PMC8648037/ /pubmed/34860139 http://dx.doi.org/10.1080/0886022X.2021.1997761 Text en © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Study Dong, Gui-Ying Qin, Jun-Ping An, Youzhong Kang, Yan Yu, Xiangyou Zhao, Mingyan Ma, Xiaochun Ai, Yuhang Xu, Yuan Xi, Xiuming Qian, Chuanyun Wu, Dawei Sun, Renhua Li, Shusheng Hu, Zhenjie Cao, Xiangyuan Zhou, Fachun Jiang, Li Lin, Jiandong Chen, Erzhen Qin, Tiehe He, Zhenyang Zhu, Jihong Du, Bin Utilizing reclassification to explore characteristics and prognosis of KDIGO(SCr) AKI subgroups: a retrospective analysis of a multicenter prospective cohort study |
title | Utilizing reclassification to explore characteristics and prognosis of KDIGO(SCr) AKI subgroups: a retrospective analysis of a multicenter prospective cohort study |
title_full | Utilizing reclassification to explore characteristics and prognosis of KDIGO(SCr) AKI subgroups: a retrospective analysis of a multicenter prospective cohort study |
title_fullStr | Utilizing reclassification to explore characteristics and prognosis of KDIGO(SCr) AKI subgroups: a retrospective analysis of a multicenter prospective cohort study |
title_full_unstemmed | Utilizing reclassification to explore characteristics and prognosis of KDIGO(SCr) AKI subgroups: a retrospective analysis of a multicenter prospective cohort study |
title_short | Utilizing reclassification to explore characteristics and prognosis of KDIGO(SCr) AKI subgroups: a retrospective analysis of a multicenter prospective cohort study |
title_sort | utilizing reclassification to explore characteristics and prognosis of kdigo(scr) aki subgroups: a retrospective analysis of a multicenter prospective cohort study |
topic | Clinical Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8648037/ https://www.ncbi.nlm.nih.gov/pubmed/34860139 http://dx.doi.org/10.1080/0886022X.2021.1997761 |
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