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Dynamic monitoring of kidney injury status over 3 days in the intensive care unit as a sepsis phenotype associated with hospital mortality and hyperinflammation

BACKGROUND: Sepsis-associated acute kidney injury (AKI) often worsens with the deterioration of a patient's condition. Therefore, we hypothesized that monitoring AKI dynamically from day 1 to day 3 was potential to predict hospital mortality. Specifically, we explored whether monitoring AKI dyn...

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Autores principales: Lin, Chiung-Yu, Wang, Yi-Hsi, Chen, Yu-Mu, Hung, Kai-Yin, Chang, Ya-Chun, Fang, Ying-Tang, Chang, Ya-Ting, Chen, Hung-Cheng, Huang, Kuo-Tung, Chang, Huang-Chih, Chen, Yung-Che, Wang, Chin-Chou, Lin, Meng-Chih, Fang, Wen-Feng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Chang Gung University 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486242/
https://www.ncbi.nlm.nih.gov/pubmed/34482015
http://dx.doi.org/10.1016/j.bj.2021.08.006
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author Lin, Chiung-Yu
Wang, Yi-Hsi
Chen, Yu-Mu
Hung, Kai-Yin
Chang, Ya-Chun
Fang, Ying-Tang
Chang, Ya-Ting
Chen, Hung-Cheng
Huang, Kuo-Tung
Chang, Huang-Chih
Chen, Yung-Che
Wang, Chin-Chou
Lin, Meng-Chih
Fang, Wen-Feng
author_facet Lin, Chiung-Yu
Wang, Yi-Hsi
Chen, Yu-Mu
Hung, Kai-Yin
Chang, Ya-Chun
Fang, Ying-Tang
Chang, Ya-Ting
Chen, Hung-Cheng
Huang, Kuo-Tung
Chang, Huang-Chih
Chen, Yung-Che
Wang, Chin-Chou
Lin, Meng-Chih
Fang, Wen-Feng
author_sort Lin, Chiung-Yu
collection PubMed
description BACKGROUND: Sepsis-associated acute kidney injury (AKI) often worsens with the deterioration of a patient's condition. Therefore, we hypothesized that monitoring AKI dynamically from day 1 to day 3 was potential to predict hospital mortality. Specifically, we explored whether monitoring AKI dynamically in the intensive care unit (ICU) could be a sepsis phenotype predictive of mortality. A new classification was established based on the change in the AKI stage from admission day 1 and day 3. We compared the hospital mortality, cytokines, and immune response pattern between each group. METHODS: We retrospectively enrolled 523 patients with sepsis, and we calculated the AKI stages on day 1 and day 3 admission to ICUs. Among these 523 people, 388 of them were assigned to normal, improved, and deteriorated groups according to the changes in the AKI stages. 263 of which did not develop AKI on day 1 and day 3 (normal group). The AKI stage improved in 68 patients (improved group) and worsened in 57 (deteriorated group). We compared the mortality rates between the groups, and identified the relationship between the dynamic AKI status, immune response patterns, and cytokine levels. RESULTS: The hospital mortality rate in the deteriorated group was higher than that in the non-deteriorated group (combination of normal and improved group) (p = 0.004). Additionally, according to the Kaplan–Meier analysis, the non-deteriorated group had a distinct hospital survival curve (p = 0.004). Furthermore, both the overexpression of tumor necrosis factor-α and decreased monocyte expression of human leukocyte antigen-DR were present in the deteriorated group. CONCLUSIONS: The deteriorated group was associated with a higher hospital mortality rate, potentially resulting from an abnormal inflammatory response. Worsening AKI in the first 3 days of ICU admission may be a sepsis phenotype predictive of hospital mortality.
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spelling pubmed-94862422022-09-26 Dynamic monitoring of kidney injury status over 3 days in the intensive care unit as a sepsis phenotype associated with hospital mortality and hyperinflammation Lin, Chiung-Yu Wang, Yi-Hsi Chen, Yu-Mu Hung, Kai-Yin Chang, Ya-Chun Fang, Ying-Tang Chang, Ya-Ting Chen, Hung-Cheng Huang, Kuo-Tung Chang, Huang-Chih Chen, Yung-Che Wang, Chin-Chou Lin, Meng-Chih Fang, Wen-Feng Biomed J Original Article BACKGROUND: Sepsis-associated acute kidney injury (AKI) often worsens with the deterioration of a patient's condition. Therefore, we hypothesized that monitoring AKI dynamically from day 1 to day 3 was potential to predict hospital mortality. Specifically, we explored whether monitoring AKI dynamically in the intensive care unit (ICU) could be a sepsis phenotype predictive of mortality. A new classification was established based on the change in the AKI stage from admission day 1 and day 3. We compared the hospital mortality, cytokines, and immune response pattern between each group. METHODS: We retrospectively enrolled 523 patients with sepsis, and we calculated the AKI stages on day 1 and day 3 admission to ICUs. Among these 523 people, 388 of them were assigned to normal, improved, and deteriorated groups according to the changes in the AKI stages. 263 of which did not develop AKI on day 1 and day 3 (normal group). The AKI stage improved in 68 patients (improved group) and worsened in 57 (deteriorated group). We compared the mortality rates between the groups, and identified the relationship between the dynamic AKI status, immune response patterns, and cytokine levels. RESULTS: The hospital mortality rate in the deteriorated group was higher than that in the non-deteriorated group (combination of normal and improved group) (p = 0.004). Additionally, according to the Kaplan–Meier analysis, the non-deteriorated group had a distinct hospital survival curve (p = 0.004). Furthermore, both the overexpression of tumor necrosis factor-α and decreased monocyte expression of human leukocyte antigen-DR were present in the deteriorated group. CONCLUSIONS: The deteriorated group was associated with a higher hospital mortality rate, potentially resulting from an abnormal inflammatory response. Worsening AKI in the first 3 days of ICU admission may be a sepsis phenotype predictive of hospital mortality. Chang Gung University 2022-08 2021-09-03 /pmc/articles/PMC9486242/ /pubmed/34482015 http://dx.doi.org/10.1016/j.bj.2021.08.006 Text en © 2021 Chang Gung University. Publishing services by Elsevier B.V. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Lin, Chiung-Yu
Wang, Yi-Hsi
Chen, Yu-Mu
Hung, Kai-Yin
Chang, Ya-Chun
Fang, Ying-Tang
Chang, Ya-Ting
Chen, Hung-Cheng
Huang, Kuo-Tung
Chang, Huang-Chih
Chen, Yung-Che
Wang, Chin-Chou
Lin, Meng-Chih
Fang, Wen-Feng
Dynamic monitoring of kidney injury status over 3 days in the intensive care unit as a sepsis phenotype associated with hospital mortality and hyperinflammation
title Dynamic monitoring of kidney injury status over 3 days in the intensive care unit as a sepsis phenotype associated with hospital mortality and hyperinflammation
title_full Dynamic monitoring of kidney injury status over 3 days in the intensive care unit as a sepsis phenotype associated with hospital mortality and hyperinflammation
title_fullStr Dynamic monitoring of kidney injury status over 3 days in the intensive care unit as a sepsis phenotype associated with hospital mortality and hyperinflammation
title_full_unstemmed Dynamic monitoring of kidney injury status over 3 days in the intensive care unit as a sepsis phenotype associated with hospital mortality and hyperinflammation
title_short Dynamic monitoring of kidney injury status over 3 days in the intensive care unit as a sepsis phenotype associated with hospital mortality and hyperinflammation
title_sort dynamic monitoring of kidney injury status over 3 days in the intensive care unit as a sepsis phenotype associated with hospital mortality and hyperinflammation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486242/
https://www.ncbi.nlm.nih.gov/pubmed/34482015
http://dx.doi.org/10.1016/j.bj.2021.08.006
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