Prognostic robustness of serum creatinine based AKI definitions in patients with sepsis: a prospective cohort study

BMC Nephrology

Wim Van Biesen¹  Raymond Vanholder¹  Annemieke Dhondt¹  Norbert Lameire¹  Jill Vanmassenhove¹ 

[1] Renal Division, Ghent University Hospital, Nephrology section, 0 K12, University Hospital, De Pintelaan 185, Ghent, B9000, Belgium

关键词: Mortality;    Diagnosis;    Prognosis;    Critical illness;    Sepsis;    AKI;   

Others  :  1220816
DOI  :  10.1186/s12882-015-0107-4

 received in 2015-03-15, accepted in 2015-07-06,  发布年份 2015

【 摘 要 】

Background

It is unclear how modifications in the way to calculate serum creatinine (sCr) increase and in the cut-off value applied, influences the prognostic value of Acute Kidney Injury (AKI). We wanted to evaluate whether these modifications alter the prognostic value of AKI for prediction of mortality at 3 months, 1 and 2 years.

Methods

We prospectively included 195 septic patients and evaluated the prognostic value of AKI by using three different algorithms to calculate sCr increase: either as the difference between the highest value in the first 24 h after ICU admission and a pre-admission historical (ΔHIS) or an estimated (ΔEST) baseline value, or by subtracting the ICU admission value from the sCr value 24 h after ICU admission (ΔADM). Different cut-off levels of sCr increase (0.1, 0.2, 0.3, 0.4 and 0.5 mg/dl) were evaluated.

Results

Mortality at 3 months, 1 and 2 years in AKI defined as ΔADM > 0.3 mg/dl was 48.1 %, 63.0 % and 63.0 % vs 27.7 %, 39.8 % and 47.6 % in no AKI respectively (OR(95%CI): 2.42(1.06-5.54), 2.58(1.11-5.97) and 1.87(0.81-4.33); 0.3 mg/dl was the lowest cut-off value that was discriminatory. When AKI was defined as ΔHIS > 0.3 mg/dl or ΔEST > 0.3 mg/dl, there was no significant difference in mortality between AKI and no AKI.

Conclusions

The prognostic value of a 0.3 mg/dl increase in sCr, on mortality in sepsis, depends on how this sCr increase is calculated. Only if the evolution of serum creatinine over the first 24 h after ICU admission is taken into account, an association with mortality is found.

【 授权许可】

   
2015 Vanmassenhove et al.

【 图 表 】

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