Duration of acute kidney injury and mortality in critically ill patients: a retrospective observational study

BMC Nephrology

Ki Young Na³  Dong-Wan Chae³  Ho Jun Chin³  Dong Ki Kim¹  Jeonghwan Lee²  Shin Young Ahn³  Sejoong Kim³  Seung Seok Han¹ 

[1]Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

[2]Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, South Korea

[3]Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea

关键词: Survival;    Mortality;    Duration;    Acute renal failure;    Acute kidney injury;   

Others  :  1082906
DOI  :  10.1186/1471-2369-14-133

 received in 2012-10-18, accepted in 2013-06-24,  发布年份 2013

【 摘 要 】

Background

The addition of relevant parameters to acute kidney injury (AKI) criteria might allow better prediction of patient mortality than AKI criteria alone. Here, we evaluated whether inclusion of AKI duration could address this issue.

Methods

AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines in 2,143 critically ill patients, within 15 days of patient admission. AKI cases were categorized according to tertiles of AKI duration: 1^st tertile, 1–2 days; 2^nd tertile, 3–5 days; and 3^rd tertile, ≥6 days. The hazard ratios (HRs) for overall survival rates in three groups were calculated after adjustment for multiple covariates compared with ICU patients without AKI as the reference group. The predictive ability for mortality was assessed by calculating the area under the curve (AUC) of the receiver operating characteristic curve.

Results

AKI increased the HRs for overall mortality, and the mortality rate increased with AKI duration: the adjusted HRs were 1.99 (1^st tertile), 2.67 (2^nd tertile), and 2.85 (3^rd tertile) compared with the non-AKI group (all Ps < 0.001). The AUC of the ROC curve for overall mortality based on the AKI duration groups (0.716) was higher than the AUC of AKI staging using the KDIGO guidelines (0.696) (P = 0.001). When considering KDIGO stage and AKI duration together, the AUC (0.717) was also significantly higher than that using the KDIGO stage alone (P < 0.001).

Conclusions

AKI duration is an additional parameter for the prediction of mortality in critically ill patients. The inclusion of AKI duration could be considered as a refinement of the AKI criteria.

【 授权许可】

   
2013 Han et al.; licensee BioMed Central Ltd.

【 图 表 】

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