Using AKI burden or other more granular methods may be helpful in future epidemiological studies of AKI. Of these, 641 patients (58%) had low burden (< 0.25), 186 patients (17%) had medium burden (0.25–0.50) and 269 patients (25%) had high burden (> 0.50).

2015;41:81–8. Using multiple imputations could have optimized our analysis. 2018;8:127. https://doi.org/10.1186/s13613-018-0467-6. Vaara ST, Parviainen I, Pettilä V, Nisula S, Inkinen O, Uusaro A, et al. The datasets used during the current study are available from the corresponding author on reasonable request. The study, published in the Clinical Journal of the American Society of Nephrology, finds a kidney recovery rate of 35% in patients with kidney failure due to AKI… Acute kidney injury (AKI) is a frequent complication of hospitalization and is associated with an increased risk of chronic kidney disease (CKD), end-stage renal disease (ESRD), and mortality. California Privacy Statement, The proportions of missing values for Cr and urine output during the study period are shown in Additional file 1: Table S2. Nevertheless, we were lacking data on Cr and urine output all 5days in both cohorts, as patients could have been discharged to the ward (in which case a low burden would be expected) or deceased during these first 5 days (in which case a higher burden would be expected). AKI Burden could be calculated for 2793 patients (99%). Mehta S, Chauhan K, Patel A, Patel S, Pinotti R, Nadkarni GN, et al. Exclusion criteria were discharge within 24 h and/or absence of informed consent. Burden of acute kidney injury and subsequent mortality rate in the SICS-I cohort. Acute kidney injury is characterized by abrupt deterioration in kidney function, manifested by an increase in serum creatinine level with or without reduced urine output. We handled missing data in each cohort following the original statistical methods. Nisula S, Kaukonen K-M, Vaara ST, Korhonen A-M, Poukkanen M, Karlsson S, et al. A worldwide multicentre evaluation of the influence of deterioration or improvement of acute kidney injury on clinical outcome in critically ill patients with and without sepsis at ICU admission: results from the intensive care over nations audit. Despite the statistically significant difference, the clinical significance of this finding may be limited.

Blacks, Asians, Hispanics and Native Americans had lower likelihoods of kidney recovery as compared to white. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. They argued that time-dependent variables representing the course of AKI should be taken in to account for diagnostic and prognostic purposes, however, no urine output data were available and thus these conclusions were based on Cr AKI only [12]. Burden of acute kidney injury and 90-day mortality in critically ill patients. with these terms and conditions. The AKI burden at each specific day was maximal (i.e. Although adjusted for differences in age-distribution and population size, rankings by state do not take into account other state specific population characteristics that may affect the level of mortality. Outcomes are calculated as odds ratios (OR) with 95% confidence intervals (CI). Finally, we divided this score by the maximum possible score during the observation period to prevent underestimation of AKI burden in patients with missing data (the maximum score was 30, if there were no missing data, for examples see Table 1). Crit Care. Coca SG, King JT, Rosenthal RA, Perkal MF, Parikh CR. The authors declare that they have no competing interests. Percentages of missing data in FINNAKI. doi.org/10.2215/CJN.11200919. Peters E, Antonelli M, Wittebole X, Nanchal R, François B, Sakr Y, et al. 2017;7:e017170. J Am Soc Nephrol. Clinical practice guideline for acute kidney injury.

Intensive Care Med. 2010;25:3911–8. The Odds Ratio (OR) for 90-day mortality was the highest for AKI burden 4.56 (95%CI 3.22–6.53). This study was a post-hoc analysis of the FINNAKI [3] and SICS-I cohort studies [14]. The Ethics Committee of the Department of Surgery in Helsinki University Central Hospital approved the FINNAKI study protocol with a deferred, written consent obtained from the patient or proxy as soon as possible. Studies generally focus on the presence of AKI as a dichotomous variable or report the maximum stage, but often do not incorporate duration of AKI. In the current study, we further excluded patients from one study site as data of urine output were collected by different method. https://doi.org/10.1007/s00134-012-2796-5, https://doi.org/10.1038/s41581-018-0052-0, https://doi.org/10.1007/s00134-012-2767-x, https://doi.org/10.1016/J.ATHORACSUR.2010.04.039, https://doi.org/10.1186/s13613-018-0467-6, https://doi.org/10.1186/s12882-018-0876-7, https://doi.org/10.1007/s00134-019-05527-y, http://www.ncbi.nlm.nih.gov/pubmed/12859163, https://doi.org/10.1007/s00134-002-1272-z, https://doi.org/10.1097/CCM.0000000000003897, https://doi.org/10.1186/s13054-015-0848-2, https://doi.org/10.1186/s13054-018-2112-z, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12882-019-1645-y. Article  Compared to men, women had a 14% lower likelihood of kidney recovery. The model including AKI burden (area under the receiver operator curve (AUROC) 0.78, 0.76–0.80) outperformed the models using AKI presence (AUROC 0.77, 0.75–0.79, p = 0.026) or AKI severity (AUROC 0.77, 0.75–0.79, p = 0.012), but not AKI duration (AUROC 0.77, 0.75–0.79, p = 0.06). PubMed  We used the previously published logistic regression model from FINNAKI and the logistic regression model of SICS-I as the main models for predicting 90-day mortality; these models will from now on be referred to as the ‘original models’.

Variation in risk and mortality of acute kidney injury in critically ill patients: a multicenter study. Our observations encourage researchers to look beyond stage or duration of AKI and incorporate AKI burden as risk factor. In the FINNAKI cohort no imputations were performed. Pickkers P, Ostermann M, Joannidis M, Zarbock A, Hoste E, Bellomo R, et al. volume 21, Article number: 1 (2020) Finally, we anticipated that AKI burden had resulted in a more clinically significant increase in the prediction ability compared to presence or severity of AKI. In patients with low, medium and high AKI burden, mortality rates were 27% (CI 23–31), 35% (CI 29–42) and 44% (CI 38–50), respectively (Fig. ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients. Our objective was to analyse whether a new variable, AKI burden, would predict 90-day mortality better than either 1) the presence of AKI, 2) the highest AKI stage, or 3) the duration of AKI alone, by conducting post-hoc analyses of two independent cohorts: the Finnish Acute Kidney Injury (FINNAKI) study [3], and the Simple Intensive Care Studies-I (SICS-I) [14]. [8], who investigated the empirical relationships between oliguria, Cr disturbances, and mortality. We validated our results in a separate cohort, which is a major strength of our study and shows that our results apply to different cohorts. Day 1 was defined as the calendar day of admission. 2005;16:3365–70. KDIGO. PubMed  Article  Article  The proportions of missing values for Cr and urine output during the study period are shown in Additional file 1: Table S1. AKI burden was defined as AKI stage multiplied with the number of days that each stage was present (maximum five), divided by the maximum possible score yielding a proportion. The initial workup includes a patient history to identify the u… This site complies with the HONcode standard for trustworthy health information: verify here. The FINNAKI study has been supported by the Academy of Finland, the Sigrid Juselius Foundation, Päivikki and Sakari Sohlberg Foundation, and Institutional Grants from the Helsinki University Hospital (TYH2013343, TYH2016243, TYH 2017241). However, that study was a single centre study and did not use a fixed mortality endpoint.

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