Acute Kidney Injury Predicts Outcomes of Non-Critically Ill Patients

Abstract

OBJECTIVE: To evaluate whether acute kidney injury (AKI), defined as an increase in the serum creatinine level of 0.3 mg/dL or more within 48 hours, predicts outcomes of non-critically ill patients. PATIENTS AND METHODS:Among the adults admitted from June 1, 2005, to June 30, 2007, to the medical wards of a community teaching hospital, 735 patients with AKI and 5089 controls were identified. Demographic and health information, serum creatinine values, and outcomes were abstracted from patients' computerized medical records. Outcomes of patients with AKI were compared with those of controls. In an additional case-control analysis, more detailed clinical information was abstracted from the medical records of 282 pairs of randomly selected, age-matched AKI cases and controls. Conditional multivariate logistic regression analyses were used to adjust for potential confounders of AKI effect on outcomes.RESULTS: Overall, patients with AKI had higher in-hospital mortality (14.8% vs 1.5%; P<.001), longer lengths of stay (median 7.9 vs 3.7 days; P<.001), and higher rates of transfer to critical care areas (28.6% vs 4.3%; P<.001); survivors were more likely to be discharged to an extended care facility (43.1% vs 20.3%; P<.001). Conditional multivariate logistic regression analyses of the 282 pairs of cases and controls showed that patients with AKI were 8 times more likely to die in hospital (odds ratio [OR], 7.9; 95% CI [confidence interval], 2.9-15.3) and were 5 times more likely to have prolonged (≥7 days) hospital stays (OR, 5.2; 95% CI, 3.5-7.9) and require intensive care (OR, 4.7; 95% CI, 2.7-8.1), after adjustment for age, comorbidities, and other potential confounders. CONCLUSION:In this study, AKI was associated with adverse outcomes in non-critically ill patients.Mayo Clin Proc. 2009;84(5):410-416 AKI = acute kidney injury; CI = confidence interval; CKD = chronic kidney disease; ECF = extended-care facility; GFR = glomerular filtration rate; ICU = intensive care unit; LOS = length of stay; NGAL = neutrophil gelatinase-associated lipocalin; OR = odds ratio; RR = risk ratio; RRT = renal replacement therapy

Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study

“…It is known, that primary renal failure, secondary to a variety of pathologic conditions affecting the kidney, is usually treated in non-intensive care units and has relatively good prognosis and low mortality (5-10%) [40,41]. In contrast, the onset of AKI, as a part of multiple organ failure has 50-70% mortality [5,18].…”

Fluid accumulation and acute kidney injury: consequence or cause

“…Acute kidney injury (AKI) frequently occurs in critically ill and hospitalized patients and is associated with increased morbidity and mortality [1,2]. Despite significant advances in the global care of these patients, the incidence of AKI is increasing and its associated mortality has only decreased slightly [3].…”

An Assessment of AKIN Criteria for Hospital-Acquired Acute Kidney Injury: A Prospective Observational Cohort Study

“…To our knowledge, this is the first prospective study investigating whether the AKIN criteria have prognostic and predictive value in all hospitalized patients. While Barrantes et al [10,11 ]conducted investigations regarding the effect of AKI on outcomes for both critically ill and non-critically ill patients using the AKIN criteria, these studies were performed retrospectively and focused on AKI effects depending on the AKIN definition. Our results suggest that AKI, as defined by the AKIN criteria, is associated with an increased risk for hospital mortality compared with those patients who never developed AKI.…”