Inter-hospital transfers and outcomes of critically ill patients with severe acute kidney injury: a multicenter cohort study

Kudlow, Paul; Burns, Karen E. A.; Adhikari, Neill K. J.; Bell, Benjamin R.; Klein, David J.; Xie, Bin; Friedrich, Jan O.; Wald, Ron

doi:10.1186/s13054-014-0513-1

Cited by 8 publications

(8 citation statements)

References 14 publications

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“…These findings were consistent in a propensity-score matched sensitivity analysis. Our findings are congruent with the only other study examining patients transferred for AKI requiring dialysis, which suggested that patients requiring transfer fared no worse (at 30-days) than those presenting to a dialysis-providing hospital (11).…”

Section: Discussionsupporting

confidence: 89%

“…As RRT may reverse uremic and metabolic complications of AKI, delays in therapy associated with inter-hospital transfer may result in worse patient outcomes. To date, there has only been a single study examining patients transferred for the receipt of acute dialysis, which did not demonstrate an association between transfer and death or dialysis dependence at 30days (11). This study was limited by a relatively small sample size, the inclusion of only two centers, and limited follow-up duration.…”

Section: Introductionmentioning

confidence: 99%

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Interhospital Transfer and Outcomes in Patients with AKI: A Population-Based Cohort Study

et al. 2020

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Background: Patients with acute kidney injury (AKI) may require inter-hospital transfer in order to receive renal replacement therapy (RRT). Inter-hospital transfer may lead to delays in therapy resulting in poor patient outcomes. There is minimal data comparing outcomes among patients undergoing transfer for RRT versus those who receive RRT at the hospital to which they first present. Methods: We conducted a population-based cohort study of all adult patients (19 years and older) who received acute dialysis within 14 days of admission to an acute care hospital between April 1, 2004 and March 31, 2015. The transferred group included all patients who presented to a hospital without a dialysis program and underwent interhospital transfer (with the start of dialysis ≤3 days of transfer and within 14 days of initial admission). All other patients were considered non-transferred. The primary outcome was time to 90-day all-cause mortality adjusting for demographics, comorbidities and measures of acute illness severity. We also assessed chronic dialysis dependence as a secondary outcome using Fine and Gray proportional hazards model to account for the competing risks of death. In a secondary post-hoc analysis, we assessed these outcomes in a propensity-score matched cohort, matching on age, sex and prior chronic kidney disease status. Results: We identified 27,270 individuals initiating acute RRT within 14 days of a hospital admission, of whom 2,113 underwent inter-hospital transfer. Inter-hospital transfer was associated with lower rate of mortality [adjusted hazard ratio (aHR) 0.90 (95%CI: 0.84-0.97)]. Chronic dialysis dependence was not significantly different between groups [aHR 0.98 (0.91-1.06)]. In the propensity score matched analysis, interhospital transfer remained associated with a lower risk of death [HR 0.88 (0.80-0.96)]. Conclusions: Inter-hospital transfer for receipt of RRT does not confer higher mortality or worse kidney outcomes.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Interhospital Transfer and Outcomes in Patients with AKI: A Population-Based Cohort Study

et al. 2020

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“…Hill et al [ 7 ] also elaborated on the above-discussed concept of determining outcomes based on admission sources. However, Kudlow et al [ 18 ] did not agree with earlier researchers' findings in terms of associating mortality with the source of admission. Their study focused on inter-hospital transfers and found no positive evidence linking mortality risk with admission sources.…”

Section: Discussionmentioning

confidence: 82%

The Association Between Admission Sources and Outcomes at a Pediatric Intensive Care Unit in Al-Ahsa, Saudi Arabia: A Retrospective Cohort Study

AlKadhem

AlKhwaitm

Alkhars

et al. 2020

Cureus

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In this study, we aimed to examine the association between sources of admission (either intra-hospital transfers or ED admissions) in pediatric intensive care units (PICUs) and the discharge rate, mortality rate, and referral over a period of three years. We also sought to identify the independent predictors of discharge and mortality rate in the study population. Patients and methods This was a retrospective cohort study involving the analysis of 2,547 patients' data collected from the Pediatric Intensive Care Registry of a secondary care community hospital. We included patients admitted to the PICU from January 1, 2016, till December 31, 2018, who were aged 0-14 years with a specific diagnosis, recorded source of admission, and clear outcome. Data were collected, coded, and analyzed using the SPSS Statistics software (IBM, Armonk, NY) and STATA software (StataCorp, College Station, TX). Results Of the included patients, 1,356 (53.2%) were males, and 1,191 (46.8%) were females. Infants were associated with an increased risk of a long stay in the hospital [relative risk ratio (RRR)=5.34, 95% CI: (1.28, 22.27)] and mortality [RRR=3.56, 95% CI: (1.41, 8.95)] compared to older children. Similarly, neonates were associated with a higher risk of mortality [RRR=2.83, 95% CI: (1.05, 7.65)]. Patients who were admitted through ED were associated with a lower risk of a long-stay [RRR=0.56, 95% CI: (10.36, 0.87)] and mortality [RRR=0.68, 95% CI: (0.49, 0.95)] compared to intra-hospital transfers. Concerning the admission date, all time periods were associated with a lower risk of mortality compared to the period of October-December. Conclusion Our findings showed that the age of patients, source of admission, and date of admission might be used as independent predictors for determining the outcome of admissions, including discharge and mortality rates. Further studies are required to confirm these findings.

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“…This finding, previously noted at our institution, 4 has also appeared in other studies: in patients with systemic lupus erythematosus, 5 acute myocardial infarction 6,7 and acute renal failure. 8 Admittedly, other comparisons between transferred and non-transferred critically ill patients have not shown that transferred patients were generally younger. 9,10 However, these studies were conducted in a different milieu from our own, being conducted in a large tertiary care referral center or in the United Kingdom, respectively.…”

Section: Discussionmentioning

confidence: 99%

A Chart Review of Acute Care Inter-Hospital Transfers from Rural WV Hospitals

Nair¹,

Vaughan²,

Bennett³

2017

mjm

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Inter-hospital transfers and outcomes of critically ill patients with severe acute kidney injury: a multicenter cohort study

Cited by 8 publications

References 14 publications

Interhospital Transfer and Outcomes in Patients with AKI: A Population-Based Cohort Study

Interhospital Transfer and Outcomes in Patients with AKI: A Population-Based Cohort Study

The Association Between Admission Sources and Outcomes at a Pediatric Intensive Care Unit in Al-Ahsa, Saudi Arabia: A Retrospective Cohort Study

A Chart Review of Acute Care Inter-Hospital Transfers from Rural WV Hospitals

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