Long-term Risk of Mortality and Other Adverse Outcomes After Acute Kidney Injury: A Systematic Review and Meta-analysis

Coca, Steven G.; Yusuf, Bushra; Shlipak, Michael G.; Garg, Amit X.; Parikh, Chirag R.

doi:10.1053/j.ajkd.2008.11.034

Cited by 983 publications

(745 citation statements)

References 74 publications

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“…These observations are in line with epidemiological data suggesting that individuals with a history of intensive hospitalization or injury with a concomitant acute-phase response have increased subsequent mortality primarily from cardiovascular disease. 36,37 In addition, when a cohort of elderly persons with ischemic heart disease were followed for 6 months and CRP levels were correlated with ambient air pollution (SAA was not assessed), CRP levels were statistically significantly associated with PM 2.5 . 38 CRP is a well-known risk factor for cardiovascular disease, independent from SAA.…”

Section: Discussionmentioning

confidence: 99%

Systemic serum amyloid A as a biomarker for exposure to zinc and/or copper-containing metal fumes

Baumann

Gube

Markert

et al. 2017

J Expo Sci Environ Epidemiol

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Zinc-and copper-containing welding fumes increase systemic C-reactive protein (CRP). The aim of this study was to investigate the performance of the biomarkers serum amyloid A (SAA) and soluble vascular cell adhesion molecule-1 (VCAM-1) in this regard. Fifteen male subjects were exposed under controlled conditions to welding fumes containing either zinc, or copper, or copper and zinc for 6 h. Plasma samples were collected before, 6 and 24 h after start of exposure and biomarkers therein were measured by electrochemiluminescent assay. For each exposure, systemic concentrations of systemic SAA, but not VCAM-1, increased significantly at 24 h after exposure start compared with baseline ("copper only": P = 0.0005, "zinc only": P = 0.027, "copper and zinc": P = 0.001). SAA showed a wider range of concentrations than did CRP and its levels increased up to 19-fold after welding fume exposure. The recognition of copper as a potential harmful component in welding fumes, also independent from zinc, deserves further consideration. SAA might represent a new sensitive biomarker for potential subclinical sterile inflammation after inhalation of copper-and/or zinc-containing welding fumes. As elevations of CRP and SAA protein have both been linked to a higher risk for cardiovascular disease, these findings might particularly be important for long-term welders. Journal of Exposure Science and Environmental Epidemiology INTRODUCTIONA large number of workers are exposed to welding fumes containing various types of gases and metal particles in occupational settings. Depending on the constitution of the welding fumes and the respective exposure conditions, epidemiological studies have shown that welding fume exposure is associated with the risk of health impairment through respiratory illness, inflammation and cardiovascular disease. [1][2][3][4] Zinc and copper play an increasing role in modern joining technology, especially in the automotive industry, and hence exposures from workers become more frequent. In a recent study, a distinct increase of systemic C-reactive protein (CRP) has been shown after inhalation of welding fume from a metal inert gas brazing process of zinc-coated steel using a copper-containing welding wire at an average fume concentration of 2.5 mg/m 3 . 5 A further study tested the effect of elevated systemic CRP levels after exposure with three different doses of this welding fume and found increases of CRP after exposure with 2.0 and 2.5 mg/m 3 average fume concentration, but not at 1.4 mg/m 3 . Hence, it was concluded that the no-observed-effect level for systemic inflammation after such exposures was 1.4 mg/m 3 and the lowest observed effect level was 2.0 mg/m 3 . 6 This corresponds to zinc concentrations of 0.84 mg/m 3 and 1.2 mg/m 3 , respectively, and copper concentrations of 0.24 mg/m 3 and 0.34 mg/m 3 , respectively. 6 A subsequent third study showed that the observed effects were due to the zinc as well as copper present in the welding fume, as the welding fumes which contained either zinc and no cop...

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Section: Discussionmentioning

confidence: 99%

Systemic serum amyloid A as a biomarker for exposure to zinc and/or copper-containing metal fumes

Baumann

Gube

Markert

et al. 2017

J Expo Sci Environ Epidemiol

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“…[19][20][21][22][23][24][25][26][27][28][29] To assess a dose-response relationship between an increasing number of instabilities and adverse outcomes, we used the Cochran-Armitage test for trend. We accounted for clustering of patients by hospital using generalized estimating equations.…”

Section: Discussionmentioning

confidence: 99%

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

et al. 2016

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BACKGROUND: Vital sign instability on discharge could be a clinically objective means of assessing readiness and safety for discharge; however, the association between vital sign instability on discharge and post-hospital outcomes is unclear. OBJECTIVE: To assess the association between vital sign instability at hospital discharge and post-discharge adverse outcomes. DESIGN: Multi-center observational cohort study using electronic health record data. Abnormalities in temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation were assessed within 24 hours of discharge. We used logistic regression adjusted for predictors of 30-day death and readmission. PARTICIPANTS: Adults (≥18 years) with a hospitalization to any medicine service in 2009-2010 at six hospitals (safety-net, community, teaching, and non-teaching) in north Texas. MAIN MEASURES: Death or non-elective readmission within 30 days after discharge. KEY RESULTS: Of 32,835 individuals, 18.7 % were discharged with one or more vital sign instabilities. Overall, 12.8 % of individuals with no instabilities on discharge died or were readmitted, compared to 16.9 % with one instability, 21.2 % with two instabilities, and 26.0 % with three or more instabilities (p < 0.001). The presence of any (≥1) instability was associated with higher risk-adjusted odds of either death or readmission (AOR 1.36, 95 % CI 1.26-1.48), and was more strongly associated with death (AOR 2.31, 95 % CI 1.91-2.79). Individuals with three or more instabilities had nearly fourfold increased odds of death (AOR 3.91, 95 % CI 1.69-9.06) and increased odds of 30-day readmission (AOR 1.36, 95 % 0.81-2.30) compared to individuals with no instabilities. Having two or more vital sign instabilities at discharge had a positive predictive value of 22 % and positive likelihood ratio of 1.8 for 30-day death or readmission. CONCLUSIONS: Vital sign instability on discharge is associated with increased risk-adjusted rates of 30-day mortality and readmission. These simple vital sign criteria could be used to assess safety for discharge, and to reduce 30-day mortality and readmissions.

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“…Cardiac‐surgery–associated acute kidney injury (AKI) results in high resource utilization, in‐hospital mortality, permanent loss of renal function, and poor long‐term survival 1, 2, 3, 4. Patients undergoing cardiac surgery procedures performed with cardiopulmonary bypass (CPB; on‐pump) have a high risk of developing AKI 5…”

Section: Introductionmentioning

confidence: 99%

ABT‐719 for the Prevention of Acute Kidney Injury in Patients Undergoing High‐Risk Cardiac Surgery: A Randomized Phase 2b Clinical Trial

McCullough

Bennett‐Guerrero

Chawla³

et al. 2016

JAHA

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BackgroundPatients undergoing cardiac surgeries with cardiopulmonary bypass (on‐pump) have a high risk for acute kidney injury (AKI). We tested ABT‐719, a novel α‐melanocyte‐stimulating hormone analog, for prevention of AKI in postoperative cardiac surgery patients.Methods and ResultsThis phase 2b randomized, double‐blind, placebo‐controlled trial included adult patients with stable renal function undergoing high‐risk on‐pump cardiac surgery in the United States and Denmark. Participants received placebo (n=61) or cumulative ABT‐719 doses of 800 (n=59), 1600 (n=61), or 2100 μg/kg (n=59). Primary outcome was development of AKI based on Acute Kidney Injury Network (AKIN) criteria, measured utilizing preoperative creatinine value and maximum value within 48 hours and urine output within the first 42 hours postsurgery. Secondary outcomes included incidence of AKI based on maximal changes from baseline in novel AKI biomarkers over a 72‐hour period after clamp release and length of intensive care unit stays through 90 days postsurgery. A total of 65.5%, 62.7%, and 69.6% of patients in the 800‐, 1600‐, and 2100‐μg/kg groups, respectively, developed AKI (stages 1, 2, and 3 combined) versus 65.5% in the placebo group (for each pair‐wise comparison with placebo, P=0.966, 0.815, and 0.605, respectively). Adverse events occurred at a similar rate in all treatment groups.Conclusions ABT‐719 treatment did not lower AKI incidence using AKIN criteria, influence the elevations of novel biomarkers, or change 90‐day outcomes in patients after cardiac surgery.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique Identifier: NCT01777165.

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Long-term Risk of Mortality and Other Adverse Outcomes After Acute Kidney Injury: A Systematic Review and Meta-analysis

Abstract: Background-Acute kidney injury (AKI) is common in hospitalized patients. The impact of AKI on long-term outcomes is controversial.

Cited by 983 publications

References 74 publications

Systemic serum amyloid A as a biomarker for exposure to zinc and/or copper-containing metal fumes

Systemic serum amyloid A as a biomarker for exposure to zinc and/or copper-containing metal fumes

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

ABT‐719 for the Prevention of Acute Kidney Injury in Patients Undergoing High‐Risk Cardiac Surgery: A Randomized Phase 2b Clinical Trial

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