ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients.,Annals of Intensive Care

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ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients.
Annals of Intensive Care ( IF 8.1 ) Pub Date : 2018-12-17 , DOI: 10.1186/s13613-018-0467-6
A S Truche _{1,

2,

3} , S Perinel Ragey ₄ , B Souweine ₅ , S Bailly _{1,

2} , L Zafrani _{6,

7} , L Bouadma ₈ , C Clec'h _{9,

10} , M Garrouste-Orgeas _{11,

12} , G Lacave ₁₃ , C Schwebel ₂ , F Guebre-Egziabher ₃ , C Adrie ₁₄ , A S Dumenil ₁₅ , Ph Zaoui ₃ , L Argaud ₁₆ , S Jamali ₁₇ , D Goldran Toledano ₁₈ , G Marcotte ₁₉ , J F Timsit _{1,

8} , M Darmon _{6,

7,

20}

Affiliation

UMR 1137 - IAME Team 5 - DeSCID : Decision SCiences in Infectious Diseases, Control and Care, Inserm/Paris Diderot University, Sorbonne Paris Cité, Paris, France.
Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, U823, La Tronche, France.
Nephrology Dialysis Renal Transplantation, Grenoble University Hospital, La Tronche, France.
Medical Intensive Care Unit, Croix Rousse Hospital, Lyon University Hospital, Lyon, France.
Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France.
Medical Intensive Care Unit, AP-HP, Saint Louis Hospital, Paris, France.
Medicine University, Paris 7 University, Paris, France.
Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris Diderot University, 75018, Paris, France.
Intensive Care Unit, AP-HP, Avicenne Hospital, Paris, France.
Medicine University, Paris 13 University, Bobigny, France.
Intensive Care Unit, Saint Joseph Hospital Network, Paris, France.
Medicine University, Paris Descartes University, Sorbonne Cite, Paris, France.
Medical Intensive Care Unit, André Mignot Hospital, Versailles, France.
Physiology Department, Cochin University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris Descartes University des, Sorbonne Cite, Paris, France.
Medical-Surgical Intensive Care Unit, AP-HP, Antoine Béclère University Hospital, Clamart, France.
Medical Intensive Care Unit, Edouard Herriot University Hospital, Lyon, France.
Critical Care Medicine Unit, Dourdan Hospital, Dourdan, France.
Intensive Care Unit, Gonesse Hospital, Gonesse, France.
Surgical ICU, Edouard Herriot University Hospital, Lyon, France.
ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris, France.

Background

Transient and persistent acute kidney injury (AKI) could share similar physiopathological mechanisms. The objective of our study was to assess prognostic impact of AKI duration on ICU mortality.

Design

Retrospective analysis of a prospective database via cause-specific model, with 28-day ICU mortality as primary end point, considering discharge alive as a competing event and taking into account time-dependent nature of renal recovery. Renal recovery was defined as a decrease of at least one KDIGO class compared to the previous day.

Setting

23 French ICUs.

Patients

Patients of a French multicentric observational cohort were included if they suffered from AKI at ICU admission between 1996 and 2015.

Intervention

None.

Results

A total of 5242 patients were included. Initial severity according to KDIGO creatinine definition was AKI stage 1 for 2458 patients (46.89%), AKI stage 2 for 1181 (22.53%) and AKI stage 3 for 1603 (30.58%). Crude 28-day ICU mortality according to AKI severity was 22.74% (n = 559), 27.69% (n = 327) and 26.26% (n = 421), respectively. Renal recovery was experienced by 3085 patients (58.85%), and its rate was significantly different between AKI severity stages (P < 0.01). Twenty-eight-day ICU mortality was independently lower in patients experiencing renal recovery [CSHR 0.54 (95% CI 0.46–0.63), P < 0.01]. Lastly, RRT requirement was strongly associated with persistent AKI whichever threshold was chosen between day 2 and 7 to delineate transient from persistent AKI.

Conclusions

Short-term renal recovery, according to several definitions, was independently associated with higher mortality and RRT requirement. Moreover, distinction between transient and persistent AKI is consequently a clinically relevant surrogate outcome variable for diagnostic testing in critically ill patients.

中文翻译：

重症患者的 ICU 生存率和肾脏替代治疗的需要与 AKI 持续时间有关。

背景

短暂性和持续性急性肾损伤（AKI）可能具有相似的病理生理机制。我们研究的目的是评估 AKI 持续时间对 ICU 死亡率的预后影响。

设计

通过特定原因模型对前瞻性数据库进行回顾性分析，以 28 天 ICU 死亡率作为主要终点，将活着出院视为竞争事件，并考虑肾脏恢复的时间依赖性。肾脏恢复被定义为与前一天相比至少减少一个 KDIGO 等级。

环境

23 个法国 ICU。

患者

法国多中心观察队列的患者如果在 1996 年至 2015 年间入住 ICU 时患有 AKI，则被纳入其中。

干涉

没有任何。

结果

总共纳入了 5242 名患者。根据 KDIGO 肌酐定义，初始严重程度为 AKI 1 期，其中 2458 名患者 (46.89%)，AKI 2 期为 1181 名患者 (22.53%)，AKI 3 期为 1603 名患者 (30.58%)。根据 AKI 严重程度，28 天 ICU 粗死亡率分别为 22.74% ( n = 559)、27.69% ( n = 327) 和 26.26% ( n = 421)。3085 例患者（58.85%）肾脏恢复，不同 AKI 严重程度的恢复率差异有统计学意义（P < 0.01）。肾脏恢复的患者 28 天 ICU 死亡率独立较低 [CSHR 0.54 (95% CI 0.46–0.63)，P < 0.01]。最后，RRT 要求与持续性 AKI 密切相关，无论在第 2 天到第 7 天之间选择哪个阈值来描述持续性 AKI 的短暂性。