TY - JOUR
T1 - Epidemiology and outcomes of acute kidney injury in critically ill surgical patients
AU - Harris, Donald G.
AU - McCrone, Michelle P.
AU - Koo, Grace
AU - Weltz, Adam S.
AU - Chiu, William C.
AU - Scalea, Thomas M.
AU - Diaz, Jose J.
AU - Lissauer, Matthew E.
N1 - Publisher Copyright: © 2014 Elsevier Inc.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Purpose: Acute kidney injury (AKI) is common in critically ill patients but is poorly defined in surgical patients. We studied AKI in a representative cohort of critically ill surgical patients. Methods: This was a retrospective 1-year cohort study of general surgical intensive care unit patients. Patients were identified from a prospective database, and clinical data were reviewed. Acute kidney injury events were defined by risk, injury, failure, loss, and end-stage renal classification criteria. Outcomes were inpatient and 1-year mortality, inpatient lengths of stay, and discharge renal function. Risk factors for AKI and outcomes were compared by univariate and multivariate analyses. Results: Of 624 patients, 296 (47%) developed AKI. Forty-two percent of events were present upon admission, whereas 36% occurred postoperatively. Risk, injury, failure, loss, and end-stage renal classification distributions by grade were as follows: risk, 152 (51%); injury, 69 (23%); and failure, 75 (25%). Comorbid diabetes, emergency admission, major surgery, sepsis, and illness severity were independently associated with renal dysfunction. Patients with AKI had significantly worse outcomes, including increased inpatient and 1-year mortality. Acute kidney injury starting before admission was associated with worse renal dysfunction and greater renal morbidity than de novo inpatient events. Conclusions: Acute kidney injury is common in critically ill surgical patients and is associated with increased mortality, persisting renal impairment and greater resource use.
AB - Purpose: Acute kidney injury (AKI) is common in critically ill patients but is poorly defined in surgical patients. We studied AKI in a representative cohort of critically ill surgical patients. Methods: This was a retrospective 1-year cohort study of general surgical intensive care unit patients. Patients were identified from a prospective database, and clinical data were reviewed. Acute kidney injury events were defined by risk, injury, failure, loss, and end-stage renal classification criteria. Outcomes were inpatient and 1-year mortality, inpatient lengths of stay, and discharge renal function. Risk factors for AKI and outcomes were compared by univariate and multivariate analyses. Results: Of 624 patients, 296 (47%) developed AKI. Forty-two percent of events were present upon admission, whereas 36% occurred postoperatively. Risk, injury, failure, loss, and end-stage renal classification distributions by grade were as follows: risk, 152 (51%); injury, 69 (23%); and failure, 75 (25%). Comorbid diabetes, emergency admission, major surgery, sepsis, and illness severity were independently associated with renal dysfunction. Patients with AKI had significantly worse outcomes, including increased inpatient and 1-year mortality. Acute kidney injury starting before admission was associated with worse renal dysfunction and greater renal morbidity than de novo inpatient events. Conclusions: Acute kidney injury is common in critically ill surgical patients and is associated with increased mortality, persisting renal impairment and greater resource use.
KW - Acute kidney injury
KW - Organ failure
KW - Outcomes
KW - Renal replacement therapy
KW - Surgical critical care
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U2 - https://doi.org/10.1016/j.jcrc.2014.07.028
DO - https://doi.org/10.1016/j.jcrc.2014.07.028
M3 - Article
C2 - 25171816
SN - 0883-9441
VL - 30
SP - 102
EP - 106
JO - Journal of Critical Care
JF - Journal of Critical Care
IS - 1
ER -