1. Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study.
- Author
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Hofer, Debora M., Ruzzante, Livio, Waskowski, Jan, Messmer, Anna S., and Pfortmueller, Carmen A.
- Subjects
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LYMPHEDEMA , *RISK assessment , *MORTALITY , *HYPERVOLEMIA , *CRITICALLY ill , *PATIENTS , *CREATININE , *THERAPEUTICS , *RENAL replacement therapy , *T-test (Statistics) , *SCIENTIFIC observation , *ACUTE kidney failure , *RETROSPECTIVE studies , *MANN Whitney U Test , *LONGITUDINAL method , *ODDS ratio , *INTENSIVE care units , *ADVERSE health care events , *LENGTH of stay in hospitals , *HEALTH outcome assessment , *CONFIDENCE intervals , *DATA analysis software , *REGRESSION analysis , *DISEASE risk factors , *DISEASE complications - Abstract
Background: Fluid accumulation (FA) is known to be associated with acute kidney injury (AKI) during intensive care unit (ICU) stay but data on mid-term renal outcome is scarce. The aim of this study was to investigate the association between FA at ICU day 3 and major adverse kidney events in the first 30 days after ICU admission (MAKE30). Methods: Retrospective, single-center cohort study including adult ICU patients with sufficient data to compute FA and MAKE30. We defined FA as a positive cumulative fluid balance greater than 5% of bodyweight. The association between FA and MAKE30, including its sub-components, as well as the serum creatinine trajectories during ICU stay were examined. In addition, we performed a sensitivity analysis for the stage of AKI and the presence of chronic kidney disease (CKD). Results: Out of 13,326 included patients, 1,100 (8.3%) met the FA definition. FA at ICU day 3 was significantly associated with MAKE30 (adjusted odds ratio [aOR] 1.96; 95% confidence interval [CI] 1.67–2.30; p < 0.001) and all sub-components: need for renal replacement therapy (aOR 3.83; 95%CI 3.02–4.84), persistent renal dysfunction (aOR 1.72; 95%CI 1.40–2.12), and 30-day mortality (aOR 1.70; 95%CI 1.38–2.09), p all < 0.001. The sensitivity analysis showed an association of FA with MAKE30 independent from a pre-existing CKD, but exclusively in patients with AKI stage 3. Furthermore, FA was independently associated with the creatinine trajectory over the whole observation period. Conclusions: Fluid accumulation is significantly associated with MAKE30 in critically ill patients. This association is independent from pre-existing CKD and strongest in patients with AKI stage 3. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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