1. ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients.
- Author
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Truche, A. S., Ragey, S. Perinel, Souweine, B., Bailly, S., Zafrani, L., Bouadma, L., Clec'h, C., Garrouste-Orgeas, M., Lacave, G., Schwebel, C., Guebre-Egziabher, F., Adrie, C., Dumenil, A. S., Zaoui, Ph., Argaud, L., Jamali, S., Goldran Toledano, D., Marcotte, G., Timsit, J. F., and Darmon, M.
- Subjects
CRITICALLY ill - Abstract
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. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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