Acute Kidney Injury Recovery Patterns in Critically Ill Patients: Results of a Retrospective Cohort Study
| Autor: | Michael Darmon, Moustafa Abdel-Nabey, Etienne Ghrenassia, Elie Azoulay, Lara Zafrani, Guillaume Morel, Virginie Lemiale, Sandrine Valade, Eric Mariotte |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Organ Dysfunction Scores medicine.medical_treatment Critical Illness Disease Critical Care and Intensive Care Medicine 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Risk Factors Internal medicine medicine Humans Cumulative incidence Stage (cooking) Aged Probability Retrospective Studies Mechanical ventilation Creatinine Models Statistical business.industry Acute kidney injury 030208 emergency & critical care medicine Retrospective cohort study Recovery of Function Acute Kidney Injury Middle Aged medicine.disease Respiration Artificial Intensive Care Units 030228 respiratory system chemistry Female business Kidney disease |
| Zdroj: | Critical care medicine. 49(7) |
| ISSN: | 1530-0293 |
| Popis: | OBJECTIVES Acute kidney injury, acute kidney injury severity, and acute kidney injury duration are associated with both short- and long-term outcomes. Despite recent definitions, only few studies assessed pattern of renal recovery and time-dependent competing risks are usually disregarded. Our objective was to describe pattern of acute kidney injury recovery, change of transition probability over time and their risk factors. DESIGN Monocenter retrospective cohort study. Acute kidney injury was defined according to Kidney Disease Improving Global Outcomes definition. Renal recovery was defined as normalization of both serum creatinine and urine output criteria. Competing risk analysis, time-inhomogeneous Markov model, and group-based trajectory modeling were performed. SETTING Monocenter study. PATIENTS Consecutive patients admitted in ICU from July 2018 to December 2018 were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Three-hundred fifty patients were included. Acute kidney injury occurred in 166 patients at ICU admission, including 64 patients (38.6%) classified as acute kidney disease according to Acute Disease Quality Initiative definition and 44 patients (26.5%) who could not be classified. Cumulative incidence of recovery was 25 % at day 2 (95% CI, 18-32%) and 35% at day 7 (95% CI, 28-42%). After adjustment, need for mechanical ventilation (subdistribution hazard ratio, 0.42; 95% CI, 0.23-0.74) and severity of the acute kidney injury (stage 3 vs stage 1 subdistribution hazard ratio, 0.11; 95% CI, 0.03-0.35) were associated with lack of recovery. Group-based trajectory modeling identified three clusters of temporal changes in this setting, associated with both acute kidney injury recovery and patients' outcomes. CONCLUSIONS In this study, we demonstrate Acute Disease Quality Initiative to allow recovery pattern classification in 75% of critically ill patients. Our study underlines the need to take into account competing risk factors when assessing recovery pattern in critically ill patients. |
| Databáze: | OpenAIRE |
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