The importance of the urinary output criterion for the detection and prognostic meaning of AKI

Autor: Wim Van Biesen, Eric Hoste, Johan Steen, Dominique Benoit, Johan Decruyenaere, Stijn Vansteelandt, Pawel Morzywolek, Jill Vanmassenhove
Rok vydání: 2021
Předmět:
Male
Nephrology
030232 urology & nephrology
BASE-LINE CREATININE
urologic and male genital diseases
Severity of Illness Index
law.invention
chemistry.chemical_compound
0302 clinical medicine
law
Medicine and Health Sciences
030212 general & internal medicine
Kidney diseases
Multidisciplinary
Incidence (epidemiology)
Hazard ratio
Acute kidney injury
Acute Kidney Injury
Middle Aged
Prognosis
Intensive care unit
female genital diseases and pregnancy complications
Cardiac surgery
Mathematics and Statistics
Creatinine
Medicine
Female
CRITICALLY-ILL PATIENTS
Adult
medicine.medical_specialty
Science
ACUTE KIDNEY INJURY
Urination
CLASSIFICATION
Article
03 medical and health sciences
Internal medicine
medicine
Humans
Aged
Retrospective Studies
Urinary output
SERUM CREATININE
business.industry
MORTALITY
RISK PREDICTION MODELS
medicine.disease
DEFINITION
Risk factors
chemistry
Emergency medicine
business
ACUTE-RENAL-FAILURE
CARDIAC-SURGERY
Zdroj: Scientific Reports
Scientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
SCIENTIFIC REPORTS
ISSN: 2045-2322
DOI: 10.1038/s41598-021-90646-0
Popis: Most reports on AKI claim to use KDIGO guidelines but fail to include the urinary output (UO) criterion in their definition of AKI. We postulated that ignoring UO alters the incidence of AKI, may delay diagnosis of AKI, and leads to underestimation of the association between AKI and ICU mortality. Using routinely collected data of adult patients admitted to an intensive care unit (ICU), we retrospectively classified patients according to whether and when they would be diagnosed with KDIGO AKI stage ≥ 2 based on baseline serum creatinine (Screa) and/or urinary output (UO) criterion. As outcomes, we assessed incidence of AKI and association with ICU mortality. In 13,403 ICU admissions (62.2% male, 60.8 ± 16.8 years, SOFA 7.0 ± 4.1), incidence of KDIGO AKI stage ≥ 2 was 13.2% when based only the SCrea criterion, 34.3% when based only the UO criterion, and 38.7% when based on both criteria. By ignoring the UO criterion, 66% of AKI cases were missed and 13% had a delayed diagnosis. The cause-specific hazard ratios of ICU mortality associated with KDIGO AKI stage ≥ 2 diagnosis based on only the SCrea criterion, only the UO criterion and based on both criteria were 2.11 (95% CI 1.85–2.42), 3.21 (2.79–3.69) and 2.85 (95% CI 2.43–3.34), respectively. Ignoring UO in the diagnosis of KDIGO AKI stage ≥ 2 decreases sensitivity, may lead to delayed diagnosis and results in underestimation of KDIGO AKI stage ≥ 2 associated mortality.
Databáze: OpenAIRE
Externí odkaz: