The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study. (3rd July 2015)

• Record Type: Journal Article
• Authors: Wu, Hung-Chieh; Wang, Wei-Jie; Chen, Yu-Wei; Chen, Han-Hsiang
• Is Part Of: Renal failure. Volume 37:Number 6(2015)
• Page Start: 985
• Page End: 993
• Publication Date: 2015-07-03
• Subjects: Acute kidney injury -- duration -- KDIGO stages -- mortality -- non-cardiac surgery; Chronic renal failure -- Periodicals; Acute renal failure -- Periodicals; Uremia -- Periodicals; 616.614005
• DOI: 10.3109/0886022X.2015.1044755
• Languages: English
• ISSNs: 0886-022X

Abstract

Abstract: Objectives : The severity of acute kidney injury (AKI) has been a well-known predictor for in-hospital mortality. Whether AKI duration could predict in-hospital mortality is not clear. This study determines the association between the in-hospital mortality and AKI duration in patients after non-cardiac surgery. Materials and methods : Surgical patients who were admitted to the ICU were enrolled. AKI cases were defined using KDIGO guidelines and categorized according to the tertiles of AKI duration (1st tertile: 2 days, 2nd tertile: 3–6 days and 3rd tertile: 7 days). The adjusted hazard ratios (HRs) for in-hospital mortality are compared to those without AKI. The predictability of mortality is accessed by calculating the area under the curve (AUC) for the receiver operating characteristic (ROC) curve. Results : From a total of 318 postoperative patients, 98 developed AKI (1st tertile: 34 cases, 2nd tertile: 30 cases and 3rd tertile: 34 cases) and 220 had no AKI. The in-hospital mortality rates are 6.8% (non-AKI), 50% (1st tertile), 46.7% (2nd tertile) and 47% (3rd tertile). The HR's for in-hospital mortality are 7.92, 6.68 and 1.68, compared to the non-AKI group ( p = 0.006, 0.021 and 0.476). Cumulative in-hospital survival rates are significantly different for the non-AKI group and the AKI groups ( p < 0.001). The AUC for AKI duration and stage together (0.804) is higher than that for AKI stage and AKI duration alone (0.803 and 0.777) (both p s < 0.001). Conclusion : In addition to severity, the duration of AKI may be a predictor of in-hospital mortality in patients, after non-cardiac surgery.