The Attributable Mortality of Acute Kidney Injury: A Sequentially Matched Analysis
OBJECTIVE:Acute kidney injury in the critically ill is an independent risk factor for adverse outcome. The magnitude of the impact of acute kidney injury on outcome, however, is still unclear. This study aimed to estimate the excess mortality attributable to acute kidney injury. DESIGN:We performed...
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| Veröffentlicht in: | Critical care medicine 2014-04, Vol.42 (4), p.878-885 |
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| creator | Vaara, Suvi T Pettilä, Ville Kaukonen, Kirsi-Maija Bendel, Stepani Korhonen, Anna-Maija Bellomo, Rinaldo Reinikainen, Matti |
| description | OBJECTIVE:Acute kidney injury in the critically ill is an independent risk factor for adverse outcome. The magnitude of the impact of acute kidney injury on outcome, however, is still unclear. This study aimed to estimate the excess mortality attributable to acute kidney injury.
DESIGN:We performed a sequentially matched analysis according to the day of acute kidney injury diagnosis after ICU admission. Patients with acute kidney injury and those without acute kidney injury were matched according to age, sex, ICU admission diagnosis, Simplified Acute Physiology Score II without renal and age components, and the propensity to develop acute kidney injury at each of the four matching time points.
SETTING:Cohort of 16 participating ICUs from the prospective Finnish Acute Kidney Injury study.
PATIENTS:Cohort of 2,719 consecutive patients with either emergency admission or elective postsurgical patients with an expected ICU stay greater than 24 hours.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Of the 2,719 patients included in the study, acute kidney injury developed in 1,081 patients (39.8%) according to the Kidney DiseaseImproving Global Outcomes—definition during ICU treatment on days 1–5. Of these, 477 patients were successfully matched to 477 patients who did not develop acute kidney injury. The 90-day mortality of the matched patients with acute kidney injury was 125 of 477 (26.2%) compared with 84 of 477 (17.6%) for their matched controls without acute kidney injury. Thus, the absolute excess 90-day mortality attributable to acute kidney injury was estimated at 8.6 percentage points (95% CI, 2.6–17.6 percentage points). The population attributable risk (95% CI) of 90-day mortality associated with acute kidney injury was 19.6% (10.3–34.1%).
CONCLUSIONS:In general ICU patients, the absolute excess 90-day mortality statistically attributable to acute kidney injury is substantial (8.6%), and the population attributable risk was nearly 20%. Our findings are useful in planning suitably powered future clinical trials to prevent and treat acute kidney injury in critically ill patients. |
| doi_str_mv | 10.1097/CCM.0000000000000045 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1508413317</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1508413317</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3355-44604c32e7ab028fc749a5b74b22cd5b9285b408e19f34a8a3d92358c96253aa3</originalsourceid><addsrcrecordid>eNp9kMlKxEAQhhtRdFzeQKQvgpdorybtLQxu6CC4nEOlU2GiPYl2d5C8vZEZFT1Yl7p8_8JPyD5nx5yZ9GQ6nR2zX6f0GplwLVnChJHrZMKYYYlURm6R7RCeGeNKp3KTbAklGOepmpD7xznSPEbflH2E0iGddT6Ca-JAu5rmto9Ib5qqxYFet8-9H85oTh_wrcc2NuDcQGcQ7RwrmrfghtCEXbJRgwu4t_o75Oni_HF6ldzeXV5P89vESql1otQpU1YKTKFkIqttqgzoMlWlELbSpRGZLhXLkJtaKshAVkZInVlzKrQEkDvkaOn76ruxTojFogkWnYMWuz4UXLNMcSl5OqJqiVrfheCxLl59swA_FJwVn2sW45rF3zVH2cEqoS8XWH2LvuYbgcMVAMGCqz20tgk_3Jg_OpmRy5bce-ci-vDi-nf0xRzBxfn_HT4Ah4KLww</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1508413317</pqid></control><display><type>article</type><title>The Attributable Mortality of Acute Kidney Injury: A Sequentially Matched Analysis</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Vaara, Suvi T ; Pettilä, Ville ; Kaukonen, Kirsi-Maija ; Bendel, Stepani ; Korhonen, Anna-Maija ; Bellomo, Rinaldo ; Reinikainen, Matti</creator><creatorcontrib>Vaara, Suvi T ; Pettilä, Ville ; Kaukonen, Kirsi-Maija ; Bendel, Stepani ; Korhonen, Anna-Maija ; Bellomo, Rinaldo ; Reinikainen, Matti ; Finnish Acute Kidney Injury Study Group</creatorcontrib><description>OBJECTIVE:Acute kidney injury in the critically ill is an independent risk factor for adverse outcome. The magnitude of the impact of acute kidney injury on outcome, however, is still unclear. This study aimed to estimate the excess mortality attributable to acute kidney injury.
DESIGN:We performed a sequentially matched analysis according to the day of acute kidney injury diagnosis after ICU admission. Patients with acute kidney injury and those without acute kidney injury were matched according to age, sex, ICU admission diagnosis, Simplified Acute Physiology Score II without renal and age components, and the propensity to develop acute kidney injury at each of the four matching time points.
SETTING:Cohort of 16 participating ICUs from the prospective Finnish Acute Kidney Injury study.
PATIENTS:Cohort of 2,719 consecutive patients with either emergency admission or elective postsurgical patients with an expected ICU stay greater than 24 hours.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Of the 2,719 patients included in the study, acute kidney injury developed in 1,081 patients (39.8%) according to the Kidney DiseaseImproving Global Outcomes—definition during ICU treatment on days 1–5. Of these, 477 patients were successfully matched to 477 patients who did not develop acute kidney injury. The 90-day mortality of the matched patients with acute kidney injury was 125 of 477 (26.2%) compared with 84 of 477 (17.6%) for their matched controls without acute kidney injury. Thus, the absolute excess 90-day mortality attributable to acute kidney injury was estimated at 8.6 percentage points (95% CI, 2.6–17.6 percentage points). The population attributable risk (95% CI) of 90-day mortality associated with acute kidney injury was 19.6% (10.3–34.1%).
CONCLUSIONS:In general ICU patients, the absolute excess 90-day mortality statistically attributable to acute kidney injury is substantial (8.6%), and the population attributable risk was nearly 20%. Our findings are useful in planning suitably powered future clinical trials to prevent and treat acute kidney injury in critically ill patients.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0000000000000045</identifier><identifier>PMID: 24201174</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Acute Kidney Injury - mortality ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Critical Illness - mortality ; Female ; Finland - epidemiology ; Humans ; Intensive care medicine ; Intensive Care Units - statistics & numerical data ; Kidneys ; Male ; Medical sciences ; Middle Aged ; Nephrology. Urinary tract diseases ; Propensity Score ; Prospective Studies ; Risk Factors ; Urinary system involvement in other diseases. Miscellaneous</subject><ispartof>Critical care medicine, 2014-04, Vol.42 (4), p.878-885</ispartof><rights>2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3355-44604c32e7ab028fc749a5b74b22cd5b9285b408e19f34a8a3d92358c96253aa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28410009$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24201174$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vaara, Suvi T</creatorcontrib><creatorcontrib>Pettilä, Ville</creatorcontrib><creatorcontrib>Kaukonen, Kirsi-Maija</creatorcontrib><creatorcontrib>Bendel, Stepani</creatorcontrib><creatorcontrib>Korhonen, Anna-Maija</creatorcontrib><creatorcontrib>Bellomo, Rinaldo</creatorcontrib><creatorcontrib>Reinikainen, Matti</creatorcontrib><creatorcontrib>Finnish Acute Kidney Injury Study Group</creatorcontrib><title>The Attributable Mortality of Acute Kidney Injury: A Sequentially Matched Analysis</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:Acute kidney injury in the critically ill is an independent risk factor for adverse outcome. The magnitude of the impact of acute kidney injury on outcome, however, is still unclear. This study aimed to estimate the excess mortality attributable to acute kidney injury.
DESIGN:We performed a sequentially matched analysis according to the day of acute kidney injury diagnosis after ICU admission. Patients with acute kidney injury and those without acute kidney injury were matched according to age, sex, ICU admission diagnosis, Simplified Acute Physiology Score II without renal and age components, and the propensity to develop acute kidney injury at each of the four matching time points.
SETTING:Cohort of 16 participating ICUs from the prospective Finnish Acute Kidney Injury study.
PATIENTS:Cohort of 2,719 consecutive patients with either emergency admission or elective postsurgical patients with an expected ICU stay greater than 24 hours.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Of the 2,719 patients included in the study, acute kidney injury developed in 1,081 patients (39.8%) according to the Kidney DiseaseImproving Global Outcomes—definition during ICU treatment on days 1–5. Of these, 477 patients were successfully matched to 477 patients who did not develop acute kidney injury. The 90-day mortality of the matched patients with acute kidney injury was 125 of 477 (26.2%) compared with 84 of 477 (17.6%) for their matched controls without acute kidney injury. Thus, the absolute excess 90-day mortality attributable to acute kidney injury was estimated at 8.6 percentage points (95% CI, 2.6–17.6 percentage points). The population attributable risk (95% CI) of 90-day mortality associated with acute kidney injury was 19.6% (10.3–34.1%).
CONCLUSIONS:In general ICU patients, the absolute excess 90-day mortality statistically attributable to acute kidney injury is substantial (8.6%), and the population attributable risk was nearly 20%. Our findings are useful in planning suitably powered future clinical trials to prevent and treat acute kidney injury in critically ill patients.</description><subject>Acute Kidney Injury - mortality</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Critical Illness - mortality</subject><subject>Female</subject><subject>Finland - epidemiology</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Propensity Score</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMlKxEAQhhtRdFzeQKQvgpdorybtLQxu6CC4nEOlU2GiPYl2d5C8vZEZFT1Yl7p8_8JPyD5nx5yZ9GQ6nR2zX6f0GplwLVnChJHrZMKYYYlURm6R7RCeGeNKp3KTbAklGOepmpD7xznSPEbflH2E0iGddT6Ca-JAu5rmto9Ib5qqxYFet8-9H85oTh_wrcc2NuDcQGcQ7RwrmrfghtCEXbJRgwu4t_o75Oni_HF6ldzeXV5P89vESql1otQpU1YKTKFkIqttqgzoMlWlELbSpRGZLhXLkJtaKshAVkZInVlzKrQEkDvkaOn76ruxTojFogkWnYMWuz4UXLNMcSl5OqJqiVrfheCxLl59swA_FJwVn2sW45rF3zVH2cEqoS8XWH2LvuYbgcMVAMGCqz20tgk_3Jg_OpmRy5bce-ci-vDi-nf0xRzBxfn_HT4Ah4KLww</recordid><startdate>201404</startdate><enddate>201404</enddate><creator>Vaara, Suvi T</creator><creator>Pettilä, Ville</creator><creator>Kaukonen, Kirsi-Maija</creator><creator>Bendel, Stepani</creator><creator>Korhonen, Anna-Maija</creator><creator>Bellomo, Rinaldo</creator><creator>Reinikainen, Matti</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201404</creationdate><title>The Attributable Mortality of Acute Kidney Injury: A Sequentially Matched Analysis</title><author>Vaara, Suvi T ; Pettilä, Ville ; Kaukonen, Kirsi-Maija ; Bendel, Stepani ; Korhonen, Anna-Maija ; Bellomo, Rinaldo ; Reinikainen, Matti</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3355-44604c32e7ab028fc749a5b74b22cd5b9285b408e19f34a8a3d92358c96253aa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acute Kidney Injury - mortality</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Critical Illness - mortality</topic><topic>Female</topic><topic>Finland - epidemiology</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Kidneys</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Propensity Score</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vaara, Suvi T</creatorcontrib><creatorcontrib>Pettilä, Ville</creatorcontrib><creatorcontrib>Kaukonen, Kirsi-Maija</creatorcontrib><creatorcontrib>Bendel, Stepani</creatorcontrib><creatorcontrib>Korhonen, Anna-Maija</creatorcontrib><creatorcontrib>Bellomo, Rinaldo</creatorcontrib><creatorcontrib>Reinikainen, Matti</creatorcontrib><creatorcontrib>Finnish Acute Kidney Injury Study Group</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vaara, Suvi T</au><au>Pettilä, Ville</au><au>Kaukonen, Kirsi-Maija</au><au>Bendel, Stepani</au><au>Korhonen, Anna-Maija</au><au>Bellomo, Rinaldo</au><au>Reinikainen, Matti</au><aucorp>Finnish Acute Kidney Injury Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Attributable Mortality of Acute Kidney Injury: A Sequentially Matched Analysis</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2014-04</date><risdate>2014</risdate><volume>42</volume><issue>4</issue><spage>878</spage><epage>885</epage><pages>878-885</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:Acute kidney injury in the critically ill is an independent risk factor for adverse outcome. The magnitude of the impact of acute kidney injury on outcome, however, is still unclear. This study aimed to estimate the excess mortality attributable to acute kidney injury.
DESIGN:We performed a sequentially matched analysis according to the day of acute kidney injury diagnosis after ICU admission. Patients with acute kidney injury and those without acute kidney injury were matched according to age, sex, ICU admission diagnosis, Simplified Acute Physiology Score II without renal and age components, and the propensity to develop acute kidney injury at each of the four matching time points.
SETTING:Cohort of 16 participating ICUs from the prospective Finnish Acute Kidney Injury study.
PATIENTS:Cohort of 2,719 consecutive patients with either emergency admission or elective postsurgical patients with an expected ICU stay greater than 24 hours.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Of the 2,719 patients included in the study, acute kidney injury developed in 1,081 patients (39.8%) according to the Kidney DiseaseImproving Global Outcomes—definition during ICU treatment on days 1–5. Of these, 477 patients were successfully matched to 477 patients who did not develop acute kidney injury. The 90-day mortality of the matched patients with acute kidney injury was 125 of 477 (26.2%) compared with 84 of 477 (17.6%) for their matched controls without acute kidney injury. Thus, the absolute excess 90-day mortality attributable to acute kidney injury was estimated at 8.6 percentage points (95% CI, 2.6–17.6 percentage points). The population attributable risk (95% CI) of 90-day mortality associated with acute kidney injury was 19.6% (10.3–34.1%).
CONCLUSIONS:In general ICU patients, the absolute excess 90-day mortality statistically attributable to acute kidney injury is substantial (8.6%), and the population attributable risk was nearly 20%. Our findings are useful in planning suitably powered future clinical trials to prevent and treat acute kidney injury in critically ill patients.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>24201174</pmid><doi>10.1097/CCM.0000000000000045</doi><tpages>8</tpages></addata></record> |
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| ispartof | Critical care medicine, 2014-04, Vol.42 (4), p.878-885 |
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| subjects | Acute Kidney Injury - mortality Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Critical Illness - mortality Female Finland - epidemiology Humans Intensive care medicine Intensive Care Units - statistics & numerical data Kidneys Male Medical sciences Middle Aged Nephrology. Urinary tract diseases Propensity Score Prospective Studies Risk Factors Urinary system involvement in other diseases. Miscellaneous |
| title | The Attributable Mortality of Acute Kidney Injury: A Sequentially Matched Analysis |
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