Incidence of acute kidney injury and attributive mortality in acute respiratory distress syndrome randomized trials
Purpose The development of acute kidney injury (AKI) after the acute respiratory distress syndrome (ARDS) reduces the chance of organ recovery and survival. The purpose of this study was to examine the AKI rate and attributable mortality in ARDS patients. Methods We performed an individual patient-d...
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| Veröffentlicht in: | Intensive care medicine 2024-08, Vol.50 (8), p.1240-1250 |
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| creator | Antonucci, Edoardo Garcia, Bruno Chen, David Matthay, Michael A. Liu, Kathleen D. Legrand, Matthieu |
| description | Purpose
The development of acute kidney injury (AKI) after the acute respiratory distress syndrome (ARDS) reduces the chance of organ recovery and survival. The purpose of this study was to examine the AKI rate and attributable mortality in ARDS patients.
Methods
We performed an individual patient-data analysis including 10 multicenter randomized controlled trials conducted over 20 years. We employed a Super Learner ensemble technique, including a time-dependent analysis, to estimate the adjusted risk of AKI. We calculated the mortality attributable to AKI using an inverse probability of treatment weighting estimator integrated with the Super Learner.
Results
There were 5148 patients included in this study. The overall incidence of AKI was 43.7% (
n
= 2251). The adjusted risk of AKI ranged from 38.8% (95% confidence interval [CI], 35.7 to 41.9%) in ARMA, to 55.8% in ROSE (95% CI, 51.9 to 59.6%). 37.1% recovered rapidly from AKI, with a significantly lower recovery rate in recent trials (
P
|
| doi_str_mv | 10.1007/s00134-024-07485-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11306535</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3090013484</sourcerecordid><originalsourceid>FETCH-LOGICAL-c426t-8b659e0a0e07890bdc7fb09cd0348684a87bfd5842d51ebc67d88b97a1856b243</originalsourceid><addsrcrecordid>eNp9kUlvFDEQhS0EIpPAH-CALHHh0uCtbfcJoSiESJFySc6Wtw4euu3Bdkcafj2ehbAccrBK1vvqVZUeAG8w-oAREh8LQpiyDpH2BJN9x5-BFWaUdJhQ-RysEGWkY5yRE3Bayrrhgvf4JTihUnI2YLwC5Sra4Hy0HqYRartUD78HF_0Whrhe8hbq6KCuNQez1PDg4Zxy1VOoO-DYkH3ZhKxrargLpbZ_gWUbXU5zU5tDmsNP72Bz0VN5BV6MrfjXx3oG7r5c3J5_7a5vLq_OP193lhFeO2l4P3ikkUdCDsg4K0aDBuvaWZJLpqUwo-slI67H3lgunJRmEBrLnhvC6Bn4dPDdLGb2zvpYs57UJodZ561KOqh_lRi-qfv0oDCmiPe0bw7vjw45_Vh8qWoOxfpp0tGnpSiK5CCFGORu2Lv_0HVacmz3NWrYJ7WnyIGyOZWS_fi4DUZqF6o6hKpaqGofquKt6e3fdzy2_E6xAfQAlCbFe5__zH7C9hcJALAf</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3090013484</pqid></control><display><type>article</type><title>Incidence of acute kidney injury and attributive mortality in acute respiratory distress syndrome randomized trials</title><source>MEDLINE</source><source>Springer Online Journals</source><creator>Antonucci, Edoardo ; Garcia, Bruno ; Chen, David ; Matthay, Michael A. ; Liu, Kathleen D. ; Legrand, Matthieu</creator><creatorcontrib>Antonucci, Edoardo ; Garcia, Bruno ; Chen, David ; Matthay, Michael A. ; Liu, Kathleen D. ; Legrand, Matthieu</creatorcontrib><description>Purpose
The development of acute kidney injury (AKI) after the acute respiratory distress syndrome (ARDS) reduces the chance of organ recovery and survival. The purpose of this study was to examine the AKI rate and attributable mortality in ARDS patients.
Methods
We performed an individual patient-data analysis including 10 multicenter randomized controlled trials conducted over 20 years. We employed a Super Learner ensemble technique, including a time-dependent analysis, to estimate the adjusted risk of AKI. We calculated the mortality attributable to AKI using an inverse probability of treatment weighting estimator integrated with the Super Learner.
Results
There were 5148 patients included in this study. The overall incidence of AKI was 43.7% (
n
= 2251). The adjusted risk of AKI ranged from 38.8% (95% confidence interval [CI], 35.7 to 41.9%) in ARMA, to 55.8% in ROSE (95% CI, 51.9 to 59.6%). 37.1% recovered rapidly from AKI, with a significantly lower recovery rate in recent trials (
P
< 0.001). The 90-day excess in mortality attributable to AKI was 15.4% (95% CI, 12.8 to 17.9%). It decreased from 25.4% in ARMA (95% CI, 18.7 to 32%), to 11.8% in FACTT (95% CI, 5.5 to 18%) and then remained rather stable over time. The 90-day overall excess in mortality attributable to acute kidney disease was 28.4% (95% CI, 25.3 to 31.5%).
Conclusions
The incidence of AKI appears to be stable over time in patients with ARDS enrolled in randomized trials. The development of AKI remains a significant contributing factor to mortality. These estimates are essential for designing future clinical trials for AKI prevention or treatment.</description><identifier>ISSN: 0342-4642</identifier><identifier>ISSN: 1432-1238</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-024-07485-6</identifier><identifier>PMID: 38864911</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Acute Kidney Injury - epidemiology ; Acute Kidney Injury - mortality ; Aged ; Anesthesiology ; Clinical trials ; Confidence intervals ; Critical Care Medicine ; Data analysis ; Emergency Medicine ; Female ; Health services ; Humans ; Incidence ; Injury analysis ; Intensive ; Kidney diseases ; Kidneys ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Organ removal ; Original ; Pain Medicine ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Randomized Controlled Trials as Topic ; Recovery ; Respiration ; Respiratory distress syndrome ; Respiratory Distress Syndrome - mortality ; Risk analysis ; Statistical analysis ; Time dependence ; Time dependent analysis ; Weighting methods</subject><ispartof>Intensive care medicine, 2024-08, Vol.50 (8), p.1240-1250</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c426t-8b659e0a0e07890bdc7fb09cd0348684a87bfd5842d51ebc67d88b97a1856b243</cites><orcidid>0000-0003-4891-8649 ; 0000-0001-9788-5316 ; 0000-0002-9413-8152 ; 0000-0001-7031-779X ; 0000-0001-6650-1594</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-024-07485-6$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-024-07485-6$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38864911$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Antonucci, Edoardo</creatorcontrib><creatorcontrib>Garcia, Bruno</creatorcontrib><creatorcontrib>Chen, David</creatorcontrib><creatorcontrib>Matthay, Michael A.</creatorcontrib><creatorcontrib>Liu, Kathleen D.</creatorcontrib><creatorcontrib>Legrand, Matthieu</creatorcontrib><title>Incidence of acute kidney injury and attributive mortality in acute respiratory distress syndrome randomized trials</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>Purpose
The development of acute kidney injury (AKI) after the acute respiratory distress syndrome (ARDS) reduces the chance of organ recovery and survival. The purpose of this study was to examine the AKI rate and attributable mortality in ARDS patients.
Methods
We performed an individual patient-data analysis including 10 multicenter randomized controlled trials conducted over 20 years. We employed a Super Learner ensemble technique, including a time-dependent analysis, to estimate the adjusted risk of AKI. We calculated the mortality attributable to AKI using an inverse probability of treatment weighting estimator integrated with the Super Learner.
Results
There were 5148 patients included in this study. The overall incidence of AKI was 43.7% (
n
= 2251). The adjusted risk of AKI ranged from 38.8% (95% confidence interval [CI], 35.7 to 41.9%) in ARMA, to 55.8% in ROSE (95% CI, 51.9 to 59.6%). 37.1% recovered rapidly from AKI, with a significantly lower recovery rate in recent trials (
P
< 0.001). The 90-day excess in mortality attributable to AKI was 15.4% (95% CI, 12.8 to 17.9%). It decreased from 25.4% in ARMA (95% CI, 18.7 to 32%), to 11.8% in FACTT (95% CI, 5.5 to 18%) and then remained rather stable over time. The 90-day overall excess in mortality attributable to acute kidney disease was 28.4% (95% CI, 25.3 to 31.5%).
Conclusions
The incidence of AKI appears to be stable over time in patients with ARDS enrolled in randomized trials. The development of AKI remains a significant contributing factor to mortality. These estimates are essential for designing future clinical trials for AKI prevention or treatment.</description><subject>Acute Kidney Injury - epidemiology</subject><subject>Acute Kidney Injury - mortality</subject><subject>Aged</subject><subject>Anesthesiology</subject><subject>Clinical trials</subject><subject>Confidence intervals</subject><subject>Critical Care Medicine</subject><subject>Data analysis</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Health services</subject><subject>Humans</subject><subject>Incidence</subject><subject>Injury analysis</subject><subject>Intensive</subject><subject>Kidney diseases</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Organ removal</subject><subject>Original</subject><subject>Pain Medicine</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Recovery</subject><subject>Respiration</subject><subject>Respiratory distress syndrome</subject><subject>Respiratory Distress Syndrome - mortality</subject><subject>Risk analysis</subject><subject>Statistical analysis</subject><subject>Time dependence</subject><subject>Time dependent analysis</subject><subject>Weighting methods</subject><issn>0342-4642</issn><issn>1432-1238</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9kUlvFDEQhS0EIpPAH-CALHHh0uCtbfcJoSiESJFySc6Wtw4euu3Bdkcafj2ehbAccrBK1vvqVZUeAG8w-oAREh8LQpiyDpH2BJN9x5-BFWaUdJhQ-RysEGWkY5yRE3Bayrrhgvf4JTihUnI2YLwC5Sra4Hy0HqYRartUD78HF_0Whrhe8hbq6KCuNQez1PDg4Zxy1VOoO-DYkH3ZhKxrargLpbZ_gWUbXU5zU5tDmsNP72Bz0VN5BV6MrfjXx3oG7r5c3J5_7a5vLq_OP193lhFeO2l4P3ikkUdCDsg4K0aDBuvaWZJLpqUwo-slI67H3lgunJRmEBrLnhvC6Bn4dPDdLGb2zvpYs57UJodZ561KOqh_lRi-qfv0oDCmiPe0bw7vjw45_Vh8qWoOxfpp0tGnpSiK5CCFGORu2Lv_0HVacmz3NWrYJ7WnyIGyOZWS_fi4DUZqF6o6hKpaqGofquKt6e3fdzy2_E6xAfQAlCbFe5__zH7C9hcJALAf</recordid><startdate>20240801</startdate><enddate>20240801</enddate><creator>Antonucci, Edoardo</creator><creator>Garcia, Bruno</creator><creator>Chen, David</creator><creator>Matthay, Michael A.</creator><creator>Liu, Kathleen D.</creator><creator>Legrand, Matthieu</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</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>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4891-8649</orcidid><orcidid>https://orcid.org/0000-0001-9788-5316</orcidid><orcidid>https://orcid.org/0000-0002-9413-8152</orcidid><orcidid>https://orcid.org/0000-0001-7031-779X</orcidid><orcidid>https://orcid.org/0000-0001-6650-1594</orcidid></search><sort><creationdate>20240801</creationdate><title>Incidence of acute kidney injury and attributive mortality in acute respiratory distress syndrome randomized trials</title><author>Antonucci, Edoardo ; Garcia, Bruno ; Chen, David ; Matthay, Michael A. ; Liu, Kathleen D. ; Legrand, Matthieu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-8b659e0a0e07890bdc7fb09cd0348684a87bfd5842d51ebc67d88b97a1856b243</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Acute Kidney Injury - epidemiology</topic><topic>Acute Kidney Injury - mortality</topic><topic>Aged</topic><topic>Anesthesiology</topic><topic>Clinical trials</topic><topic>Confidence intervals</topic><topic>Critical Care Medicine</topic><topic>Data analysis</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Health services</topic><topic>Humans</topic><topic>Incidence</topic><topic>Injury analysis</topic><topic>Intensive</topic><topic>Kidney diseases</topic><topic>Kidneys</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Organ removal</topic><topic>Original</topic><topic>Pain Medicine</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Recovery</topic><topic>Respiration</topic><topic>Respiratory distress syndrome</topic><topic>Respiratory Distress Syndrome - mortality</topic><topic>Risk analysis</topic><topic>Statistical analysis</topic><topic>Time dependence</topic><topic>Time dependent analysis</topic><topic>Weighting methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Antonucci, Edoardo</creatorcontrib><creatorcontrib>Garcia, Bruno</creatorcontrib><creatorcontrib>Chen, David</creatorcontrib><creatorcontrib>Matthay, Michael A.</creatorcontrib><creatorcontrib>Liu, Kathleen D.</creatorcontrib><creatorcontrib>Legrand, Matthieu</creatorcontrib><collection>SpringerOpen</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Antonucci, Edoardo</au><au>Garcia, Bruno</au><au>Chen, David</au><au>Matthay, Michael A.</au><au>Liu, Kathleen D.</au><au>Legrand, Matthieu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence of acute kidney injury and attributive mortality in acute respiratory distress syndrome randomized trials</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2024-08-01</date><risdate>2024</risdate><volume>50</volume><issue>8</issue><spage>1240</spage><epage>1250</epage><pages>1240-1250</pages><issn>0342-4642</issn><issn>1432-1238</issn><eissn>1432-1238</eissn><abstract>Purpose
The development of acute kidney injury (AKI) after the acute respiratory distress syndrome (ARDS) reduces the chance of organ recovery and survival. The purpose of this study was to examine the AKI rate and attributable mortality in ARDS patients.
Methods
We performed an individual patient-data analysis including 10 multicenter randomized controlled trials conducted over 20 years. We employed a Super Learner ensemble technique, including a time-dependent analysis, to estimate the adjusted risk of AKI. We calculated the mortality attributable to AKI using an inverse probability of treatment weighting estimator integrated with the Super Learner.
Results
There were 5148 patients included in this study. The overall incidence of AKI was 43.7% (
n
= 2251). The adjusted risk of AKI ranged from 38.8% (95% confidence interval [CI], 35.7 to 41.9%) in ARMA, to 55.8% in ROSE (95% CI, 51.9 to 59.6%). 37.1% recovered rapidly from AKI, with a significantly lower recovery rate in recent trials (
P
< 0.001). The 90-day excess in mortality attributable to AKI was 15.4% (95% CI, 12.8 to 17.9%). It decreased from 25.4% in ARMA (95% CI, 18.7 to 32%), to 11.8% in FACTT (95% CI, 5.5 to 18%) and then remained rather stable over time. The 90-day overall excess in mortality attributable to acute kidney disease was 28.4% (95% CI, 25.3 to 31.5%).
Conclusions
The incidence of AKI appears to be stable over time in patients with ARDS enrolled in randomized trials. The development of AKI remains a significant contributing factor to mortality. These estimates are essential for designing future clinical trials for AKI prevention or treatment.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38864911</pmid><doi>10.1007/s00134-024-07485-6</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-4891-8649</orcidid><orcidid>https://orcid.org/0000-0001-9788-5316</orcidid><orcidid>https://orcid.org/0000-0002-9413-8152</orcidid><orcidid>https://orcid.org/0000-0001-7031-779X</orcidid><orcidid>https://orcid.org/0000-0001-6650-1594</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Intensive care medicine, 2024-08, Vol.50 (8), p.1240-1250 |
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| source | MEDLINE; Springer Online Journals |
| subjects | Acute Kidney Injury - epidemiology Acute Kidney Injury - mortality Aged Anesthesiology Clinical trials Confidence intervals Critical Care Medicine Data analysis Emergency Medicine Female Health services Humans Incidence Injury analysis Intensive Kidney diseases Kidneys Male Medicine Medicine & Public Health Middle Aged Mortality Organ removal Original Pain Medicine Patients Pediatrics Pneumology/Respiratory System Randomized Controlled Trials as Topic Recovery Respiration Respiratory distress syndrome Respiratory Distress Syndrome - mortality Risk analysis Statistical analysis Time dependence Time dependent analysis Weighting methods |
| title | Incidence of acute kidney injury and attributive mortality in acute respiratory distress syndrome randomized trials |
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