Dataset Information

A decrease in serum creatinine after ICU admission is associated with increased mortality.

ABSTRACT:

Background

The elevation of serum creatinine (SCr), acute kidney injury (AKI), is associated with an increase of mortality in critically ill patients. However, it is uncertain whether a decrease in SCr in the intensive care unit (ICU) has an effect on outcomes.

Methods

In a retrospective study, we enrolled 486 patients who had been admitted to an urban tertiary center ICU between Jan 2014 and Dec 2014. The effect of changes in SCr after ICU admission on 90 day mortality was analyzed. Patients were classified into 3 groups based on change in SCr after ICU admission: a stable SCr group (? SCr < 0.3mg/dL during ICU stay), a decreased SCr group (? SCr ? -0.3 mg/dL during ICU stay) and an increased SCr group with criteria based on the KDIGO AKI criteria.

Results

In total, 486 patients were identified. SCr decreased in 123 (25.3%) patients after ICU admission. AKI developed in 125 (24.4%) patients. The overall 90-day mortality rate was 29.0%. In a Kaplan-Meyer analysis, the mortality of the AKI group was higher than that of other groups (p<0.0001). Patients with a decrease in SCr had a higher mortality rate than those with stable SCr (p<0.0001). A Cox analysis showed that both a decrease in SCR (HR, 3.56; 95% CI, 1.59-7.97; p = 0.002) and an increase in SCr (AKI stage 1, HR, 9.35; 95% CI, 4.18-20.9; p<0.0001; AKI stage 2, HR, 11.82; 95% CI, 3.85-36.28; p<0.0001; AKI stage 3, HR, 17.41; 95% CI, 5.50-55.04; p<0.0001) were independent risk factors for death compared to stable SCr.

Conclusion

Not only an increase in SCr, but also a decrease in SCr was associated with mortality in critically ill patients.

SUBMITTER: Kang HR

PROVIDER: S-EPMC5570436 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

A decrease in serum creatinine after ICU admission is associated with increased mortality.

Kang Hye Ran HR Lee Si Nae SN Cho Yun Ju YJ Jeon Jin Seok JS Noh Hyunjin H Han Dong Cheol DC Park Suyeon S Kwon Soon Hyo SH

PloS one 20170824 8

<h4>Background</h4>The elevation of serum creatinine (SCr), acute kidney injury (AKI), is associated with an increase of mortality in critically ill patients. However, it is uncertain whether a decrease in SCr in the intensive care unit (ICU) has an effect on outcomes.<h4>Methods</h4>In a retrospective study, we enrolled 486 patients who had been admitted to an urban tertiary center ICU between Jan 2014 and Dec 2014. The effect of changes in SCr after ICU admission on 90 day mortality was analyz ...[more]

PMID: 28837589

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Project description:BACKGROUND:High glycemic variability (GV) is common in critically ill patients; however, the prevalence and mortality association with early GV in patients with sepsis remains unclear. METHODS:This retrospective cohort study was conducted in a medical intensive care unit (ICU) in central Taiwan. Patients in the ICU with sepsis between January 2014 and December 2015 were included for analysis. All of these patients received protocol-based management, including blood sugar monitoring every 2 h for the first 24 h of ICU admission. Mean amplitude of glycemic excursions (MAGE) and coefficient of variation (CoV) were used to assess GV. RESULTS:A total of 452 patients (mean age 71.4?±?14.7 years; 76.7% men) were enrolled for analysis. They were divided into high GV (43.4%, 196/452) and low GV (56.6%, 256/512) groups using MAGE 65 mg/dL as the cut-off point. Patients with high GV tended to have higher HbA1c (6.7?±?1.8% vs. 5.9?±?0.9%, p?<?0.01) and were more likely to have diabetes mellitus (DM) (50.0% vs. 23.4%, p?<?0.01) compared with those in the low GV group. Kaplan-Meier analysis showed that a high GV was associated with increased 30-day mortality (log-rank test, p?=?0.018). The association remained strong in the non-DM (log-rank test, p?=?0.035), but not in the DM (log-rank test, p?=?0.254) group. Multivariate Cox proportional hazard regression analysis identified that high APACHE II score (adjusted hazard ratio (aHR) 1.045, 95% confidence interval (CI) 1.013-1.078), high serum lactate level at 0 h (aHR 1.009, 95% CI 1.003-1.014), having chronic airway disease (aHR 0.478, 95% CI 0.302-0.756), high mean day 1 glucose (aHR 1.008, 95% CI 1.000-1.016), and high MAGE (aHR 1.607, 95% CI 1.008-2.563) were independently associated with increased 30-day mortality. The association with 30-day mortality remained consistent when using CoV to assess GV. CONCLUSIONS:We found that approximately 40% of the septic patients had a high early GV, defined as MAGE >?65 mg/dL. Higher GV within 24 h of ICU admission was independently associated with increased 30-day mortality. These findings highlight the need to monitor GV in septic patients early during an ICU admission.

Project description:BackgroundBile acids (BAs) not only play an important role in lipid metabolism and atherosclerosis but also have antiapoptotic and neuroprotective effects. However, few studies have focused on the relationship of the total bile acid (TBA) levels with the severity and prognosis of acute ischemic stroke (AIS).ObjectivesThe aim of this study was to investigate the potential associations of the fasting serum TBA levels on admission with the stroke severity, in-hospital complication incidence and 3 -month all-cause mortality in patients with AIS.MethodsA total of 777 consecutive AIS patients were enrolled in this study and were divided into four groups according to the quartiles of the serum TBA levels on admission. Univariate and multivariate logistic regression analyses were used to explore the relationship between the fasting TBA levels and the stroke severity, in-hospital complications, and 3-month mortality in AIS patients.ResultsPatients in group Q3 had the lowest risk of severe AIS (NIHSS > 10) regardless of the adjustments for confounders (P < 0.05). During hospitalization, 115 patients (14.8%) had stroke progression (NIHSS score increased by ≥ 2), and 222 patients (28.6%) developed at least one complication, with no significant difference among the four groups (P > 0.05). There was no significant difference in the incidence of pneumonia, urinary tract infection (UTI), hemorrhagic transformation (HT), gastrointestinal bleeding (GIB), seizures or renal insufficiency (RI) among the four groups (P > 0.05). A total of 114 patients (14.7%) died from various causes (including in-hospital deaths) at the 3-month follow-up, including 42 (21.3%), 26 (13.3%), 19 (9.9%) and 27 (13.9%) patients in groups Q1, Q2, Q3 and Q4 respectively, with significant differences (P = 0.013). After adjusting for confounding factors, the risk of death decreased (P -trend < 0.05) in groups Q2, Q3, and Q4 when compared with group Q1, and the OR values were 0.36 (0.16-0.80), 0.30 (0.13-0.70), and 0.29 (0.13-0.65), respectively.ConclusionsTBA levels were inversely associated with the 3-month mortality of AIS patients but were not significantly associated with the severity of stroke or the incidence of complications.

Dataset Information

A decrease in serum creatinine after ICU admission is associated with increased mortality.

Background

Methods

Results

Conclusion

Publications

A decrease in serum creatinine after ICU admission is associated with increased mortality.

Similar Datasets

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