Dataset Information

Incident infection following acute kidney injury with recovery to baseline creatinine: A propensity score matched analysis.

ABSTRACT:

Background

Severe acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with incident infection is unknown.

Objective

We hypothesized that risk of both short and long term infection would be higher among patients with AKI and return to baseline creatinine than in propensity score matched peers without AKI in the year following a non-infectious hospital admission.

Design

Retrospective, propensity score matched cohort study.

Participants

We identified 494 patients who were hospitalized between January 1, 1999 and December 31, 2009 and had AKI followed by return to baseline creatinine. These were propensity score matched to controls without AKI.

Main measures

The predictor variable was AKI defined by International Classification of Diseases, Ninth Revision (ICD-9) codes and by the Kidney Disease Improving Global Outcomes definition, with return to baseline creatinine defined as a decrease in serum creatinine level to within 10% of the baseline value within 7 days of hospital discharge. The outcome variable was incident infection defined by ICD-9 code within 1 year of hospital discharge.

Results

AKI followed by return to baseline creatinine was associated with a 4.5-fold increased odds ratio for infection (odds ratio 4.53 [95% CI, 2.43-8.45]; p<0.0001) within 30 days following discharge. The association between AKI and subsequent infection remained significant at 31-60 days and 91 to 365 days but not during 61-90 days following discharge.

Conclusion

Among patients from an integrated health care delivery system, non-infectious AKI followed by return to baseline creatinine was associated with an increased odds ratio for infection in the year following discharge.

SUBMITTER: Griffin BR

PROVIDER: S-EPMC6590794 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

Incident infection following acute kidney injury with recovery to baseline creatinine: A propensity score matched analysis.

Griffin Benjamin R BR You Zhiying Z Holmen John J SooHoo Megan M Gist Katja M KM Colbert James F JF Chonchol Michel M Faubel Sarah S Jovanovich Anna A

PloS one 20190624 6

<h4>Background</h4>Severe acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with incident infection is unknown.<h4>Objective</h4>We hypothesized that risk of both short and long term infection would be higher among patients with AKI and return to baseline creatinine than in propensity score matched peers without AKI in the year following a non-infectious hospital admission.<h4>Design</h4>Retrospective, propens ...[more]

PMID: 31233518

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Project description:BackgroundThe association between preoperative aspirin use and postoperative acute kidney injury (AKI) in cardiovascular surgery is unclear. We sought to evaluate the effect of preoperative aspirin use on postoperative AKI in cardiac surgery.MethodsA total of 770 patients who underwent cardiovascular surgery under cardiopulmonary bypass were reviewed. Perioperative clinical parameters including preoperative aspirin administration were retrieved. We matched 108 patients who took preoperative aspirin continuously with patients who stopped aspirin more than 7 days or did not take aspirin for the month before surgery. The parameters used in the matching included variables related to surgery type, patient's demographics, underlying medical conditions and preoperative medications.ResultsIn the first seven postoperative days, 399 patients (51.8%) developed AKI, as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria and 128 patients (16.6%) required hemodialysis. Most patients took aspirin 100 mg once daily (n = 195, 96.5%) and the remaining 75 mg once daily. Multivariable analysis showed that preoperative maintenance of aspirin was independently associated with decreased incidence of postoperative AKI (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.21-0.98, P = 0.048; after propensity score matching: OR 0.39, 95% CI 0.22-0.67, P = 0.001). Preoperative maintenance of aspirin was associated with less incidence of AKI defined by KDIGO both in the entire and matched cohort (n = 44 [40.7%] vs. 69 [63.9%] in aspirin and non-aspirin group, respectively in matched sample, relative risk [RR] 0.64, 95% CI 0.49, 0.83, P = 0.001). Preoperative aspirin was associated with decreased postoperative hospital stay after matching (12 [9-18] days vs. 16 [10-25] in aspirin and non-aspirin group, respectively, P = 0.038). Intraoperative estimated or calculated blood loss using hematocrit difference and estimated total blood volume showed no difference according to aspirin administration in both entire and matched cohort.ConclusionsPreoperative low dose aspirin administration without discontinuation was protective against postoperative AKI defined by KDIGO criteria independently in both entire and matched cohort. Preoperative aspirin was also associated with decreased hemodialysis requirements and decreased postoperative hospital stay without increasing bleeding. However, differences in AKI and hospital stay were not associated with in-hospital mortality.

Project description:Background Acute kidney injury (AKI) remains a concern in hospitalized children undergoing CT with intravenous iodinated contrast material (ICM). Adult studies have shown frequencies of AKI after CT with intravenous ICM to be similar to propensity score-matched ICM-unexposed patient groups; similar data in pediatric patients are lacking. Purpose To evaluate the association between intravenous ICM exposure and AKI in hospitalized pediatric patients with stable kidney function undergoing contrast material-enhanced CT by comparing with a propensity score-matched ICM-unexposed patient sample undergoing abdominal US. Materials and Methods In this retrospective observational study, hospitalized patients aged 18 years or younger with stable kidney function and available serum creatinine (SCr) measurement before and after imaging who underwent CT with intravenous ICM or abdominal US (control group) between January 2009 and November 2018 were identified. The 1:1 propensity score matching was performed by using 23 covariates, stratified by estimated glomerular filtration rate (eGFR) before imaging (≥60 mL/min/1.73 m2 or <60 mL/min/1.73 m2). AKI was defined by using Acute Kidney Injury Network SCr-related criteria. Multivariable logistic regression was performed to identify risk factors for AKI after imaging, including the effects of eGFR and intravenous ICM exposure before imaging. Results A total of 1850 unique patients were included in the propensity score-matched sample (925 exposed to ICM [mean age ± standard deviation, 8 years ± 6; 484 female patients]; 925 unexposed to ICM [mean age, 7 years ± 6; 484 female patients]). Frequency of AKI with eGFR greater than or equal to 60 mL/min/1.73 m2 was 2.2% (20 of 889) for CT and US (odds ratio [OR]: 0.98; 95% confidence interval [CI]: 0.52, 1.86; adjusted P = .95) and with eGFR less than 60 mL/min/1.73 m2 was 5.6% (two of 36) and 11.1% (four of 36) for CT and US, respectively (OR: 0.75; 95% CI: 0.11, 5.00; adjusted P = .76). Significant multivariable predictors of AKI included eGFR before imaging (OR: 0.99; 95% CI: 0.98, 0.995; P = .001), body mass index (OR: 1.06; 95% CI: 1.02, 1.10; P = .003), acquired kidney disease (OR: 1.95; 95% CI: 1.004, 3.78; P = .049), and nephrotoxic antibiotic exposure (OR: 2.86; 95% CI: 1.55, 5.25; P < .001). Intravenous ICM exposure was not predictive (OR: 0.91; 95% CI: 0.51, 1.64; P > .05). Conclusion Hospitalized children with stable kidney function who underwent CT with intravenous iodinated contrast material (ICM) had a similar frequency of acute kidney injury (AKI) compared with a propensity score-matched ICM-unexposed patient group. In pediatric inpatients with estimated glomerular filtration rate greater than or equal to 60 mL/min/1.73 m2, ICM was not independently associated with AKI. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Paltiel in this issue.

Dataset Information

Incident infection following acute kidney injury with recovery to baseline creatinine: A propensity score matched analysis.

Background

Objective

Design

Participants

Main measures

Results

Conclusion

Publications

Incident infection following acute kidney injury with recovery to baseline creatinine: A propensity score matched analysis.

Similar Datasets

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