Acute kidney injury in non-critical care setting: elaboration and validation of an in-hospital death prognosis score.
Acute Kidney Injury
/ mortality
Adult
Aged
Aged, 80 and over
Area Under Curve
Blood Pressure
Cause of Death
Cohort Studies
Female
Fluid Therapy
Glasgow Coma Scale
Hospital Mortality
Humans
Male
Middle Aged
Multiple Myeloma
/ complications
Oxygen
/ administration & dosage
Patient Admission
Prognosis
Prospective Studies
Prothrombin Time
ROC Curve
Young Adult
Cute kidney injury
Iatrogenesis
In-hospital death
Prognosis score
Score validation
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
21 11 2019
21 11 2019
Historique:
received:
08
03
2019
accepted:
29
10
2019
entrez:
23
11
2019
pubmed:
23
11
2019
medline:
12
11
2020
Statut:
epublish
Résumé
Acute kidney injury (AKI) is still characterized by a high mortality rate. While most patients with AKI are admitted in conventional medical units, current available data are still obtained from studies designed for patients admitted in intensive care units (ICU). Our study aimed to elaborate and validate an in-hospital death prognosis score for AKI admitted in conventional medical care units. We included two prospective cohorts of consecutive patients with AKI admitted between 2001 and 2004 (elaboration cohort (EC)) and between 2010 and 2014 (validation cohort (VC)). We developed a scoring system from clinical and biological parameters recorded at admission from the EC to predict in-hospital mortality. This score was then tested for validation in the VC. Three-hundred and twenty-three and 534 patients were included in the EC and VC cohorts, respectively. The proportion of in-hospital death were 15.5% (EC) and 8.9% (VC), mainly due to sepsis. The parameters independently associated with the in-hospital death in the EC were Glasgow score, oxygen requirement, fluid overload, blood diastolic pressure, multiple myeloma and prothrombin time. The in-hospital death prognosis score AUC was 0.845 +/- 0.297 (p < 0.001) after validation in the VC. Our in-hospital death prognosis score is the first to be prospectively developed and validated for AKI admitted in a conventional medical care unit. Based on current parameters, easily collected at time of admission, this score could be a useful tool for physicians and nephrologists to determine the in-hospital death prognosis of this AKI population.
Sections du résumé
BACKGROUND
Acute kidney injury (AKI) is still characterized by a high mortality rate. While most patients with AKI are admitted in conventional medical units, current available data are still obtained from studies designed for patients admitted in intensive care units (ICU). Our study aimed to elaborate and validate an in-hospital death prognosis score for AKI admitted in conventional medical care units.
METHODS
We included two prospective cohorts of consecutive patients with AKI admitted between 2001 and 2004 (elaboration cohort (EC)) and between 2010 and 2014 (validation cohort (VC)). We developed a scoring system from clinical and biological parameters recorded at admission from the EC to predict in-hospital mortality. This score was then tested for validation in the VC.
RESULTS
Three-hundred and twenty-three and 534 patients were included in the EC and VC cohorts, respectively. The proportion of in-hospital death were 15.5% (EC) and 8.9% (VC), mainly due to sepsis. The parameters independently associated with the in-hospital death in the EC were Glasgow score, oxygen requirement, fluid overload, blood diastolic pressure, multiple myeloma and prothrombin time. The in-hospital death prognosis score AUC was 0.845 +/- 0.297 (p < 0.001) after validation in the VC.
CONCLUSIONS
Our in-hospital death prognosis score is the first to be prospectively developed and validated for AKI admitted in a conventional medical care unit. Based on current parameters, easily collected at time of admission, this score could be a useful tool for physicians and nephrologists to determine the in-hospital death prognosis of this AKI population.
Identifiants
pubmed: 31752723
doi: 10.1186/s12882-019-1610-9
pii: 10.1186/s12882-019-1610-9
pmc: PMC6868787
doi:
Substances chimiques
Oxygen
S88TT14065
Types de publication
Journal Article
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
419Références
JAMA. 2003 Feb 12;289(6):747-51
pubmed: 12585954
J Am Soc Nephrol. 2002 May;13(5):1350-7
pubmed: 11961023
PLoS One. 2012;7(11):e48580
pubmed: 23133643
J Clin Invest. 2004 Jul;114(1):5-14
pubmed: 15232604
Clin Nephrol. 1996 Sep;46(3):206-11
pubmed: 8879857
Indian J Nephrol. 2013 Jan;23(1):24-9
pubmed: 23580801
Lancet. 2005 Jan 29-Feb 4;365(9457):417-30
pubmed: 15680458
J Am Soc Nephrol. 1998 Apr;9(4):692-8
pubmed: 9555672
J Am Soc Nephrol. 2006 Apr;17(4):1135-42
pubmed: 16495381
Nephrol Dial Transplant. 2004 Sep;19(9):2282-8
pubmed: 15266030
Arch Intern Med. 1995 Jul 24;155(14):1505-11
pubmed: 7605152
Kidney Int. 2007 Jul;72(2):208-12
pubmed: 17507907
Clin Nephrol. 2014 Mar;81(3):174-84
pubmed: 24361059
Nephrology (Carlton). 2013 Mar;18(3):183-7
pubmed: 23336108
Kidney Int. 2004 Oct;66(4):1613-21
pubmed: 15458458
Nephron. 1993;63(1):21-31
pubmed: 8446248
Artif Organs. 1998 Apr;22(4):273-8
pubmed: 9555958
Am J Kidney Dis. 2004 Sep;44(3):410-9
pubmed: 15332213
Ann Fr Anesth Reanim. 2005 Feb;24(2):134-9
pubmed: 15737499
Am J Nephrol. 2012;35(4):349-55
pubmed: 22473149
Am J Kidney Dis. 1988 Mar;11(3):254-9
pubmed: 3344747
Crit Care. 2013 Jan 24;17(1):R14
pubmed: 23347825
Ren Fail. 2007;29(2):163-8
pubmed: 17365931
Kidney Int. 2012 Mar;81(5):442-8
pubmed: 22113526
Crit Care. 2007;11(2):R31
pubmed: 17331245
Circulation. 2002 May 14;105(19):2259-64
pubmed: 12010907
Am J Med. 2002 Oct 15;113(6):456-61
pubmed: 12427493
Nefrologia. 2004;24(1):47-53
pubmed: 15083957
Nat Rev Nephrol. 2010 Feb;6(2):107-15
pubmed: 20027192
Clin J Am Soc Nephrol. 2014 Jun 6;9(6):1007-14
pubmed: 24677557
Clin J Am Soc Nephrol. 2017 Feb 7;12(2):228-236
pubmed: 28119408
Nephrol Dial Transplant. 2013 Jun;28(6):1447-54
pubmed: 23355628
Clin J Am Soc Nephrol. 2013 Sep;8(9):1482-93
pubmed: 23744003
Crit Care. 2004 Aug;8(4):R204-12
pubmed: 15312219
Kidney Int. 1999 Jul;56(1):238-43
pubmed: 10411698
Nephrol Dial Transplant. 1996 Feb;11(2):293-9
pubmed: 8700363
Arch Intern Med. 1985 Nov;145(11):2015-8
pubmed: 4062452
JAMA. 1996 May 15;275(19):1489-94
pubmed: 8622223
Clin Nephrol. 2000 Jan;53(1):10-7
pubmed: 10661477
J Am Soc Nephrol. 2011 Jan;22(1):28-38
pubmed: 21209252
Ren Fail. 2005;27(3):289-96
pubmed: 15957545
Kidney Int. 2009 Aug;76(4):422-7
pubmed: 19436332
Kidney Int. 2008 Jul;74(1):101-7
pubmed: 18385668