Donald G Harris1, Michelle P McCrone2, Grace Koo2, Adam S Weltz2, William C Chiu3, Thomas M Scalea3, Jose J Diaz3, Matthew E Lissauer4. 1. Division of General Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD. Electronic address: dharris@smail.umaryland.edu. 2. Division of General Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD. 3. R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD. 4. R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; Department of Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ.
Abstract
PURPOSE: Acute kidney injury (AKI) is common in critically ill patients but is poorly defined in surgical patients. We studied AKI in a representative cohort of critically ill surgical patients. METHODS: This was a retrospective 1-year cohort study of general surgical intensive care unit patients. Patients were identified from a prospective database, and clinical data were reviewed. Acute kidney injury events were defined by risk, injury, failure, loss, and end-stage renal classification criteria. Outcomes were inpatient and 1-year mortality, inpatient lengths of stay, and discharge renal function. Risk factors for AKI and outcomes were compared by univariate and multivariate analyses. RESULTS: Of 624 patients, 296 (47%) developed AKI. Forty-two percent of events were present upon admission, whereas 36% occurred postoperatively. Risk, injury, failure, loss, and end-stage renal classification distributions by grade were as follows: risk, 152 (51%); injury, 69 (23%); and failure, 75 (25%). Comorbid diabetes, emergency admission, major surgery, sepsis, and illness severity were independently associated with renal dysfunction. Patients with AKI had significantly worse outcomes, including increased inpatient and 1-year mortality. Acute kidney injury starting before admission was associated with worse renal dysfunction and greater renal morbidity than de novo inpatient events. CONCLUSIONS: Acute kidney injury is common in critically ill surgical patients and is associated with increased mortality, persisting renal impairment and greater resource use.
PURPOSE:Acute kidney injury (AKI) is common in critically illpatients but is poorly defined in surgical patients. We studied AKI in a representative cohort of critically ill surgical patients. METHODS: This was a retrospective 1-year cohort study of general surgical intensive care unit patients. Patients were identified from a prospective database, and clinical data were reviewed. Acute kidney injury events were defined by risk, injury, failure, loss, and end-stage renal classification criteria. Outcomes were inpatient and 1-year mortality, inpatient lengths of stay, and discharge renal function. Risk factors for AKI and outcomes were compared by univariate and multivariate analyses. RESULTS: Of 624 patients, 296 (47%) developed AKI. Forty-two percent of events were present upon admission, whereas 36% occurred postoperatively. Risk, injury, failure, loss, and end-stage renal classification distributions by grade were as follows: risk, 152 (51%); injury, 69 (23%); and failure, 75 (25%). Comorbid diabetes, emergency admission, major surgery, sepsis, and illness severity were independently associated with renal dysfunction. Patients with AKI had significantly worse outcomes, including increased inpatient and 1-year mortality. Acute kidney injury starting before admission was associated with worse renal dysfunction and greater renal morbidity than de novo inpatient events. CONCLUSIONS:Acute kidney injury is common in critically ill surgical patients and is associated with increased mortality, persisting renal impairment and greater resource use.
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