Utilizing reclassification to explore characteristics and prognosis of KDIGOSCr AKI subgroups: a retrospective analysis of a multicenter prospective cohort study
Gui-Ying Dong,
Jun-Ping Qin,
Youzhong An,
Yan Kang,
Xiangyou Yu,
Mingyan Zhao,
Xiaochun Ma,
Yuhang Ai,
Yuan Xu,
Xiuming Xi,
Chuanyun Qian,
Dawei Wu,
Renhua Sun,
Shusheng Li,
Zhenjie Hu,
Xiangyuan Cao,
Fachun Zhou,
Li Jiang,
Jiandong Lin,
Erzhen Chen,
Tiehe Qin,
Zhenyang He,
Jihong Zhu,
Bin Du
Affiliations
Gui-Ying Dong
Medical Intensive Care Unit, Peking Union Medical College Hospital
Jun-Ping Qin
Department of Critical Care Medicine, Tsinghua changgung Hospital
Youzhong An
Department of Critical Care Medicine, Peking University People’s Hospital
Yan Kang
Department of Critical Care Medicine, West China Hospital, Sichuan University
Xiangyou Yu
Department of Critical Care Medicine, First Affiliated Hospital, Xinjiang Medical University
Mingyan Zhao
Department of Critical Care Medicine, The First Affiliated Hospital, Harbin Medical University
Xiaochun Ma
Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University
Yuhang Ai
Department of Critical Care Medicine, Xiangya Hospital, Central South University
Yuan Xu
Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University
Xiuming Xi
Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University
Chuanyun Qian
Department of Emergency Medicine, The First Affiliated Hospital of Kunming Medical College
Dawei Wu
Department of Critical Care Medicine, Qilu Hospital, Shandong University
Renhua Sun
Department of Critical Care Medicine, Zhejiang Provincial People’s Hospital
Shusheng Li
Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology
Zhenjie Hu
Department of Critical Care Medicine, Hebei Medical University Fourth Hospital
Xiangyuan Cao
Department of Critical Care Medicine, Affiliated Hospital of Ningxia Medical University
Fachun Zhou
Department of Critical Care Medicine, The First Affiliated Hospital, Chongqing Medical University
Li Jiang
Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University
Jiandong Lin
Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University
Erzhen Chen
Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University
Tiehe Qin
Department of Critical Care Medicine, Guangdong General Hospital
Zhenyang He
Department of Critical Care Medicine, Hainan Provincial People’s Hospital
Jihong Zhu
Department of Emergency Medicine, Peking University People’s Hospital
Bin Du
Medical Intensive Care Unit, Peking Union Medical College Hospital
Background Acute kidney injury (AKI) is widespread in the intensive care unit (ICU) and affects patient prognosis. According to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, the absolute and relative increases of serum creatinine (Scr) are classified into the same stage. Whether the prognosis of the two types of patients is similar in the ICU remains unclear. Methods According to the absolute and relative increase of Scr, AKI stage 1 and stage 3 patients were divided into stage 1a and 1b, stage 3a and 3b groups, respectively. Their demographics, laboratory results, clinical characteristics, and outcomes were analyzed retrospectively. Results Of the 345 eligible cases, we analyzed stage 1 because stage 3a group had only one patient. Using 53 or 61.88 µmol/L as the reference Scr (Scrref), no significant differences were observed in ICU mortality (P53=0.076, P61.88=0.070) or renal replacement therapy (RRT) ratio, (P53=0.356, P61.88=0.471) between stage 1a and 1b, but stage 1b had longer ICU length of stay (LOS) than stage 1a (P53<0.001, P61.88=0.032). In the Kaplan-Meier survival analysis, no differences were observed in ICU mortality between stage 1a and 1b (P53=0.378, P61.88=0.255). In a multivariate analysis, respiratory failure [HR = 4.462 (95% CI 1.144–17.401), p = 0.031] and vasoactive drug therapy [HR = 4.023 (95% CI 1.584–10.216), p = 0.003] were found to be independently associated with increased risk of death. Conclusion ICU LOS benefit was more prominent in KDIGOSCr AKI stage 1a patients than in stage 1 b. Further prospective studies with a larger sample size are necessary to confirm the effectiveness of reclassification.
