Acute kidney injury-attributable mortality in critically ill patients with sepsis

Wang, Zhiyi; Weng, Jie; Yang, Jin-Wen; Zhou, Xiaoming; Xu, Zhe; Hou, Ruonan; Zhou, Zhiliang; Wang, Liang; Chen, Chan; Jin, Shengwei

doi:10.7717/peerj.13184

Cited by 11 publications

(7 citation statements)

References 37 publications

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“…However, our study only focused on septic patients, which may account for the disparity in results. According to Wang Zhiyi’s research [ 26 ], the Medical Information Mart for Intensive Care (MIMIC) IV cohort, consisting of 15,610 patients, had an excess attributable mortality rate of 58.6% for AKI in critically ill patients with sepsis. In contrast, in the Wenzhou cohort, consisting of 1,341 patients, the excess attributable mortality was 44.6%.…”

Section: Discussionmentioning

confidence: 99%

Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study

Wang,

Zhao,

et al. 2024

BMC Nephrol

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Background Sepsis and acute kidney injury (AKI) are common severe diseases in the intensive care unit (ICU). This study aimed to estimate the attributable mortality of AKI among critically ill patients with sepsis and to assess whether AKI was an independent risk factor for 30-day mortality. Methods The information we used was derived from a multicenter prospective cohort study conducted in 18 Chinese ICUs, focusing on septic patients post ICU admission. The patients were categorized into two groups: those who developed AKI (AKI group) within seven days following a sepsis diagnosis and those who did not develop AKI (non-AKI group). Using propensity score matching (PSM), patients were matched 1:1 as AKI and non-AKI groups. We then calculated the mortality rate attributable to AKI in septic patients. Furthermore, a survival analysis was conducted comparing the matched AKI and non-AKI septic patients. The primary outcome of interest was the 30-day mortality rate following the diagnosis of sepsis. Results Out of the 2175 eligible septic patients, 61.7% developed AKI. After the application of PSM, a total of 784 septic patients who developed AKI were matched in a 1:1 ratio with 784 septic patients who did not develop AKI. The overall 30-day attributable mortality of AKI was 6.6% (95% CI 2.3 ∼ 10.9%, p = 0.002). A subgroup analysis revealed that the 30-day attributable mortality rates for stage 1, stage 2, and stage 3 AKI were 0.6% (95% CI −5.9 ∼ 7.2%, p = 0.846), 4.7% (95% CI −3.1 ∼ 12.4%, p = 0.221) and 16.8% (95% CI 8.1 ∼ 25.2%, p < 0.001), respectively. Particularly noteworthy was that stage 3 AKI emerged as an independent risk factor for 30-day mortality, possessing an adjusted hazard ratio of 1.80 (95% CI 1.31 ∼ 2.47, p < 0.001). Conclusions The overall 30-day attributable mortality of AKI among critically ill patients with sepsis was 6.6%. Stage 3 AKI had the most significant contribution to 30-day mortality, while stage 1 and stage 2 AKI did not increase excess mortality.

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Section: Discussionmentioning

confidence: 99%

Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study

Wang,

Zhao,

et al. 2024

BMC Nephrol

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“…This was similar to the conclusions of several previous studies, in which deteriorated renal function was a crucial prognostic factor affecting mortality in patients with severe infections, including BSI. 23 – 25 Westgeest et al 9 conducted a multicenter retrospective cohort study and found that AKI development was highly associated with 30-day mortality in patients with S. aureus bacteremia. Moreover, patients with CRAB complex bacteremia had poor clinical outcomes when they had AKI.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury should not be neglected – optimization of quick Pitt bacteremia score for predicting mortality in critically ill patients with bloodstream infection: a retrospective cohort study

Cai,

Yang,

Deng

et al. 2024

Therapeutic Advances in Infection

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Background: Considering the therapeutic difficulties and mortality associated with bloodstream infection (BSI), it is essential to investigate other potential factors affecting mortality in critically ill patients with BSI and examine the utility of the quick Pitt bacteremia (qPitt) score to improve the survival rate. Objectives: To improve the predictive accuracy of the qPitt scoring system by evaluating the five current components of qPitt and including other potential factors influencing mortality in critically ill patients with BSI. Design: This was a retrospective cohort study. Methods: Medical information from the Medical Information Mart for Intensive Care IV database was used in this retrospective cohort study. The risk factors associated with mortality were examined using a multivariate logistic regression model. The area under the receiver operating characteristic curve (AUC) was used to assess the discriminatory capability of the prediction models. Results: In total, 1240 eligible critically ill patients with BSI were included. After adjustment for age, community-onset BSI, indwelling invasive lines, and Glasgow Coma Scale (GCS) ⩽ 8, acute kidney injury (AKI) was identified as a notable risk factor for 14-day mortality. Except for altered mental status, the four other main components of the original qPitt were significantly associated with 14-day mortality. Hence, we established a modified qPitt (m-qPitt) by adding AKI and replacing altered mental status with GCS ⩽ 8. The AUCs for m-qPitt and qPitt were 0.723 [95% confidence interval (CI): 0.683–0.759] and 0.708 (95% CI: 0.669–0.745) in predicting 14-day mortality, respectively. Moreover, m-qPitt also had acceptable performance and discrimination power [0.700 (95% CI: 0.666–0.732)] in predicting 28-day mortality. Conclusion: AKI significantly influenced the survival of critically ill patients with BSIs. Compared with the original qPitt, our new m-qPitt was proven to have a better predictive performance for mortality in critically ill patients with BSI. Further studies should be conducted to validate the practicality of m-qPitt.

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“…These events are also known to cause structural renal damage and functional impairment, a syndrome known as acute kidney injury (AKI) 19 , 24 , 25 . AKI does not only increase the risk for chronic kidney disease but is also attributed to high morbidity, especially in patients with preexisting conditions 26 , 27 .…”

Section: Introductionmentioning

confidence: 99%

A proof-of-concept assay for quantitative and optical assessment of drug-induced toxicity in renal organoids

Dilz

Auge

Groeneveld

et al. 2023

Sci Rep

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Kidneys are complex organs, and reproducing their function and physiology in a laboratory setting remains difficult. During drug development, potential compounds may exhibit unexpected nephrotoxic effects, which imposes a significant financial burden on pharmaceutical companies. As a result, there is an ongoing need for more accurate model systems. The use of renal organoids to simulate responses to nephrotoxic insults has the potential to bridge the gap between preclinical drug efficacy studies in cell cultures and animal models, and the stages of clinical trials in humans. Here we established an accessible fluorescent whole-mount approach for nuclear and membrane staining to first provide an overview of the organoid histology. Furthermore, we investigated the potential of renal organoids to model responses to drug toxicity. For this purpose, organoids were treated with the chemotherapeutic agent doxorubicin for 48 h. When cell viability was assessed biochemically, the organoids demonstrated a significant, dose-dependent decline in response to the treatment. Confocal microscopy revealed visible tubular disintegration and a loss of cellular boundaries at high drug concentrations. This observation was further reinforced by a dose-dependent decrease of the nuclear area in the analyzed images. In contrast to other approaches, in this study, we provide a straightforward experimental framework for drug toxicity assessment in renal organoids that may be used in early research stages to assist screen for potential adverse effects of compounds.

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Acute kidney injury-attributable mortality in critically ill patients with sepsis

Cited by 11 publications

References 37 publications

Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study

Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study

Acute kidney injury should not be neglected – optimization of quick Pitt bacteremia score for predicting mortality in critically ill patients with bloodstream infection: a retrospective cohort study

A proof-of-concept assay for quantitative and optical assessment of drug-induced toxicity in renal organoids

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