Impact of acute kidney injury on neurological outcome and long-term survival after cardiac arrest – A 10 year observational follow up

Storm, Christian; Krannich, Alexander; Schachtner, Thomas; Engels, Martin; Schindler, R; Kahl, Andreas; Otto, Natalie

doi:10.1016/j.jcrc.2018.07.023

Cited by 33 publications

(33 citation statements)

References 28 publications

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“…Acute kidney injury diagnosed in hospital forms the corner stone of a number of in hospital mortality prediction models . Furthermore, AKI is a major risk factor for long‐term mortality and impaired neurological outcomes following cardio‐pulmonary resuscitation. It is unknown if a window of opportunity exists were early identification and aggressive resuscitation can circumvent acute mortality and reduce long‐term morbidity.…”

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confidence: 99%

Epidemiology of emergency department acute kidney injury

et al. 2019

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Aim: The epidemiology of acute kidney injury (AKI) diagnosed in the emergency department (ED) is poorly described. This study describes the incidence, demographics and outcomes of patients diagnosed with AKI in the ED (ED-AKI).Methods: A prospective cohort study was completed in a University Teaching Hospital, (UK) between April and August 2016. In total, 20 421 adult patients attended the ED and had a serum creatinine measurement. The incident ED-AKI patient episodes were compared with a randomly selected cohort of non-AKI ED patients.Results: A total of 572 patients had confirmed eAlert ED-AKI (548 incident cases), incidence 2.8% (of all ED attendances). ED-AKI was associated with a 24.4% in-patient mortality (non-AKI 3.2%, P < .001) of which 22.3% of deaths occurred within 24 hours and 58% within 7 days. Progression of the admission AKI stage to a higher AKI stage was associated with a 38.8% mortality compared with a 21.4% mortality in those who did not progress (P < .001). In multivariate analysis, ED-AKI was an independent risk for mortality (hazard ratio, 6.293; 95% confidence interval, 1.887-20.790, P = .003). For those discharged from hospital, 20.4% of ED-AKI patients re-attend for acute assessment within 30-days post-discharge (non-AKI 7.6%, P < .001). At 90-days post-discharge, 10.0% of ED-AKI patients died (non-AKI 1.4%, P < .001). Twelve months post-discharge 17.8% of ED-AKI patients developed CKD progression or de-novo CKD (non-AKI 6.0%). Conclusion:The ED-AKI is an independent predictor of death. Mortality is predominantly in the early stages of hospital admission, but for those who survive to discharge have significant long-term morbidity and mortality. K E Y W O R D S acute kidney injury, emergency departments, epidemiology Acute kidney injury (AKI) is a common medical emergency, complicating 6% to 18% of all hospital admissions.

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confidence: 99%

Epidemiology of emergency department acute kidney injury

et al. 2019

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“…Moreover, the study aimed to verify the association between neurologic outcome and the ROSC-NGAL and 3 h-NGAL levels. AKI is associated with poor clinical outcome in PCAS patients, and the incidence of AKI in PCAS patients ranges from 12 to 80% [3][4][5][6][7]. In a study by Oh et al [3] that was published in 2019, AKI occurred in 348 (60%) of 583 patients who underwent TTM and was associated with poor neurologic outcome at 6 months (adjusted OR 0.206; 95% CI 0.099-0.426; p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…The ischemia-reperfusion response of PCAS could injure various organs, including the kidneys, which in turn could lead to AKI [2]. AKI occurs in approximately half of patients with PCAS and is associated with poor clinical outcome [3][4][5][6][7]. The serum creatinine level is the gold standard diagnostic criterion for AKI.…”

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confidence: 99%

Serum neutrophil gelatinase-associated lipocalin at 3 hours after return of spontaneous circulation in patients with cardiac arrest and therapeutic hypothermia: early predictor of acute kidney injury

Choi

Lee

2020

BMC Nephrol

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Background Serum neutrophil gelatinase-associated lipocalin (NGAL) could be used as a predictive marker of acute kidney injury (AKI) in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) who are managed with targeted temperature management (TTM). However, the NGAL measurement timepoints vary from immediately after ROSC to several days later. The primary objective of this study was to determine an association between AKI and NGAL, both immediately (ROSC-NGAL) and 3 h after ROSC (3 h-NGAL), in OHCA patients with TTM. The secondary objective was to ascertain the association between NGAL levels in the early post-ROSC phase and the neurologic outcomes at discharge. Methods This prospective observational study was conducted between January 2016 and December 2018 and enrolled adult OHCA patients (≥18 years) with TTM after ROSC. The serum NGAL level was measured both immediately and 3 h after ROSC. Univariate and multivariate analyses were performed to identify the associations between AKI, poor neurologic outcome, and NGAL. Results Among 861 OHCA patients, 89 patients were enrolled. AKI occurred in 48 (55.1%) patients. On multivariate logistic regression analysis, 3 h-NGAL was significantly associated with AKI (odds ratio [OR] 1.022; 95% confidence interval [CI] 1.009–1.035; p = 0.001). The area under the receiver operating characteristic curve of 3 h-NGAL for AKI was 0.910 (95% CI 0.830–0.960), and a cut-off value of 178 ng/mL was identified. Both ROSC-NGAL and 3 h-NGAL were not significantly associated with poor neurologic outcome on multivariate logistic regression analysis (ROSC-NGAL; OR 1.017; 95% CI 0.998–1.036; p = 0.084, 3 h-NGAL; OR 0.997; 95% CI 0.992–1.001; p = 0.113). Conclusions The serum NGAL concentration measured 3 h after ROSC is an excellent early predictive marker for AKI in OHCA patients treated with TTM. Future research is needed to identify the optimal measurement timepoint to establish NGAL as a predictor of neurologic outcome and to validate the findings of this research.

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“…AKI is associated with poor clinical outcome in PCAS patients, and the incidence of AKI in PCAS patients ranges from 12% to 80% [3][4][5][6][7]. In a study by Oh et al [3] that was published in 2019, AKI occurred in 348 (60%) of 583 patients who underwent TTM and was associated with poor neurologic outcome at 6 months (adjusted OR 0.206; 95% CI 0.099-0.426; p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Serum Neutrophil Gelatinase-associated Lipocalin at 3 Hours after Return of Spontaneous Circulation in Patients with Cardiac Arrest and Therapeutic Hypothermia: Early Predictor of Acute Kidney Injury

Choi

Lee

2020

Preprint

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Background: Serum neutrophil gelatinase-associated lipocalin (NGAL) could be used as a predictive marker of acute kidney injury (AKI) in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) who are managed with targeted temperature management (TTM). However, the NGAL measurement timepoints vary from immediately after ROSC to several days later. The primary objective of this study was to determine an association between AKI and NGAL, both immediately (ROSC-NGAL) and 3 hours after ROSC (3h-NGAL), in OHCA patients with TTM. The secondary objective was to ascertain the association between NGAL levels in the early post-ROSC phase and the neurologic outcomes at discharge.Methods: This prospective observational study was conducted between January 2016 and December 2018 and enrolled adult OHCA patients (≥18 years) with TTM after ROSC. The serum NGAL level was measured both immediately and 3 hours after ROSC. Univariate and multivariate analyses were performed to identify the associations between AKI, poor neurologic outcome, and NGAL.Results: Among 861 OHCA patients, 89 patients were enrolled. AKI occurred in 48 (55.1%) patients. On multivariate logistic regression analysis, 3h-NGAL was significantly associated with AKI (odds ratio [OR] 1.022; 95% confidence interval [CI] 1.009–1.035; p = 0.001). The area under the receiver operating characteristic curve of 3h-NGAL for AKI was 0.910 (95% CI 0.830–0.960), and a cut-off value of 178 ng/mL was identified. Both ROSC-NGAL and 3h-NGAL were not significantly associated with poor neurologic outcome on multivariate logistic regression analysis (ROSC-NGAL; OR 1.017; 95% CI 0.998–1.036; p = 0.084, 3h-NGAL; OR 0.997; 95% CI 0.992–1.001; p = 0.113) Conclusions: The serum NGAL concentration measured 3 hours after ROSC is an excellent early predictive marker for AKI in OHCA patients treated with TTM. Future research is needed to identify the optimal measurement timepoint to establish NGAL as a predictor of neurologic outcome and to validate the findings of this research.

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Impact of acute kidney injury on neurological outcome and long-term survival after cardiac arrest – A 10 year observational follow up

Cited by 33 publications

References 28 publications

Epidemiology of emergency department acute kidney injury

Epidemiology of emergency department acute kidney injury

Serum neutrophil gelatinase-associated lipocalin at 3 hours after return of spontaneous circulation in patients with cardiac arrest and therapeutic hypothermia: early predictor of acute kidney injury

Serum Neutrophil Gelatinase-associated Lipocalin at 3 Hours after Return of Spontaneous Circulation in Patients with Cardiac Arrest and Therapeutic Hypothermia: Early Predictor of Acute Kidney Injury

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Impact of acute kidney injury on neurological outcome and long-term survival after cardiac arrest – A 10 year observational follow up

Cited by 33 publications

References 28 publications

Epidemiology of emergency department acute kidney injury

Epidemiology of emergency department acute kidney injury

Serum neutrophil gelatinase-associated lipocalin at 3 hours after return of spontaneous circulation in patients with cardiac arrest and therapeutic hypothermia: early predictor of acute kidney injury

Serum Neutrophil Gelatinase-associated Lipocalin at 3 Hours after Return of Spontaneous Circulation in Patients with Cardiac Arrest and Therapeutic Hypothermia: Early Predictor of Acute Kidney Injury

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Impact of acute kidney injury on neurological outcome and long-term survival after cardiac arrest – A 10 year observational follow up