Incidence and Prognostic Implications of Acute Kidney Injury on Admission in Patients With Community-Acquired Pneumonia

Akram, Ahsan R.; Singanayagam, Aran; Choudhury, Gourab; Mandal, Pallavi; Chalmers, James D.; Hill, Adam T.

doi:10.1378/chest.09-3071

Cited by 67 publications

(83 citation statements)

References 25 publications

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“…The guidelines do not suggest a pre-specified cut-off for these variables and so cut-offs were identified based on the published literature (hypoglycaemia ,4.4 mmol?L -1 , hyperglycaemia .14 mol?L -1 , pH ,7.35 and hyponatraemia ,130 mmol?L -1 ) [16][17][18][19]. Lactate was only measured routinely in one study hospital and so was excluded from this analysis due to missing data.…”

Section: Data Extractionmentioning

confidence: 99%

Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observational data

Salih

Schembri

Chalmers

2013

European Respiratory Journal

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The 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) guidelines proposed ''minor'' criteria to predict intensive care unit (ICU) admission in patients with community-acquired pneumonia. These criteria were based on expert opinion. Consequently, the authors of the guidelines asked investigators to determine whether the score could be simplified by excluding noncontributory variables.Each IDSA/ATS minor criterion was validated using a random effects meta-analysis of seven studies. Variables present in ,5% of cases or that were nonsignificantly associated with mortality/ICU admission were excluded. A simplified score excluding these variables was tested for prediction of mortality and ICU admission in an established database. Prediction was assessed using the area under the receiver operator characteristic curve (AUC).Leukopenia (,4000 cells?mm -3 ), thrombocytopenia (,100 000 cells?mm -3 ) and hypothermia ,36uC occurred in ,5% of cases. A simplified score excluding these variables was performed similarly for prediction of mortality, AUC 0.77 (95% CI 0.73-0.81) versus 0.78 (95% CI 0.74-0.82) (p50.9) and intensive care unit admission, AUC 0.85 (95% CI 0.82-0.87) versus 0.85 (95% CI 0.82-0.88) (p50.9). Additional predictors suggested by the IDSA/ATS were associated with mortality and ICU admission, but only incorporating acidosis (pH ,7.35) altered the AUC (0.82 (95% CI 0.78-0.86) (p50.6) for mortality and 0.86 (95% CI 0.82-0.88) (p50.8) for ICU admission). No improvements were statistically significant.The IDSA/ATS criteria can be simplified by removing three infrequent variables. @ERSpublicationsThe IDSA/ATS criteria can be simplified by removing three infrequent variables

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Section: Data Extractionmentioning

confidence: 99%

Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observational data

Salih

Schembri

Chalmers

2013

European Respiratory Journal

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“…Pre-existing comorbidities, such as chronic renal, hepatic, cardiac, cerebrovascular and neoplastic disease or diabetes mellitus, have been independently associated with adverse prognosis in CAP [2,13,14,[37][38][39][40]. Acute systemic inflammatory and pro-coagulatory changes caused by CAP increase the risk for decompensation of organ function [14,[38][39][40].…”

Section: Risk Of Unstable Comorbiditiesmentioning

confidence: 99%

“…Acute systemic inflammatory and pro-coagulatory changes caused by CAP increase the risk for decompensation of organ function [14,[38][39][40]. Nonpulmonary acute organ dysfunction occurs in about 40% of hospitalised CAP patients and is already present in half of them at hospital admission [41].…”

Section: Risk Of Unstable Comorbiditiesmentioning

confidence: 99%

Management-based risk prediction in community-acquired pneumonia by scores and biomarkers

2012

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Community-acquired pneumonia (CAP) represents a major life-threatening infection, but disease course and outcome is highly variable. Major drivers of prognosis are respiratory failure, sepsis-related organ dysfunction and unstable comorbidities.Current risk stratification tools have been primarily designed to predict mortality and identify low risk patients potentially suitable for ambulatory management. Detection of patients at high risk for clinical deterioration by current scores remains suboptimal.Therefore, management-related risk stratification tools designed to predict benefit from early intensified monitoring and treatment strategies in hospitalised CAP are advocated. An approach including early and repeatedly evaluated clinical markers of respiratory failure, sepsis-related organ dysfunction or decompensating comorbidity combined with individual definition of treatment goals is suggested.Inflammatory biomarkers can add prognostic information. New cardiovascular or stress-related biomarkers like copeptin, midregional proadrenomedullin and cortisol have been repeatedly linked with outcome and disease course in CAP and improved clinical scoring in observational studies. Thus they represent promising tools for individualised risk stratification. A major task in future CAP research will be the evaluation of their additional value in large interventional trials with control groups incorporating strict management guidance by clinical criteria.

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“…Clinicians rely on three traditional markers to evaluate AKI: serum creatinine (SCr), urine output, and microscopic urine sediment examination. The peak change in SCr during hospitalization associates with mortality by the Risk, Injury, Failure, Loss and Endstage renal disease (RIFLE) (3) and Acute Kidney Injury Network (AKIN) (4) classification systems (5,6); however, these staging methods have limited predictive power for outcomes at the initial moment of AKI diagnosis. Apart from reflex laboratory evaluation of abnormal urinalyses for AKI, urine microscopy is typically only performed by consulting nephrologists days later.…”

Section: Introductionmentioning

confidence: 99%

Risk of Poor Outcomes with Novel and Traditional Biomarkers at Clinical AKI Diagnosis

Hall

Coca

Perazella³

et al. 2011

Clinical Journal of the American Society of Nephrology

107

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SummaryBackground and objectives Studies have evaluated acute kidney injury (AKI) using biomarkers in various settings, but their prognostic utility within current practice is unclear. Thus, we sought to determine the prognostic utility of newer biomarkers or traditional markers (fractional excretion of sodium [FeNa] and urea [FeUrea] and microscopy) over clinical assessment alone.Design, setting, participants, & measurements This is a prospective cohort study of adults on the first day of meeting AKI criteria. We measured urine concentrations of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and IL-18 and determined FeNa, FeUrea, and microscopy score for casts and tubular cells. Primary outcome was worsened AKI stage from enrollment to peak serum creatinine or in-hospital death.Results In 249 recipients, 57% were Ն65 years old, 48% were from intensive care, and mean baseline GFR was 69 Ϯ 30 ml/min per 1.73 m 2 . AKI was considered prerenal in 164 (66%), acute tubular necrosis (ATN) in 51 (20%), and "other" in 34 (14%). All mean protein biomarker concentrations, FeNa, FeUrea, and microscopy scores were statistically different between prerenal and ATN. Seventy-two patients (29%) developed the primary outcome. There was an approximate three-fold increase in adjusted risk for the outcome for upper versus lower values of NGAL, KIM-1, IL-18, and microscopy score (P values Ͻ0.05). Net reclassification improved after adding these to baseline clinical assessment. FeNa and FeUrea were not useful. ConclusionsOn the first day of AKI, urine protein biomarkers and microscopy significantly improve upon clinical determination of prognosis, indicating their potential utility in current practice.

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Incidence and Prognostic Implications of Acute Kidney Injury on Admission in Patients With Community-Acquired Pneumonia

Cited by 67 publications

References 25 publications

Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observational data

Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observational data

Management-based risk prediction in community-acquired pneumonia by scores and biomarkers

Risk of Poor Outcomes with Novel and Traditional Biomarkers at Clinical AKI Diagnosis

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