Predicting Hospital Mortality in Critically Ill Cancer Patients according to Acute Kidney Injury Severity

Libório, Alexandre Braga; Abreu, Krasnalhia Lívia S.; Silva, Geraldo Bezerra da; Lima, Rafael Siqueira Athayde; Barreto, Adller Gonçalves Costa; Barbosa, Orivaldo Alves; Daher, Elizabeth De Francesco

doi:10.1159/000329042

Cited by 48 publications

(29 citation statements)

References 59 publications

(45 reference statements)

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“…Another study evaluated predictors of hospital mortality in critically ill cancer patients according to the severity of renal dysfunction. AKI, as defined by the RIFLE criteria [19], occurred in 54.2% and mortality increased with progression from ‘R’ to ‘F’ [20]. The results from our study are more or less in line with data from the literature: incidences of AKI were higher in sepsis than in non-septic patients, survival in sepis-associated AKI was lower than in AKI without sepsis or in sepsis without AKI.…”

Section: Discussionsupporting

confidence: 87%

Prognosis of AKI in malignant diseases with and without sepsis

Heeg¹,

Mertens²,

Ellenberger

et al. 2013

BMC Anesthesiol

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BackgroundAKI significantly worsens prognosis of hospitalized patients. This is particularly the case in patients with sepsis. The risk for aquiring sepsis is significantly increased in malignant diseases. Aim of the present retrospective study was to analyze outcomes of tumor patients with sepsis and AKI.MethodsOne-thousand and seventeen patients, treated at the ICU of the Department of Nephrology and Rheumatology of the University Hospital Göttingen from 2009 to 2011 were retrospectively analyzed for mortality, sepsis, AKI, need for renal replacement therapy (dialysis) and malignancies.ResultsAKI occurred significantly more frequent in septic than in non-septic patients and in tumor as oposed to non-tumor patients. Mortaliy rates were higher in the respective latter groups. Mortality increased even further if patients suffered from a malignant disease with sepsis and AKI. Mortality rates peaked if dialysis treatment became mandatory. In non-solid tumors 100% of the patients died if they suffered drom sepsis and AKI. This was not the case in solid malignancies (mortality rate 56%).ConclusionsWe conclude that prognosis of tumor patients with AKI and sepsis is very poor. Mortality increases to almost 70% if diaylsis therapy is initiated. Non-solid tumors are associated with a 100% mortality if sepsis and AKI conincide.

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Section: Discussionsupporting

confidence: 87%

Prognosis of AKI in malignant diseases with and without sepsis

Heeg¹,

Mertens²,

Ellenberger

et al. 2013

BMC Anesthesiol

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“…Other efforts identified AKI using hospital discharge diagnosis codes [4,5]. Many studies have focused on AKI in intensive care units and have not considered AKI in the general hospital setting [6,7,8,9,10,11,12]. …”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury and Mortality in Hospitalized Patients

Wang¹,

Muntner²,

et al. 2012

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Background: The objective of this study was to determine the incidence of acute kidney injury (AKI) and its relation with mortality among hospitalized patients. Methods: Analysis of hospital discharge and laboratory data from an urban academic medical center over a 1-year period. We included hospitalized adult patients receiving two or more serum creatinine (sCr) measurements. We excluded prisoners, psychiatry, labor and delivery, and transferred patients, ‘bedded outpatients’ as well as individuals with a history of kidney transplant or chronic dialysis. We defined AKI as (a) an increase in sCr of ≥0.3 mg/dl; (b) an increase in sCr to ≥150% of baseline, or (c) the initiation of dialysis in a patient with no known history of prior dialysis. We identified factors associated with AKI as well as the relationships between AKI and in-hospital mortality. Results: Among the 19,249 hospitalizations included in the analysis, the incidence of AKI was 22.7%. Older persons, Blacks, and patients with reduced baseline kidney function were more likely to develop AKI (all p < 0.001). Among AKI cases, the most common primary admitting diagnosis groups were circulatory diseases (25.4%) and infection (16.4%). After adjustment for age, sex, race, admitting sCr concentration, and the severity of illness index, AKI was independently associated with in-hospital mortality (adjusted odds ratio 4.43, 95% confidence interval 3.68–5.35). Conclusions: AKI occurred in over 1 of 5 hospitalizations and was associated with a more than fourfold increased likelihood of death. These observations highlight the importance of AKI recognition as well as the association of AKI with mortality in hospitalized patients.

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“…[12][13][14][15][16] The common negative prognostic factors for all patients are multiple organ failure, the requirement for mechanical ventilation, vasopressors, renal replacement therapy, advanced age and high disease severity scores at admittance. [17][18][19][20][21] Other factors that may be responsible of mortality are the etiology and severity of respiratory failure, duration of invasive mechanical ventilation, the source of infection, presence of sepsis and neutropenia, the timing of ICU admittance and the procedures applied for diagnosis and treatment. [22][23][24][25][26] In this study, we aimed to evaluate the factors at admittance affecting the ICU mortality of cancer patients and meanwhile guide practitioners in admittance and monitorization of cancer patients and cost effective management of ICU resources.…”

Section: Introductionmentioning

confidence: 99%