Predictors of Health Utility among 60-Day Survivors of Acute Kidney Injury in the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study

Johansen, Kirsten L.; Smith, Mark W.; Unruh, Mark; Siroka, Andrew; O’Connor, Theresa; Palevsky, Paul M.

doi:10.2215/cjn.02570310

Cited by 86 publications

(58 citation statements)

References 36 publications

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“…Survivors of AKI were found to have a utility of 0.40 with a standard deviation of 0.37 at 60 days. We did not find evidence of improved health utilities over the 5 year period 11 . The health utility of death was valued at 0 9 .…”

Section: Methodscontrasting

confidence: 78%

Scepticaemia: The impact on the health system and patients of delaying new treatments with uncertain evidence; a case study of the sepsis bundle

Blythe¹,

Cook²,

Graves³

2018

F1000Res

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Background: A sepsis care bundle of intravenous vitamin C, thiamine, and hydrocortisone was reported to improve treatment outcomes. The data to support it are uncertain and decision makers are likely to be cautious about adopting it. The objective of this study was to model the opportunity costs in dollars and lives of waiting for better information before adopting the bundle. Methods: A decision tree was built using information from the literature. We modelled the impact of bundle adoption under three scenarios using a simulation in which the bundle was effective as reported in the primary trial, less effective based on other information, and ineffective. The measurements were health services costs, quality-adjusted life years, and transition probabilities. Results: If the bundle proves to be effective under either scenario, it will save billions of dollars and millions of life-years in the United States. This is the opportunity cost of delaying an adoption decision and waiting for better quality evidence. We suggest that hospital decision-makers consider implementing the bundle on a trial basis while monitoring costs and outcomes data even while the evidence base is uncertain. Conclusions: If the decision maker is unwilling to use the best available evidence now, but rather wishes to wait for definitive evidence they are risking incurring large costs for health care systems and for the patients they serve. An explicit analysis of uncertain clinical outcomes is a useful adjunct to guide decision making where there is clinical ambiguity. This approach offers a valid alternative to the default of clinical inactivity when faced with uncertainty.

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Section: Methodscontrasting

confidence: 78%

Scepticaemia: The impact on the health system and patients of delaying new treatments with uncertain evidence; a case study of the sepsis bundle

Blythe¹,

Cook²,

Graves³

2018

F1000Res

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“…Cr and BUN were the classical standards to evaluate renal damage (34). Accordingly, Hsu et al demonstrated the observation of elevated Cr in an atypical antipsychotic drug administration (35).…”

Section: Discussionmentioning

confidence: 99%

Olanzapine-induced renal damage and metabolic side effects: the protective effect of thymoquinone

Bilğiç¹,

Korkmaz²,

Azırak³

et al. 2017

J Turgut Ozal Med Cent

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Aim: The goal of the study is to examine the protective qualities of thymoquinone (TQ) against the side-effects of olanzapine (OLZ) in an experimental model in rat kidneys. Material and Methods: Thirty five female Spraque-Dawley rats were divided into 5 groups (n=7): Control, OLZ, OLZ+TQ-1, OLZ+TQ-2, OLZ+TQ-3. All treatments were administered for two weeks by gavage. Two weeks administration of OLZ (4 mg/kg, once a day for the first week, 8 mg/kg once a day for the second week, p.o.) was given to all groups, except control. TQ was administered (25, 50, 100 mg/kg, once daily) by gastric tube. On treatment day 15, kidney tissues were removed for analysis. Results: TQ increased the total antioxidant status (TAS) and decreased creatinine (Cr), blood urea nitrogen (BUN), oxidative stress index (OSI) and total oxidant status (TOS) levels significantly (p<0.05). Conclusion: These results revealed that TQ improved the side-effects of OLZ, contributed to the oxygen radical scavenging activity, increased antioxidant activity and had ameliorative effects on recovery of increased serum biochemical and oxidative stress parameters. Thus, these results demonstrated that TQ had protective and antioxidant effects against adverse effects of OLZ in kidney of rats. TQ could be an effective course of therapy to enhance therapeutic efficacy.

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“…Acute kidney injury (AKI) requiring dialysis occurs in 1% to 4% of hospitalized patients and, in the setting of multisystem organ failure, is associated with exceptionally high morbidity and mortality (1)(2)(3). To date, there is no specific treatment for AKI.…”

Section: Introductionmentioning

confidence: 99%

Model to Predict Mortality in Critically Ill Adults with Acute Kidney Injury

Demirjian

Chertow

Zhang

et al. 2011

Clinical Journal of the American Society of Nephrology

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127

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SummaryBackground and objectives Acute kidney injury (AKI) requiring dialysis is associated with high mortality. Most prognostic tools used to describe case complexity and to project patient outcome lack predictive accuracy when applied in patients with AKI. In this study, we developed an AKI-specific predictive model for 60-day mortality and compared the model to the performance of two generic ( Results The 60-day mortality was 53%. Twenty-one independent predictors of 60-day mortality were identified. The logistic regression model exhibited good discrimination, with an area under the receiver operating characteristic (ROC) curve of 0.85 (0.83 to 0.88), and a derived integer risk score yielded a value of 0.80 (0.77 to 0.83). Existing scoring systems, including APACHE II, SOFA, and CCF, when applied to our cohort, showed relatively poor discrimination, reflected by areas under the ROC curve of 0.68 (0.64 to 0.71), 0.69 (0.66 to 0.73), and 0.65 (0.62 to 0.69), respectively.Conclusions Our new risk model outperformed existing generic and disease-specific scoring systems in predicting 60-day mortality in critically ill patients with AKI. The current model requires external validation before it can be applied to other patient populations.

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Predictors of Health Utility among 60-Day Survivors of Acute Kidney Injury in the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study

Cited by 86 publications

References 36 publications

Scepticaemia: The impact on the health system and patients of delaying new treatments with uncertain evidence; a case study of the sepsis bundle

Scepticaemia: The impact on the health system and patients of delaying new treatments with uncertain evidence; a case study of the sepsis bundle

Olanzapine-induced renal damage and metabolic side effects: the protective effect of thymoquinone

Model to Predict Mortality in Critically Ill Adults with Acute Kidney Injury

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