Prognostic Importance of Low Admission Serum Creatinine Concentration for Mortality in Hospitalized Patients

Cheungpasitporn, Wisit; Kittanamongkolchai, Wonngarm; Harrison, Andrew M.; Kashani, Kianoush

doi:10.1016/j.amjmed.2016.11.020

Cited by 34 publications

(33 citation statements)

References 21 publications

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“…b) with strong statistical significance. Previous studies have shown that an ECW ratio >0.398 is suggestive of excessive water retention and can result in an overestimation of SMI . When 11 of the 50 patients were excluded due to ECW ratios >0.398, the association of Scre/Scys ratio with SMI (r = 0.386, P = 0.015; Fig.…”

Section: Resultsmentioning

confidence: 79%

“…Serum creatinine (Scre) is frequently used to evaluate renal function in daily clinical practice; however, the level of Scre can be affected by muscle mass, diet, exercise, and several other factors . A low Scre level accompanied by a loss of muscle mass has been reported as a biomarker for predicting survival rates in hospitalized patients . The decrease of hepatic creatine production in cirrhosis leads to low Scre levels, suggesting that decreased Scre will have clinical significance.…”

Section: Introductionmentioning

confidence: 99%

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Ratio between estimated glomerular filtration rates of creatinine and cystatin C predicts overall survival in patients with hepatocellular carcinoma

Tamai

Iwasa

Kawasaki

et al. 2018

Hepatology Research

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Section: Resultsmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Ratio between estimated glomerular filtration rates of creatinine and cystatin C predicts overall survival in patients with hepatocellular carcinoma

Tamai

Iwasa

Kawasaki

et al. 2018

Hepatology Research

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“…However, we performed subgroup analysis to assess the AKI incidence based on types of ECMO and a separate meta-analysis that only included studies with confounder-adjusted analysis for mortality risk. Another limitation was that AKI diagnosis was mainly based on serum creatinine [102,103,104] while the data on urine output and novel biomarkers for AKI [105,106,107,108] were limited. Lastly, this systematic review is primarily based on observational studies, as the data from clinical trials or population-based studies were limited.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis

Thongprayoon

Cheungpasitporn

Lertjitbanjong

et al. 2019

JCM

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Background: Although acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. Methods: A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). Results: 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%–72.4%) and 44.9% (95%CI: 40.8%–49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87–4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21–4.99). There was no publication bias as evaluated by the funnel plot and Egger’s regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively. Conclusion: Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.

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“…For serum sodium, patients with low SCr had a higher risk of mortality for hyponatremia. Low SCr value at admission has been suggested to be independently associated with increased in-hospital mortality in hospitalized patients [32]. Although diseases (e.g., CVDs) are common causes of impaired sodium and potassium homeostasis and associated with poor prognosis among AKI patients [12–14], but our sensitivity analysis of excluding diseases, such as CVDs, chronic pulmonary disease, deficiency anemias, liver disease, or tumor related diseases, did not change our conclusions.…”

Section: Discussionmentioning

confidence: 99%

Admission serum sodium and potassium levels predict survival among critically ill patients with acute kidney injury: a cohort study

et al. 2019

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Background Patients suffering from acute kidney injury (AKI) were associated with impaired sodium and potassium homeostasis. We aimed to investigate how admission serum sodium and potassium independently and jointly modified adverse clinical outcomes among AKI patients. Methods Patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III. Participants were categorized into three groups according to admission serum sodium and potassium, and the cut-off values were determined using smooth curve fitting. The primary outcome was 90-day mortality in the intensive care unit (ICU). Cox proportional hazards models were used to evaluate the prognostic effects of admission serum sodium and potassium levels. Results We included 13,621 ICU patients with AKI (mean age: 65.3 years; males: 55.4%). The middle category of admission serum sodium and potassium levels were 136.0–144.9 mmol/L and 3.7–4.7 mmol/L through fitting smooth curve. In multivariable Cox models, compared with the middle category, patients with hyponatremia or hypernatremia were associated with excess mortality and the HRs and its 95%CIs were 1.38 (1.27, 1.50) and 1.56 (1.36, 1.79), and patients with either hypokalemia or hyperkalemia were associated with excess mortality and the hazard ratios (HRs) and its 95% confidential intervals (95% CIs) were 1.12 (1.02, 1.24) and 1.25 (1.14, 1.36), respectively. Significant interactions were observed between admission serum sodium and potassium levels (P interaction = 0.001), with a higher serum potassium level associated with increased risk of 90-day mortality among patients with hyponatremia, whereas the effects of higher sodium level on prognostic effects of potassium were subtle. Conclusions Admission serum sodium and potassium were associated with survival in a U-shaped pattern among patients with AKI, and hyperkalemia predict a worse clinical outcome among patients with hyponatremia. Electronic supplementary material The online version of this article (10.1186/s12882-019-1505-9) contains supplementary material, which is available to authorized users.

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Prognostic Importance of Low Admission Serum Creatinine Concentration for Mortality in Hospitalized Patients

Abstract: Low creatinine value at admission is independently associated with increased in-hospital mortality in hospitalized patients.

Cited by 34 publications

References 21 publications

Ratio between estimated glomerular filtration rates of creatinine and cystatin C predicts overall survival in patients with hepatocellular carcinoma

Ratio between estimated glomerular filtration rates of creatinine and cystatin C predicts overall survival in patients with hepatocellular carcinoma

Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis

Admission serum sodium and potassium levels predict survival among critically ill patients with acute kidney injury: a cohort study

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