SOFA score is superior to APACHE-II score in predicting the prognosis of critically ill patients with acute kidney injury undergoing continuous renal replacement therapy

Wang, Hai; Xiao, Kang; Shi, Yu; Bai, Zhenghai; Lv, Juan; Sun, Jiangli; Pei, Hong

doi:10.1080/0886022x.2020.1788581

Cited by 36 publications

(29 citation statements)

References 30 publications

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“…The high observed mortality in both treatment arms is in line with results of other studies considering the disease severity of investigated patient population [51].…”

Section: Discussionsupporting

confidence: 90%

Myoglobin clearance with continuous veno-venous hemodialysis using high cutoff dialyzer versus continuous veno-venous hemodiafiltration using high-flux dialyzer: a prospective randomized controlled trial

et al. 2020

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Background Myoglobin clearance in acute kidney injury requiring renal replacement therapy is important because myoglobin has direct renal toxic effects. Clinical data comparing different modalities of renal replacement therapy addressing myoglobin clearance are limited. This study aimed to compare two renal replacement modalities regarding myoglobin clearance. Methods In this prospective, randomized, single-blinded, single-center trial, 70 critically ill patients requiring renal replacement therapy were randomized 1:1 into an intervention arm using continuous veno-venous hemodialysis with high cutoff dialyzer and a control arm using continuous veno-venous hemodiafiltration postdilution with high-flux dialyzer. Regional citrate anticoagulation was used in both groups to maintain the extracorporeal circuit. The concentrations of myoglobin, urea, creatinine, β2-microglobulin, interleukin-6 and albumin were measured before and after the dialyzer at 1 h, 6 h, 12 h, 24 h and 48 h after initiating continuous renal replacement therapy. Results Thirty-three patients were allocated to the control arm (CVVHDF with high-flux dialyzer) and 35 patients to the intervention arm (CVVHD with high cutoff dialyzer). Myoglobin clearance, as a primary endpoint, was significantly better in the intervention arm than in the control arm throughout the whole study period. The clearance values for urea and creatinine were higher in the control arm. There was no measurable albumin clearance in both arms. The clearance data for β2-microglobulin and interleukin-6 were non-inferior in the intervention arm compared to those for the control arm. Dialyzer lifespan was 57.0 [38.0, 72.0] hours in the control arm and 70.0 [56.75, 72.0] hours in the intervention arm (p = 0.029). Conclusions Myoglobin clearance using continuous veno-venous hemodialysis with high cutoff dialyzer and regional citrate anticoagulation is better than that with continuous veno-venous hemodiafiltration with regional citrate anticoagulation. Trial registration German Clinical Trials Registry (DRKS00012407); date of registration 23/05/2017. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012407.

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“…The high observed mortality in both treatment arms is in line with results of other studies considering the disease severity of investigated patient population [51].…”

Section: Discussionsupporting

confidence: 90%

Myoglobin clearance with continuous veno-venous hemodialysis using high cutoff dialyzer versus continuous veno-venous hemodiafiltration using high-flux dialyzer: a prospective randomized controlled trial

et al. 2020

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“…Mortality prediction remains significant regardless of the stage of chronic kidney disease, indicating dysregulated fluid homeostasis, which is also in line with other investigations (42). Taken together with other study results, this is evidence of the strong correlation of body fluid balance with infection and mortality (43).…”

Section: Discussionsupporting

confidence: 91%

Risk assessment of sepsis through measurement of proAVP (copeptin): a secondary analysis of the TRIAGE study

Kloter

Gregoriano

Haag

et al. 2021

Endocrine Connections

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Objective: Systemic infections and sepsis lead to a strong activation of the vasopressin system, which is pivotal for stimulation of the endocrine stress response and in addition has vasoconstrictive and immunomodulatory effects. Our aim was to assess the significance of the vasopressor system through measurement of C-terminal proAVP (copeptin) regarding mortality prediction in a large prospective cohort of patients with systemic infection. Design and Methods: This secondary analysis of the observational cohort TRIAGE study included consecutive, adult, medical patients with an initial diagnosis of infection seeking emergency department care. We used multivariable regression analysis to assess associations of copeptin levels in addition to the sequential organ failure assessment (SOFA) score with 30-day mortality. Discrimination was assessed by calculation of the area under the curve (AUC). Results: Overall, 45 of 609 (7.4%) patients with infection died within 30 days. Non-survivors had a marked upregulation of the vasopressin system with a more than 4-fold increase in admission copeptin-levels compared to non-survivors (199.9 ± 204.7 vs. 46.6 ± 77.2 pmol/L). In a statistical model copeptin was significantly associated with mortality (adjusted odds ratio of 1.04, 95% CI 1.01 to 1.07, p=0.002). Regarding discrimination, copeptin alone showed an AUC of 0.82, while adding copeptin to the SOFA score significantly improved its prognostic ability (AUC 0.83 vs. 0.86, p=0.027). Conclusion: Activation of vasopressin system mirrored by an increase in copeptin levels provided significant information regarding mortality risk and improved the SOFA score for prediction of sepsis mortality. Trial registration: ClinicalTrials.gov NCT01768494. Registered January 9, 2013

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“…According to our findings, age [ 39 ], male sex [ 40 ], CKD [ 41 ] are well-known risk factors for AKI in the general population. SOFA score is a reliable prognostic scoring for critically ill patients with sepsis [ 42 ] as well as kidney injury [ 43 – 46 ]. Furthermore, extrarenal SOFA score has been identified as independent predictors for AKI in a cohort of non-COVID-19 critically ill surgical patients.…”

Section: Discussionmentioning

confidence: 99%

Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19

et al. 2021

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Background Acute kidney injury (AKI) is a severe complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate incidence, risk factors and case-fatality rate of AKI in patients with COVID-19. Methods We reviewed the health medical records of 307 consecutive patients with COVID-19 hospitalized at the University Hospital of Modena, Italy. Results AKI was diagnosed in 69 out of 307 (22.4%) COVID-19 patients. Stages 1, 2, or 3 AKI accounted for 57.9%, 24.6% and 17.3%, respectively. AKI patients had a mean age of 74.7 ± 9.9 years. These patients showed higher serum levels of the main markers of inflammation and higher rate of severe pneumonia than non-AKI patients. Kidney injury was associated with a higher rate of urinary abnormalities including proteinuria (0.44 ± 0.85 vs 0.18 ± 0.29 mg/mg; P = < 0.0001) and microscopic hematuria ( P = 0.032) compared to non-AKI patients. Hemodialysis was performed in 7.2% of the subjects and 33.3% of the survivors did not recover kidney function after AKI. Risk factors for kidney injury were age, male sex, CKD and higher non-renal SOFA score. Patients with AKI had a mortality rate of 56.5%. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (hazard ratio [HR] = 4.82; CI 95%, 1.36–17.08) compared to non-AKI patients. Conclusion AKI was a common and harmful consequence of COVID-19. It manifested with urinary abnormalities (proteinuria, microscopic hematuria) and conferred an increased risk for death. Given the well-known short-term sequelae of AKI, prevention of kidney injury is imperative in this vulnerable cohort of patients. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-021-02092-x.

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SOFA score is superior to APACHE-II score in predicting the prognosis of critically ill patients with acute kidney injury undergoing continuous renal replacement therapy

Cited by 36 publications

References 30 publications

Myoglobin clearance with continuous veno-venous hemodialysis using high cutoff dialyzer versus continuous veno-venous hemodiafiltration using high-flux dialyzer: a prospective randomized controlled trial

Myoglobin clearance with continuous veno-venous hemodialysis using high cutoff dialyzer versus continuous veno-venous hemodiafiltration using high-flux dialyzer: a prospective randomized controlled trial

Risk assessment of sepsis through measurement of proAVP (copeptin): a secondary analysis of the TRIAGE study

Incidence, risk factors and outcome of acute kidney injury (AKI) in patients with COVID-19

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