Transient and Persistent AKI and Outcomes in Patients Undergoing Major Abdominal Surgery

Gameiro, Joana; Duarte, Inês; Marques, Filipe; Fonseca, José Agapito; Jorge, Sofía; Rosario, Rosa; Lopes, José António

doi:10.1159/000506397

Cited by 13 publications

(10 citation statements)

References 49 publications

(73 reference statements)

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“…27 Joana et al demonstrated that pAKI was an independent predictor of in-hospital mortality in contrast to tAKI in a retrospective study of 450 patients who underwent major abdominal surgery. 28 Similar to this, we also found that pAKI patients For personal use only.…”

Section: Discussionsupporting

confidence: 83%

Development and External Verification of a Nomogram for Patients with Persistent Acute Kidney Injury in the Intensive Care Unit

Ding¹,

Hu²

2021

IJGM

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Background We aimed to identify the affecting features of persistent acute kidney injury (pAKI) for patients in intensive care units (ICU). Methods The Medical Information Mart for Intensive Care IV (MIMIC-IV) database and eICU Collaborative Research Database (eICU-CRD) were used to identify AKI patients with and without duration of more than 48 hours. Least absolute shrinkage and selection operator (LASSO) regression and support vector machine (SVM-RFE) were utilized to screen for the significant clinical indexes associated with pAKI. Predictive nomogram was created based on the above informative parameters to predict the probability of pAKI. Results LASSO regression and SVM-RFE revealed that serum albumin, chronic kidney disease, AKI stage, sequential organ failure assessment score, lactate and renal replacement therapy during the first day were significantly associated with pAKI in the training cohort. The predictive nomogram based on the six predictors exhibited good predictive performance as calculated by C-index 0.730 (95% CI 0.710–0.749) in the training group, 0.702 (95% CI 0.672–0.722) in the internal validation set and 0.704 (0.677–0.731) in the external validation cohort for the prediction of pAKI. Moreover, the predictive nomogram exhibited not only encouraging calibration ability, but also great clinical utility in the training group, in the internal validation group as well as in the external validation cohort. Conclusion Serum albumin, CKD, AKI stage, SOFA score, lactate, RRT during the first day were closely associated with pAKI in patients in ICU. The predictive nomogram for pAKI manifested good predictive ability for the identification of ICU patients with pAKI.

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Section: Discussionsupporting

confidence: 83%

Development and External Verification of a Nomogram for Patients with Persistent Acute Kidney Injury in the Intensive Care Unit

Ding¹,

Hu²

2021

IJGM

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“…Early reversal within 7 days of AKI occurred in 63% of patients and was associated with improved outcome [ 31 ]. A study of AKI after major abdominal surgery reported an incidence of 22% of postoperative AKI, a recovery rate of 52% in the first 48 h, and increased mortality of 52% in patients with persistent AKI [ 32 ]. The AKI recovery rate of 78% found in our study was higher than previously reported and was associated with significantly lower in-hospital mortality compared to patients with persistent AKI after the first 7 days.…”

Section: Discussionmentioning

confidence: 99%

Renal Recovery after the Implementation of an Electronic Alert and Biomarker-Guided Kidney-Protection Strategy following Major Surgery

Halmy

Riedel

Zeman

et al. 2021

JCM

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Background: The facilitation of early recovery of acute kidney injury (AKI) is an important step to improve outcome, particularly because of the limited therapeutic interventions currently available for AKI. The combination of an electronic alert and biomarker-guided kidney-protection strategy implemented in the routine care may have an impact on the incidence of early complete reversal of AKI after major non-cardiac surgery. Methods: We studied 294 patients in two cohorts before (n = 151) and after protocol implementation (n = 143). Data collection required 6 months for each cohort. The kidney-protection protocol included an electronic alert to detect patients who were eligible for urinary biomarker [TIMP2 × IGFBP7]-guided kidney-protection intervention. Intervention was stratified according to three levels of immediate AKI risk: low, moderate, and high. After intervention, postoperative changes in the glomerular filtration rate (eGFR) were identified with a tracking software that included an alert for nephrology consultation if the eGFR had declined by >25% from the preoperative reference value. Primary outcome was early AKI recovery, i.e., the complete reversal of any AKI stage to absence of AKI within the first 7 postoperative days. Results: Protocol implementation significantly increased the recovery of AKI (36/46, 78% compared to control 27/48, 56%, (p = 0.025)) and reduced the length of the ICU stay (p < 0.001). There was no significant difference in the overall incidence of all AKI and moderate and severe AKI in the first 7 postoperative days: 46/143 (32%) and 12/151 (8%) in the protocol implementation group compared to 48/151 (32%) and 18/151 (12%) in the historical control group. Patients with AKI reversal within the first 7 postoperative days had lower in-hospital mortality than patients without AKI reversal. Conclusions: Implementing a combined electronic alert and biomarker-guided kidney-protection strategy in routine care improved early recovery of AKI after major surgery.

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“…When used before an injurious exposure has occurred, the test will not forecast AKI. Similarly, the test avoidance of nephrotoxic drugs, and preventing hyperglycemia, resulted in an absolute risk reduction of 16.6% in the incidence of AKI compared with the standard care [29].…”

Section: Mortality Was Higher In Individuals With Akimentioning

confidence: 99%

“…The concept that time should also be considered in the description of AKI and not only severity, was demonstrated in a study reporting that duration of AKI following surgery was independently associated with hospital mortality after adjusting for severity of illness [25]. avoidance of nephrotoxic drugs, and preventing hyperglycemia, resulted in an absolute risk reduction of 16.6% in the incidence of AKI compared with the standard care [29].…”

Section: Mortality Was Higher In Individuals With Akimentioning

confidence: 99%

Role of Tissue Inhibitor of Metalloproteinases-2 and Insulin Like Growth Factor Binding Protein 7 for Early Recognition of Acute Kidney Injury in Critically Ill COVID-19 Patients

CASAS

Barrera

Escamilla-Illescas

et al. 2021

Preprint

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Background: A high proportion of critically ill patients with COVID-19 develop acute kidney injury (AKI) and die. Early recognition of subclinical AKI could contribute to AKI prevention. Therefore, this study was aimed at exploring the role of the urinary biomarkers NGAL and [TIMP-2]•[IGFBP7] for early detection of AKI in this population. Methods: This prospective, longitudinal cohort study included critically ill COVID-19 patients without AKI at study entry. Urine samples were collected on admission to critical care areas for determination of NGAL and [TIMP-2]•[IGFBP7] concentrations. Demographic information, comorbidities, clinical and laboratory data were recorded. The study outcomes were development of AKI and mortality during hospitalization. Comparisons of individuals who developed AKI during hospitalization vs. those without AKI were made using chi-squared test for categorical variables and Mann-Whitney U for continuous variables. Urinary biomarkers and their cutoff values were selected based on the highest sensitivity, specificity and area under the receiver-operating characteristics curve with 95% confidence intervals for prediction of AKI. Selected biomarkers and cutoffs were used in the Kaplan-Meier survival analyses for the time to AKI. Logistic regression analysis was used to identify the association between relevant covariates with AKI and mortality. For all analyses, two-sided P values £0.05 were considered statistically significant.Results: Of the 51 individuals studied, 25 developed AKI during hospitalization (49%). The risk factors for AKI were male gender (HR=7.57, 95% CI: 1.28-44.8; p=0.026) and [TIMP-2]•[IGFBP7] ³ 0.2 (ng/ml)2/1000 (HR=7.23 , 95% CI: 0.99-52.4; p=0.050). Mortality during hospitalization was significantly higher in the group with AKI than in the group without AKI (p=0.004). Persistent AKI was a risk factor for mortality (HR=7.42, 95% CI: 1.04-53.04; p=0.046).Conclusions: The combination of [TIMP-2]•[IGFBP7], together with clinical information, were useful for identification of subclinical AKI in critically ill COVID-19 patients. The role of additional biomarkers and their possible combinations for detection of AKI in critically ill COVID-19 patients remains to be explored in large clinical trials.

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Transient and Persistent AKI and Outcomes in Patients Undergoing Major Abdominal Surgery

Cited by 13 publications

References 49 publications

Development and External Verification of a Nomogram for Patients with Persistent Acute Kidney Injury in the Intensive Care Unit

Development and External Verification of a Nomogram for Patients with Persistent Acute Kidney Injury in the Intensive Care Unit

Renal Recovery after the Implementation of an Electronic Alert and Biomarker-Guided Kidney-Protection Strategy following Major Surgery

Role of Tissue Inhibitor of Metalloproteinases-2 and Insulin Like Growth Factor Binding Protein 7 for Early Recognition of Acute Kidney Injury in Critically Ill COVID-19 Patients

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