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Derivation of urine output thresholds that identify a very high risk of AKI in patients with septic shock.

AbstractBACKGROUND AND OBJECTIVES:
To promote early detection of AKI, recently proposed pretest probability models combine sub-Kidney Disease Improving Global Outcomes (KDIGO) AKI criteria with baseline AKI risk. The primary objective of this study was to determine sub-KDIGO thresholds that identify patients with septic shock at highest risk for AKI.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:
This was a retrospective analysis of 390 adult patients admitted to the medical intensive care unit (ICU) of a tertiary, academic medical center with septic shock between January 2008 and December 2010. Hourly urine output was collected from the time of septic shock recognition (hour 0) to hour 96, urine catheter removal, or ICU discharge (whichever occurred first). All available serum creatinine (SCr) measurements were collected until hour 96. The AKI pretest probability model was assessed during the first 12 hours of resuscitation and included the initial episode of oliguria, increase from baseline to peak SCr level, and Acute Physiology and Chronic Health Evaluation (APACHE) III score in a multivariable receiver-operator characteristic (ROC) analysis. The primary outcome was the incidence of stage II or III (stage II+) AKI defined by KDIGO criteria. Secondary outcomes included the need for RRT and 28-day mortality.
RESULTS:
Ninety-eight (25%) patients developed stage II+ AKI after septic shock recognition. APACHE III score and increase in SCr level in the first 12 hours were not statistically associated with stage II+ AKI in multivariable ROC analysis. Consecutive oliguria for 3 hours had fair predictive ability for achieving stage II+ AKI criteria (area under ROC curve, 0.73; 95% confidence interval [95% CI], 0.68 to 0.78), and oliguria for 5 hours demonstrated optimal accuracy (82%; 95% CI, 79% to 86%).
CONCLUSIONS:
Three to 5 hours of consecutive oliguria in patients with septic shock may provide a valuable measure of AKI risk. Further validation to support this finding is needed.
AuthorsDavid D Leedahl, Erin N Frazee, Garrett E Schramm, Ross A Dierkhising, Eric J Bergstralh, Lakhmir S Chawla, Kianoush B Kashani
JournalClinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol) Vol. 9 Issue 7 Pg. 1168-74 (Jul 2014) ISSN: 1555-905X [Electronic] United States
PMID24789551 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2014 by the American Society of Nephrology.
Chemical References
  • Biomarkers
  • Creatinine
Topics
  • APACHE
  • Academic Medical Centers
  • Acute Kidney Injury (blood, diagnosis, etiology, mortality, physiopathology, therapy)
  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Biomarkers (blood)
  • Creatinine (blood)
  • District of Columbia
  • Early Diagnosis
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Oliguria (blood, diagnosis, etiology, mortality, physiopathology, therapy)
  • Predictive Value of Tests
  • ROC Curve
  • Renal Replacement Therapy
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Shock, Septic (blood, complications, diagnosis, mortality, physiopathology, therapy)
  • Tertiary Care Centers
  • Time Factors
  • Treatment Outcome
  • Urinary Catheterization
  • Urination
  • Urodynamics

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