9 research outputs found
Evaluation of the prognostic value of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria for acute kidney injury
AIM: The experts have argued about the use of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria as a prognosis scoring system. We examined the association between in-hospital mortality and the RIFLE criteria, and discussed its accuracy as a prognosis factor.
METHODS: In this prospective study, we analysed the data gathered from a cohort of 956 patients admitted in a Spanish tertiary hospital between January 1998 and April 2006. Hazard ratios for mortality, and survival curves within 60 days were calculated. Discrimination and calibration of the model were also assessed.
RESULTS: Excluding 53 patients, 903 patients were finally analysed. We classified them into groups according to the maximum RIFLE class reached during their admission. The RIFLE class was assessed by the glomerular filtration rate criterion. We found an increase in the in-hospital mortality risk. Cox proportional hazard models showed that RIFLE classes risk, injury, and failure were significant predictive factors (hazard ratios were 2.77, 3.23 and 3.52, respectively; P for trend was 0.005). The multivariate analyses from the cross-classification of the participants according to Liano score values (severity of illness) and RIFLE classes showed additive effects of the exposures on in-hospital mortality.
CONCLUSION: In this population, the risk of in-hospital mortality during the acute kidney injury (AKI) episode was positively associated with RIFLE classes. We showed that the RIFLE classification system had discriminative power in predicting hospital mortality within 60 days in AKI patients, but not better than a specific AKI predictive model. However, a combined use of both may give a more robust prognosis system
Karnofsky performance score in acute renal failure as a predictor of short-term survival
Karnofsky Performance Scale Index (KPS) is a measure of functional
status that allows patients to be classified according to their functional
impairment. We aim to assess if the prior KPS may predict the risk of death among
patients with acute renal failure (ARF). METHODS: A cohort of 668 consecutive
patients who had been admitted in an university-affiliated hospital between June
2000 and June 2006, and had been diagnosed with ARF, were studied. Three hundred
and eighty-six patients with ARF who matched at least one of the RIFLE (Risk,
Injury, Failure, Loss and End stage) criteria on increased serum creatinine were
included for subsequent analysis. The group was divided into four categories,
according to different Karnofsky scores measured by a nephrologist (>or=80, 70,
60 and <or=50). We used an adjusted logistic regression model to assess the
relationship between the Karnofky score and mortality. RESULTS: A significant
risk of in-hospital mortality within 90 days was observed when the other groups
were compared with the >or=80 Karnofsky group. Adjusted odds ratios were 8.87
(95% confidence interval (CI) 3.03-25.99), 6.78 (95% CI 2.61-17.58) and 2.83 (95%
CI 1.04-7.68), for Karnofsky groups of <or=50, 60 and 70, respectively. An
adjusted odds ratio of 1.75 (95% CI 1.37-2.23) was observed for every 10 point
decrease in KPS score. CONCLUSION: Functional status as indicated by the KPS is
an independent predictor of death in this cohort of patients with ARF. Patients
who presented lower scores had increased mortality rate
Serum C-reactive protein on the prognosis of oncology patients with acute renal failure: an observational cohort study
We undertook this study to evaluate the significance of the C-reactive protein level (CRP) as a prognostic factor in oncology patients with acute renal failure (ARF) during nephrology consultation. METHODS: The study was
comprised of a cohort of 375 consecutive oncology patients who had been admitted
to a university-affiliated hospital between March 1998 and April 2006 and had
been diagnosed with ARF. One hundred and fifty nine patients with ARF who matched
at least one of the RIFLE criteria on increased serum creatinine were included
for subsequent analysis. We used a Cox proportional hazard model. RESULTS:
Clinical pathological variables were compared among patients with serum CRP
levels > or =8 mg/dL (exposed group; cut-off point: median) and patients with
serum CRP level <8 mg/dL (control group). In-hospital mortality rates associated
with CRP levels were 53.8% for > or =8 mg/dL and 21.5% for <8 mg/dL (p <0.001).
After adjusted analysis, the presence of a CRP level > or =8 mg/dL was
significantly associated with an increased in-hospital mortality (HR 2.10; 95%
CI: 1.17-3.78) than in those patients with similar Liano scoring, the same RIFLE
classes, and the same treatment for ARF. In addition, each increment of 1 mg/dL
of serum CRP was associated with an adjusted 4% increment of in-hospital
mortality (HR 1.04, 95% CI: 1.01-1.06). CONCLUSIONS: CRP levels at nephrology
consultation were an independent predictor of death in this cohort of oncology
patients with ARF. Patients with levels > or =8 mg/dL may be considered at higher
risk of death
Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study
Acute kidney injury is among the most serious complications after
cardiac surgery and is associated with an impaired outcome. Multiple factors may
concur in the development of this disease. Moreover, severe renal failure
requiring renal replacement therapy (RRT) presents a high mortality rate.
Consequently, we studied a Spanish cohort of patients to assess the risk factors
for RRT in cardiac surgery-associated acute kidney injury (CSA-AKI). METHODS: A
retrospective case-cohort study in 24 Spanish hospitals. All cases of RRT after
cardiac surgery in 2007 were matched in a crude ratio of 1:4 consecutive patients
based on age, sex, treated in the same year, at the same hospital and by the same
group of surgeons. RESULTS: We analyzed the data from 864 patients enrolled in
2007. In multivariate analysis, severe acute kidney injury requiring
postoperative RRT was significantly associated with the following variables:
lower glomerular filtration rates, less basal haemoglobin, lower left ventricular
ejection fraction, diabetes, prior diuretic treatment, urgent surgery, longer
aortic cross clamp times, intraoperative administration of aprotinin, and
increased number of packed red blood cells (PRBC) transfused. When we conducted a
propensity analysis using best-matched of 137 available pairs of patients, prior
diuretic treatment, longer aortic cross clamp times and number of PRBC transfused
were significantly associated with CSA-AKI.Patients requiring RRT needed longer
hospital stays, and suffered higher mortality rates. CONCLUSION: Cardiac-surgery
associated acute kidney injury requiring RRT is associated with worse outcomes.
For this reason, modifiable risk factors should be optimised and higher risk
patients for acute kidney injury should be identified before undertaking cardiac
surgery
Evaluation of the prognostic value of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria for acute kidney injury
AIM: The experts have argued about the use of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria as a prognosis scoring system. We examined the association between in-hospital mortality and the RIFLE criteria, and discussed its accuracy as a prognosis factor.
METHODS: In this prospective study, we analysed the data gathered from a cohort of 956 patients admitted in a Spanish tertiary hospital between January 1998 and April 2006. Hazard ratios for mortality, and survival curves within 60 days were calculated. Discrimination and calibration of the model were also assessed.
RESULTS: Excluding 53 patients, 903 patients were finally analysed. We classified them into groups according to the maximum RIFLE class reached during their admission. The RIFLE class was assessed by the glomerular filtration rate criterion. We found an increase in the in-hospital mortality risk. Cox proportional hazard models showed that RIFLE classes risk, injury, and failure were significant predictive factors (hazard ratios were 2.77, 3.23 and 3.52, respectively; P for trend was 0.005). The multivariate analyses from the cross-classification of the participants according to Liano score values (severity of illness) and RIFLE classes showed additive effects of the exposures on in-hospital mortality.
CONCLUSION: In this population, the risk of in-hospital mortality during the acute kidney injury (AKI) episode was positively associated with RIFLE classes. We showed that the RIFLE classification system had discriminative power in predicting hospital mortality within 60 days in AKI patients, but not better than a specific AKI predictive model. However, a combined use of both may give a more robust prognosis system
Karnofsky performance score in acute renal failure as a predictor of short-term survival
Karnofsky Performance Scale Index (KPS) is a measure of functional
status that allows patients to be classified according to their functional
impairment. We aim to assess if the prior KPS may predict the risk of death among
patients with acute renal failure (ARF). METHODS: A cohort of 668 consecutive
patients who had been admitted in an university-affiliated hospital between June
2000 and June 2006, and had been diagnosed with ARF, were studied. Three hundred
and eighty-six patients with ARF who matched at least one of the RIFLE (Risk,
Injury, Failure, Loss and End stage) criteria on increased serum creatinine were
included for subsequent analysis. The group was divided into four categories,
according to different Karnofsky scores measured by a nephrologist (>or=80, 70,
60 and <or=50). We used an adjusted logistic regression model to assess the
relationship between the Karnofky score and mortality. RESULTS: A significant
risk of in-hospital mortality within 90 days was observed when the other groups
were compared with the >or=80 Karnofsky group. Adjusted odds ratios were 8.87
(95% confidence interval (CI) 3.03-25.99), 6.78 (95% CI 2.61-17.58) and 2.83 (95%
CI 1.04-7.68), for Karnofsky groups of <or=50, 60 and 70, respectively. An
adjusted odds ratio of 1.75 (95% CI 1.37-2.23) was observed for every 10 point
decrease in KPS score. CONCLUSION: Functional status as indicated by the KPS is
an independent predictor of death in this cohort of patients with ARF. Patients
who presented lower scores had increased mortality rate
Timing of renal replacement therapy after cardiac surgery: a retrospective multicenter Spanish Cohort Study
Background: The optimal time to initiate renal replacement therapy (RRT) in cardiac surgery-associated acute kidney injury (CSA-AKI) is unknown. Evidence suggests that the early use of RRT in critically ill patients is associated with improved outcomes. We studied the effects of time to initiation of RRT on outcome in patients with CSA-AKI. Methods: This was a retrospective observational multicenter study (24 Spanish hospitals). We analyzed data on 203 patients who required RRT after cardiac surgery in 2007. The cohort was divided into 2 groups based on the time at which RRT was initiated: in the early RRT group, therapy was initiated within the first 3 days after cardiac surgery; in the late group, RRT was begun after the 3rd day. Multivariate nonconditional logistic and linear regression models were used to adjust for potential confounders. Results: In-hospital mortality was significantly higher in the late RRT group compared with early RRT patients (80.4 vs. 53.2%; p < 0.001; adjusted odds ratio of 4.1, 95% CI: 1.6–10.0). Also, patients in the late RRT group had longer adjusted hospital stays by 11.6 days (95% CI: 1.4–21.9) and higher adjusted percentage increases in creatinine at discharge compared with baseline by 67.7% (95% CI: 28.5–106.4). Conclusions: Patients who undergo early initiation of RRT after CSA-AKI have improved survival rates and renal function at discharge and decreased lengths of hospital stay
External Validation and Comparison of Three Scores to Predict Renal Replacement Therapy after Cardiac Surgery: A Multicenter Cohort
Purpose: Cardiac surgery-associated acute kidney injury requiring renal replacement therapy (RRT) is
independently associated with mortality. Several risk scores have been developed to predict the need
for RRT after cardiac surgery. We have compared and verified the external validity of the three main
available scores for RRT prediction after cardiac surgery: the Thakar score, the Mehta tool, and the
Simplified Renal Index.
Methods: The risk scores were calculated in a cohort of 1084 adult patients, 248 of whom required
RRT, who underwent open-heart surgery in 24 Spanish hospitals in 2007. The performance of the
systems was determined by examining their discrimination (areas under the receiver operating characteristic curves (aROC) and calibration (Lemeshow-Hosmer chi-square goodness-of-fit statistics).
Results: The aROCs in the Thakar score, the Mehta tool, and the Simplified Renal Index were 0.82,
0.76 and 0.79, respectively. The three scoring systems were poorly calibrated and tended to underestimate the actual need for RRT.
Conclusions: The Thakar score and the Simplified Renal Index discriminated well between low - and
high-risk patients in our cohort, and Thakar outperformed the Mehta tool. These best-performing
scores may aid in the selection of optimal therapy, facilitate the planning of hospital resource utilization, improve preoperative counseling, select participants for clinical trials of renal-protective therapies and enable an accurate comparison between different institutions or surgeons
External validation and comparison of three scores to predict renal replacement therapy after cardiac surgery: A multicenter cohort
Purpose: Cardiac surgery-associated acute kidney injury requiring renal replacement therapy (RRT) is
independently associated with mortality. Several risk scores have been developed to predict the need
for RRT after cardiac surgery. We have compared and verified the external validity of the three main
available scores for RRT prediction after cardiac surgery: the Thakar score, the Mehta tool, and the
Simplified Renal Index.
Methods: The risk scores were calculated in a cohort of 1084 adult patients, 248 of whom required
RRT, who underwent open-heart surgery in 24 Spanish hospitals in 2007. The performance of the
systems was determined by examining their discrimination (areas under the receiver operating characteristic curves (aROC) and calibration (Lemeshow-Hosmer chi-square goodness-of-fit statistics).
Results: The aROCs in the Thakar score, the Mehta tool, and the Simplified Renal Index were 0.82,
0.76 and 0.79, respectively. The three scoring systems were poorly calibrated and tended to underestimate the actual need for RRT.
Conclusions: The Thakar score and the Simplified Renal Index discriminated well between low - and
high-risk patients in our cohort, and Thakar outperformed the Mehta tool. These best-performing
scores may aid in the selection of optimal therapy, facilitate the planning of hospital resource utilization, improve preoperative counseling, select participants for clinical trials of renal-protective therapies and enable an accurate comparison between different institutions or surgeons