Association between acute kidney injury and clinical outcomes in non-surgical patients receiving intensive cardiac care_West China Medical Journal

Authors：

LI Hongwei ^1,2 , LIU Qi ¹ , LI Yiming ¹ ,  CHEN Fei ¹ , HUANG Baotao ¹ , PENG Yong ¹ ,  CHEN Mao ¹

1. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Cardiology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CHEN Fei, Email: chenfeicardio@foxmail.com; CHEN Mao, Email: hmaochen@vip.sina.com

Keywords：

Acute kidney injury; cardiac critical illness; clinical outcome

DOI：

10.7507/1002-0179.202311221

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Objective To explore the clinical characteristics, in-hospital outcomes, and short-term survival of patients with acute kidney injury (AKI) in a large non-surgical cardiac intensive care unit (ICCU) in China. Methods Patients who had been admitted to the ICCU of the Department of Cardiology, West China Hospital of Sichuan University between June 2016 and May 2017 were retrospectively included. The diagnosis and staging of AKI were based on the Kidney Disease: Improving Global Outcomes criteria. The in-hospital outcomes were the composite of all-cause death or discharge against medical advice under extremely critical conditions. Patients without in-hospital composite outcomes were followed up to determine whether all-cause death occurred during the study period. The association of AKI with in-hospital composite outcomes or short-term survival was analyzed. Normally distributed quantitative data were expressed as mean±standard deviation, and non-normally distributed quantitative data were expressed as median (lower quartile, upper quartile). Results This study included 2083 patients, with an average age of (65.5±14.6) years old, and 681 (32.7%) were women. The prevalence rate of AKI was 15.0% (312/2083) (stage 1: 6.9%; stage 2: 4.9%; stage 3: 3.2%; respectively). Compared with patients without AKI, patients with AKI were older [(68.9±14.3) vs. (64.9±14.6) years old, P<0.001], had a higher Charles Comorbidity Index [4.0 (3.0, 6.0) vs. 2.0 (1.0, 3.0), P<0.001] and a greater Oxford Acute Illness Severity Score [32.0 (24.0, 41.2) vs. 21.0 (16.0, 26.0), P<0.001]. The incidence of in-hospital composite endpoint events was 8.4% (174/2083). Multiple logistic regression analysis showed that as the AKI stage increased, the risk of in-hospital composite endpoint events was higher [AKI stage 1 vs. no AKI: odds ratio (OR)=1.13, 95% confidence interval (CI) (0.57, 2.24); AKI stage 2 vs. no AKI: OR=2.21, 95%CI (1.08, 4.51); AKI stage 3 vs. no AKI: OR=10.88, 95%CI (4.50, 26.34); P for trend<0.001]. The patients without in-hospital composite endpoint events were followed up for a median time of 13.5 (10.7, 16.6) months, and the all-cause mortality rate was 5.5% (105/1909). Multiple Cox regression analysis showed that AKI was independently associated with all-cause death [hazard ratio=2.27, 95%CI (1.40, 3.69), P<0.001]. Conclusions AKI is common in the large ICCU in China and is more likely to occur in older patients who have more significant chronic illness complexity and acute illness severity. Moreover, AKI is independently associated with the in-hospital composite endpoint events and short-term survival.

Citation： LI Hongwei, LIU Qi, LI Yiming, CHEN Fei, HUANG Baotao, PENG Yong, CHEN Mao. Association between acute kidney injury and clinical outcomes in non-surgical patients receiving intensive cardiac care. West China Medical Journal, 2024, 39(1): 22-29. doi: 10.7507/1002-0179.202311221 Copy

1.	Thakar CV, Christianson A, Freyberg R, et al. Incidence and outcomes of acute kidney injury in intensive care units: a veterans administration study. Crit Care Med, 2009, 37(9): 2552-2558.
2.	Susantitaphong P, Cruz DN, Cerda J, et al. World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol, 2013, 8(9): 1482-1493.
3.	Danziger J, Chen KP, Lee J, et al. Obesity, acute kidney injury, and mortality in critical illness. Crit Care Med, 2016, 44(2): 328-334.
4.	Stanski NL, Rodrigues CE, Strader M, et al. Precision management of acute kidney injury in the intensive care unit: current state of the art. Intensive Care Med, 2023, 49(9): 1049-1061.
5.	Lau G, Wald R, Sladen R, et al. Acute kidney injury in cardiac surgery and cardiac intensive care. Semin Cardiothorac Vasc Anesth, 2015, 19(4): 270-287.
6.	Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nat Rev Nephrol, 2017, 13(11): 697-711.
7.	Katz JN, Shah BR, Volz EM, et al. Evolution of the coronary care unit: clinical characteristics and temporal trends in healthcare delivery and outcomes. Crit Care Med, 2010, 38(2): 375-381.
8.	Sinha SS, Sjoding MW, Sukul D, et al. Changes in primary noncardiac diagnoses over time among elderly cardiac intensive care unit patients in the United States. Circ Cardiovasc Qual Outcomes, 2017, 10(8): e003616.
9.	Holland EM, Moss TJ. Acute noncardiovascular illness in the cardiac intensive care unit. J Am Coll Cardiol, 2017, 69(16): 1999-2007.
10.	Naruse H, Ishii J, Takahashi H, et al. Predicting acute kidney injury using urinary liver-type fatty-acid binding protein and serum N-terminal pro-B-type natriuretic peptide levels in patients treated at medical cardiac intensive care units. Crit Care, 2018, 22(1): 197.
11.	Jentzer JC, Breen T, Sidhu M, et al. Epidemiology and outcomes of acute kidney injury in cardiac intensive care unit patients. J Crit Care, 2020, 60: 127-134.
12.	Chen F, Li YM, Liu Q, et al. Clinical characteristics and in-hospital outcomes of patients receiving contemporary intensive cardiac care: retrospective study from a large centre in China. J Geriatr Cardiol, 2021, 18(2): 94-103.
13.	Chen F, Liu Q, Huang B, et al. Association of fine particulate matter exposure with acute noncardiovascular critical illnesses and in-hospital outcomes in patients receiving intensive cardiac care. BMC Public Health, 2020, 20(1): 610.
14.	Kellum JA, Lameire N, KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care, 2013, 17(1): 204.
15.	Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987, 40(5): 373-383.
16.	Johnson AE, Kramer AA, Clifford GD. A new severity of illness scale using a subset of Acute Physiology And Chronic Health Evaluation data elements shows comparable predictive accuracy. Crit Care Med, 2013, 41(7): 1711-1718.
17.	Braunwald E. Evolution of the management of acute myocardial infarction: a 20th century saga. Lancet, 1998, 352(9142): 1771-1774.
18.	Katz JN, Turer AT, Becker RC. Cardiology and the critical care crisis: a perspective. J Am Coll Cardiol, 2007, 49(12): 1279-1282.
19.	Yang L, Xing G, Wang L, et al. Acute kidney injury in China: a cross-sectional survey. Lancet, 2015, 386(10002): 1465-1471.
20.	Katz JN, Lishmanov A, van Diepen S, et al. Length of stay, mortality, cost, and perceptions of care associated with transition from an open to closed staffing model in the cardiac intensive care unit. Crit Pathw Cardiol, 2017, 16(2): 62-70.
21.	Fanari Z, Barekatain A, Kerzner R, et al. Impact of a multidisciplinary team approach including an intensivist on the outcomes of critically ill patients in the cardiac care unit. Mayo Clin Proc, 2016, 91(12): 1727-1734.
22.	Jentzer JC, Bennett C, Wiley BM, et al. Predictive value of the sequential organ failure assessment score for mortality in a contemporary cardiac intensive care unit population. J Am Heart Assoc, 2018, 7(6): e008169.
23.	Lameire NH, Bagga A, Cruz D, et al. Acute kidney injury: an increasing global concern. Lancet, 2013, 382(9887): 170-179.
24.	Bhatraju PK, Prince DK, Mansour S, et al. Integrated analysis of blood and urine biomarkers to identify acute kidney injury subphenotypes and associations with long-term outcomes. Am J Kidney Dis, 2023, 82(3): 311-321.
25.	Ponce D, Zorzenon Cde P, dos Santos NY, et al. Early nephrology consultation can have an impact on outcome of acute kidney injury patients. Nephrol Dial Transplant, 2011, 26(10): 3202-3206.
26.	Morrow DA. Trends in cardiac critical care: reshaping the cardiac intensive care unit. Circ Cardiovasc Qual Outcomes, 2017, 10(8): e004010.
27.	Chon GR, Chang JW, Huh JW, et al. A comparison of the time from sepsis to inception of continuous renal replacement therapy versus RIFLE criteria in patients with septic acute kidney injury. Shock, 2012, 38(1): 30-36.
28.	Na SJ, Chung CR, Jeon K, et al. Association between presence of a cardiac intensivist and mortality in an adult cardiac care unit. J Am Coll Cardiol, 2016, 68(24): 2637-2648.

1. Thakar CV, Christianson A, Freyberg R, et al. Incidence and outcomes of acute kidney injury in intensive care units: a veterans administration study. Crit Care Med, 2009, 37(9): 2552-2558.
2. Susantitaphong P, Cruz DN, Cerda J, et al. World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol, 2013, 8(9): 1482-1493.
3. Danziger J, Chen KP, Lee J, et al. Obesity, acute kidney injury, and mortality in critical illness. Crit Care Med, 2016, 44(2): 328-334.
4. Stanski NL, Rodrigues CE, Strader M, et al. Precision management of acute kidney injury in the intensive care unit: current state of the art. Intensive Care Med, 2023, 49(9): 1049-1061.
5. Lau G, Wald R, Sladen R, et al. Acute kidney injury in cardiac surgery and cardiac intensive care. Semin Cardiothorac Vasc Anesth, 2015, 19(4): 270-287.
6. Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nat Rev Nephrol, 2017, 13(11): 697-711.
7. Katz JN, Shah BR, Volz EM, et al. Evolution of the coronary care unit: clinical characteristics and temporal trends in healthcare delivery and outcomes. Crit Care Med, 2010, 38(2): 375-381.
8. Sinha SS, Sjoding MW, Sukul D, et al. Changes in primary noncardiac diagnoses over time among elderly cardiac intensive care unit patients in the United States. Circ Cardiovasc Qual Outcomes, 2017, 10(8): e003616.
9. Holland EM, Moss TJ. Acute noncardiovascular illness in the cardiac intensive care unit. J Am Coll Cardiol, 2017, 69(16): 1999-2007.
10. Naruse H, Ishii J, Takahashi H, et al. Predicting acute kidney injury using urinary liver-type fatty-acid binding protein and serum N-terminal pro-B-type natriuretic peptide levels in patients treated at medical cardiac intensive care units. Crit Care, 2018, 22(1): 197.
11. Jentzer JC, Breen T, Sidhu M, et al. Epidemiology and outcomes of acute kidney injury in cardiac intensive care unit patients. J Crit Care, 2020, 60: 127-134.
12. Chen F, Li YM, Liu Q, et al. Clinical characteristics and in-hospital outcomes of patients receiving contemporary intensive cardiac care: retrospective study from a large centre in China. J Geriatr Cardiol, 2021, 18(2): 94-103.
13. Chen F, Liu Q, Huang B, et al. Association of fine particulate matter exposure with acute noncardiovascular critical illnesses and in-hospital outcomes in patients receiving intensive cardiac care. BMC Public Health, 2020, 20(1): 610.
14. Kellum JA, Lameire N, KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care, 2013, 17(1): 204.
15. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987, 40(5): 373-383.
16. Johnson AE, Kramer AA, Clifford GD. A new severity of illness scale using a subset of Acute Physiology And Chronic Health Evaluation data elements shows comparable predictive accuracy. Crit Care Med, 2013, 41(7): 1711-1718.
17. Braunwald E. Evolution of the management of acute myocardial infarction: a 20th century saga. Lancet, 1998, 352(9142): 1771-1774.
18. Katz JN, Turer AT, Becker RC. Cardiology and the critical care crisis: a perspective. J Am Coll Cardiol, 2007, 49(12): 1279-1282.
19. Yang L, Xing G, Wang L, et al. Acute kidney injury in China: a cross-sectional survey. Lancet, 2015, 386(10002): 1465-1471.
20. Katz JN, Lishmanov A, van Diepen S, et al. Length of stay, mortality, cost, and perceptions of care associated with transition from an open to closed staffing model in the cardiac intensive care unit. Crit Pathw Cardiol, 2017, 16(2): 62-70.
21. Fanari Z, Barekatain A, Kerzner R, et al. Impact of a multidisciplinary team approach including an intensivist on the outcomes of critically ill patients in the cardiac care unit. Mayo Clin Proc, 2016, 91(12): 1727-1734.
22. Jentzer JC, Bennett C, Wiley BM, et al. Predictive value of the sequential organ failure assessment score for mortality in a contemporary cardiac intensive care unit population. J Am Heart Assoc, 2018, 7(6): e008169.
23. Lameire NH, Bagga A, Cruz D, et al. Acute kidney injury: an increasing global concern. Lancet, 2013, 382(9887): 170-179.
24. Bhatraju PK, Prince DK, Mansour S, et al. Integrated analysis of blood and urine biomarkers to identify acute kidney injury subphenotypes and associations with long-term outcomes. Am J Kidney Dis, 2023, 82(3): 311-321.
25. Ponce D, Zorzenon Cde P, dos Santos NY, et al. Early nephrology consultation can have an impact on outcome of acute kidney injury patients. Nephrol Dial Transplant, 2011, 26(10): 3202-3206.
26. Morrow DA. Trends in cardiac critical care: reshaping the cardiac intensive care unit. Circ Cardiovasc Qual Outcomes, 2017, 10(8): e004010.
27. Chon GR, Chang JW, Huh JW, et al. A comparison of the time from sepsis to inception of continuous renal replacement therapy versus RIFLE criteria in patients with septic acute kidney injury. Shock, 2012, 38(1): 30-36.
28. Na SJ, Chung CR, Jeon K, et al. Association between presence of a cardiac intensivist and mortality in an adult cardiac care unit. J Am Coll Cardiol, 2016, 68(24): 2637-2648.

West China Medical Journal

Association between acute kidney injury and clinical outcomes in non-surgical patients receiving intensive cardiac care

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