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Critical care (London, England) 01/2013; 17(1):408. · 4.61 Impact Factor
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Critical care (London, England) 12/2012; 16(6):468. · 4.61 Impact Factor
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Critical care (London, England) 11/2012; 16(6):467. · 4.61 Impact Factor
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American Journal of Kidney Diseases 07/2010; 56(1):185-6. · 5.43 Impact Factor
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ABSTRACT: Acute kidney injury (AKI) is associated with increased short-term mortality of septic patients; however, the exact influence of AKI on long-term mortality in such patients has not yet been determined.
We retrospectively evaluated the impact of AKI, defined by the "Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease" (RIFLE) classification based on creatinine criteria, on 2-year mortality in a cohort of 234 hospital surviving septic patients who had been hospitalized at the Infectious Disease Intensive Care Unit of our Hospital.
Mean-follow-up was 21 +/- 6.4 months. During this period, 32 patients (13.7%) died. At 6 months, 1 and 2 years of follow-up, the cumulative probability of death of patients with previous AKI was 8.3, 16.9 and 34.2%, respectively, as compared with 2.2, 6 and 8.9% in patients without previous AKI (log-rank, P < 0.0001). In the univariate analysis, age (hazard ratio 1.4, 95% CI 1.2-1.7, P < 0.0001), as well as pre-existing cardiovascular disease (hazard ratio 3.6, 95% CI 1.4-9.4, P = 0.009), illness severity as evaluated by nonrenal APACHE II (hazard ratio 1.3, 95% CI 1.1-1.6, P = 0.002), and previous AKI (hazard ratio 4.2, 95% CI 2.1-8.5, P < 0.0001) were associated with increased 2-year mortality, while gender, race, pre-existing hypertension, cirrhosis, HIV infection, neoplasm, and baseline glomerular filtration rate did not. In the multivariate analysis, however, only previous AKI (hazard ratio 3.2, 95% CI 1.6-6.5, P = 0.001) and age (hazard ratio 1.4, 95% CI 1.2-1.6, P < 0.0001) emerged as independent predictors of 2-year mortality.
Acute kidney injury had a negative impact on long-term mortality of patients with sepsis.
BMC Nephrology 01/2010; 11:9. · 2.18 Impact Factor
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Southern medical journal 12/2008; 101(11):1083. · 0.92 Impact Factor
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ABSTRACT: To analyze the clinical characteristics of septic acute kidney injury (AKI) according to the Acute Kidney Injury Network (AKIN) classification, and to evaluate the capacity of this system in predicting in-hospital mortality of septic patients.
Patients with sepsis admitted to the infectious diseases intensive care unit (ICU) of our hospital between January 2004 and June 2007 were retrospectively studied. Maximum AKIN stage within the first three days of hospitalization was recorded.
Three hundred fifteen patients were evaluated. According to AKIN criteria, 99 patients (31.4%) had AKI: 26.2% at stage 1, 20.2% at stage 2, and 53.6% at stage 3. Four patients (1.9%) with no AKI progressed to stage 1, two patients (7.7%) at stage 1 progressed to stage 2, one patient (3.8%) at stage 1 progressed to stage 3, and one patient at stage 2 (5%) progressed to stage 3. The mortality rate was 25.3% and increased significantly from normal renal function to stage 3 (normal, 12.5%; stage 1, 34.6%; stage 2, 45%; stage 3, 64.1%; p<0.0001). After adjusting for age, gender, race, pre-existing chronic kidney disease, illness severity as evaluated by acute physiology and chronic health evaluation, version II (APACHE II) score, need for mechanical ventilation, and vasopressor use, AKIN stage 1 (odds ratio (OR) 3.03, 95% confidence interval (CI) 1.12-8.19, p=0.029), stage 2 (OR 3.3, 95% CI 1.11-9.78, p=0.031), and stage 3 (OR 7.35, 95% CI 3.13-17.25, p<0.0001) predicted mortality.
AKIN criteria are a useful tool to characterize and stratify septic patients according to the risk of death.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 10/2008; 13(2):176-81. · 2.17 Impact Factor
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ABSTRACT: Whether discernible advantages in terms of sensitivity and specificity exist with Acute Kidney Injury Network (AKIN) criteria versus Risk, Injury, Failure, Loss of Kidney Function, End-stage Kidney Disease (RIFLE) criteria is currently unknown. We evaluated the incidence of acute kidney injury and compared the ability of the maximum RIFLE and of the maximum AKIN within intensive care unit hospitalization in predicting inhospital mortality of critically ill patients.
Patients admitted to the Department of Intensive Medicine of our hospital between January 2003 and December 2006 were retrospectively evaluated. Chronic kidney disease patients undergoing dialysis or renal transplant patients were excluded from the analysis.
In total, 662 patients (mean age, 58.6 +/- 19.2 years; 392 males) were evaluated. AKIN criteria allowed the identification of more patients as having acute kidney injury (50.4% versus 43.8%, P = 0.018) and classified more patients with Stage 1 (risk in RIFLE) (21.1% versus 14.7%, P = 0.003), but no differences were observed for Stage 2 (injury in RIFLE) (10.1% versus 11%, P = 0.655) and for Stage 3 (failure in RIFLE) (19.2% versus 18.1%, P = 0.672). Mortality was significantly higher for acute kidney injury defined by any of the RIFLE criteria (41.3% versus 11%, P < 0.0001; odds ratio = 2.78, 95% confidence interval = 1.74 to 4.45, P < 0.0001) or of the AKIN criteria (39.8% versus 8.5%, P < 0.0001; odds ratio = 3.59, 95% confidence interval = 2.14 to 6.01, P < 0.0001). The area under the receiver operator characteristic curve for inhospital mortality was 0.733 for RIFLE criteria (P < 0.0001) and was 0.750 for AKIN criteria (P < 0.0001). There were no statistical differences in mortality by the acute kidney injury definition/classification criteria (P = 0.72).
Although AKIN criteria could improve the sensitivity of the acute kidney injury diagnosis, it does not seem to improve on the ability of the RIFLE criteria in predicting inhospital mortality of critically ill patients.
Critical care (London, England) 09/2008; 12(4):R110. · 4.61 Impact Factor
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Resuscitation 06/2007; 73(2):318. · 3.60 Impact Factor
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Critical care (London, England) 02/2007; 11(2):408. · 4.61 Impact Factor
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Critical care (London, England) 02/2007; 11(1):401. · 4.61 Impact Factor
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Nephrology Dialysis Transplantation 02/2007; 22(1):285. · 3.40 Impact Factor
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Critical care (London, England) 02/2007; 11(2):411. · 4.61 Impact Factor
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ABSTRACT: Acute renal failure (ARF) is common among hospitalized HIV-infected patients. To our knowledge, however, data regarding ARF in HIV-infected patients in the intensive care unit are still lacking.
Critical care (London, England) 02/2007; 11(1):404. · 4.61 Impact Factor
