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Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
The Frequency and Outcome of Acute Kidney Injury in a Tertiary Hospital: Which Factors Affect Mortality? *Sukru Ulusoy, †Derya Arı, *Gulsum Ozkan, *Muammer Cansız, and *Kubra Kaynar Departments of *Nephrology and †Internal Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
Abstract: Acute kidney injury (AKI) is a major cause of mortality and morbidity in hospitalized patients. Incidence and mortality rates vary from country to country, and according to different in-hospital monitoring units and definitions of AKI. The aim of this study was to determine factors affecting frequency of AKI and mortality in our hospital. We retrospectively evaluated data for 1550 patients diagnosed with AKI and 788 patients meeting the Kidney Disease: Improving Global Outcomes (KDIGO) guideline AKI criteria out of a total of 174 852 patients hospitalized in our institution between January 1, 2007 and December 31, 2012. Staging was performed based on KDIGO Clinical Practice for Acute Kidney Injury and RIFLE (Risk, Injury, Failure, Loss of kidney function and End-stage renal failure). Demographic and biochemical data were recorded and correlations with mortality were assessed. The frequency of AKI in our hospital was 0.9%, with an in-hospital mortality rate of 34.6%. At multivariate analysis, diastolic blood pressure (OR 0.89, 95% CI 0.87– 0.92; P < 0.001), monitoring in the intensive care unit (OR
0.18, 95% CI 0.09–0.38; P < 0.001), urine output (OR 4.00, 95% CI 2.03–7.89; P < 0.001), duration of oliguria (OR 1.51, 95% CI 1.34–1.69; P < 0.001), length of hospitalization (OR 0.83, 95% CI 0.79–0.88; P < 0.001), dialysis requirement (OR 2.30, 95% CI 1.12–4.71; P < 0.05), APACHE II score (OR 1.16, 95% CI 1.09–1.24; P < 0.001), and albumin level (OR 0.32, 95% CI 0.21–0.50; P < 0.001) were identified as independent determinants affecting mortality. Frequency of AKI and associated mortality rates in our regional reference hospital were compatible with those in the literature. This study shows that KDIGO criteria are more sensitive in determining AKI. Mortality was not correlated with staging based on RIFLE or KDIGO. Nonetheless, our identification of urine output as one of the independent determinants of mortality suggests that this parameter should be used in assessing the correlation between staging and mortality. Key Words: Acute kidney injury—Kidney Disease: Improving Global Outcomes—Risk, Injury, Failure, Loss of kidney function and End-stage renal failure—Mortality.
Acute kidney injury (AKI) is a cause of serious mortality and morbidity. While the importance of AKI is well known, one major problem is the lack of consensus on diagnosis, with there being more than 30 definitions in existence (1). There are also variations in incidence and mortality rates. For example, the in-hospital incidence of AKI is 0.2–9.6%, while the incidence in intensive care units (ICUs) is 7–35% (2–7). The in-hospital mortality rate is approximately 20%, while the incidence and mortality rates in society and ICUs vary (2,5,6). Attempts are being
made to establish consensus on a universal definition of AKI (8). Currently, the most commonly accepted diagnostic criteria for AKI are, in order, RIFLE (Risk, Injury, Failure, Loss of kidney function and End-stage renal failure) (9), AKIN (Acute Kidney Injury Network) (10), and KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice for Acute Kidney Injury (11). RIFLE was developed by the Acute Dialysis Quality Initiative Group. Under this definition, renal dysfunction is assessed through changes in the estimated glomerular filtration rate (eGFR) and urine output per kilogram of body weight over a specific time interval. AKI staging is determined in light of these parameters (8,9). The second classification was developed by the AKIN. While this classification resembles RIFLE in terms of definition and stages, there are differences in the definition criteria, such as
doi:10.1111/aor.12449 Received May 2014; revised September 2014. Address correspondence and reprint requests to Dr. Sukru Ulusoy, Department of Nephrology, School of Medicine, Karadeniz Technical University, Tıp Fakültesi, Nefroloji Bilim Dalı, 61080 Trabzon, Turkey. E-mail: [email protected]
Artificial Organs 2015, ••(••):••–••
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S. ULUSOY ET AL.
creatinine increase in 48 h being ≥26.52 μmol/L and the removal of loss, failure, and eGFR from the staging process (10). Finally, the KDIGO Acute Kidney Injury Work Group recently published the KDIGO Clinical Practice for Acute Kidney Injury guideline. That definition of AKI is a combination of RIFLE and AKIN, and defines AKI as an increase of >26.52 μmol/L in serum creatinine (sCr) in 48 h or a >1.5-fold increase in sCr from the basal value (11). These definitions and stagings were intended to facilitate early detection of AKI and to reduce mortality. The aim of this study was to determine the frequency of AKI and associated mortality in our tertiary hospital and the factors affecting mortality. We also assessed the correlation between mortality and AKI stage using KDIGO and RIFLE. PATIENTS AND METHODS This retrospective observational study assessed the medical records and laboratory results for patients aged 18 or over and diagnosed with AKI throughout hospitalization at the Karadeniz Technical University Medical Faculty Hospital, Turkey, between January 1, 2007 and December 31, 2012. The study was approved by the local ethical committee, and informed consent was waived by the Institutional Review Board. This study was conducted in accordance with the Declaration of Helsinki guidelines. Over this 6-year period, the total number of patients hospitalized was 174 852, 1550 of whom were diagnosed with AKI. Seven hundred eighty-eight of these 1550 patients met the KDIGO AKI criteria and had fully accessible medical records (Fig. 1). AKI was defined and staged on the basis of KDIGO and RIFLE criteria (9,11). Presence of comorbidities accompanying the disease (hypertension [HT], diabetes mellitus [DM], congestive heart failure [CHF], coronary artery disease [CAD], chronic obstructive pulmonary disease [COPD], malignancy and cerebrovascular event [CVE]) was recorded. Hypovolemia, sepsis, cardiovascular event, and use of contrast material and nephrotoxic agents were determined to establish the etiology of AKI. sCr levels were recorded at the time of first visit and sCr, blood urea nitrogen (BUN), sodium, potassium, calcium, phosphorus, albumin, bilirubin, uric acid, lactate dehydrogenase (LDH), hemoglobin, high-sensitive C-reactive protein (Hs-CRP) levels, and blood pressure values were recorded in the process of hospitalization. Patients’ respiratory system (based on physical examination, history, and pulmonary radiography), cardiovascular system (based on electrocarArtif Organs, Vol. ••, No. ••, 2015
Total paƟents hospitalized (n = 174852)
PaƟents with AKI code (n = 1550 (0.9%))
Analyzed paƟents (n = 788)
KDIGO (n = 788)
RIFLE (n = 612)
Stage 1: 439
Risk: 268
Stage 2: 104
Injury: 100
Stage 3: 245
Failure: 244
FIG. 1. Flowchart showing the total cohort, patients enrolled and stratification by AKI severity grade according to the AKI criteria used (KDIGO or RIFLE).
diography and blood pressure), neurological system (based on physical examination findings), hepatic system (bilirubin elevation), and hematological system (presence of anemia) functions were assessed, and organ failure scoring was performed. One point was given for each organ failure. APACHE II scores were calculated for all patients. Patients with urine output less than 100 mL in 24 h at time of diagnosis were regarded as anuric, those with output of 100– 500 mL as oliguric, and those with output above 500 mL as nonoliguric. Duration of anuria and oliguria in anuric and oliguric patients was then recorded. Infection at time of or during hospitalization was recorded. Patients’ dialysis requirements, if any, were determined. Dialysis dose was estimated so as to be in line with patients’ electrolyte, acid base, solute and fluid balance, and for weekly Kt/V values to be 3.9 or above. Patients diagnosed with AKI were divided into two groups on the basis of whether or not the disease resulted in mortality. Statistical analysis intended to establish factors affecting mortality in patients with AKI was performed in light of these data.
ACUTE KIDNEY INJURY AND MORTALITY Statistical analysis Statistical analysis was performed on SPSS 13.0 (SPSS Inc., Chicago, IL, USA). Normal distribution of data was assessed using the Kolmogorov–Smirnov test. The two-sample test was used in comparisons between groups with normal distribution and the Mann–Whitney U-test for non-normally distributed data. The chi-square test was used to assess categorical data. Multivariate analysis was performed in the assessment of factors affecting mortality. ANOVA was used to assess RIFLE and KDIGO stages. The Kaplan–Meier analysis with log-rank test was used to compare survival rates between strata. Data were expressed as mean ± standard deviation, median (min-max). P < 0.05 was regarded as significant. RESULTS Demographic data The mean age of the 788 patients was 65.54 ± 16.65 years, and 58.5% were men. The three most significant comorbid diseases identified were HT, DM, and malignancy. Mean systolic blood pressure (SBP) was 111.70 ± 20.66 mm Hg, and mean diastolic blood pressure (DBP) was 71.29 ± 14.78 mm Hg. Median length of hospitalization was 10.00 (1–100) days. Monitoring took place in the ICU in 26.5% of patients and non-ICU in 73.5%. The mean length of hospitalization of the patients monitored in the ICU was 8 (1–70) days, compared with 10 (1–100) days for patients not monitored in the ICU. Length of hospital stay was significantly longer in the patients not monitored in the ICU (P < 0.001). At organ failure scoring, 22% of patients had no failure other than kidney, while one organ involvement in addition to the kidney was present in 45.2% of patients, two in 24.1%, three in 7.9%, and four in 0.9%. Mean APACHE II score of the patients monitored in the ICU was 22.76 ± 6.29. Infection was seen in 51.1% of patients, and dialysis was required in 37.4%. Intermittent hemodialysis was administered through a hemodialysis catheter to all patients requiring dialysis on the basis of daily physical examination, fluid intake, urine output, and biochemical parameters. Patients were classified into three groups: anuric, oliguric, or nonoliguric, on the basis of urine output; 23.6% of patients were anuric, 36.8% oliguric, and 39.6% nonoliguric. The median duration of oliguria was 3 (0–35) days. Patients’ demographic characteristics and laboratory data are given in Table 1. Patients were staged according to KDIGO and RIFLE criteria. While 788 patients were diagnosed with AKI on the basis of KDIGO criteria, 612 were diagnosed with AKI using RIFLE criteria. The mean
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TABLE 1. Characteristics of all patients Mean ± SD/ median (mean-max) Age (years) SBP (mm Hg) DBP (mm Hg) Duration of anuria/oliguria (day) Gender (F/M) Monitoring unit ICU Non-ICU AKI etiology Hypovolemia Infection and sepsis Cardiac causes Contrast media Nephrotoxic Unknown Organ failure 0 1 2 3 4 APACHE II Infection Present None Infection type Urinary infection Pneumonia Sepsis Other More than one infection Hemodialysis Comorbid disease HT DM CAD CHF COPD Malignancy CVE Urine output Anuria Oliguria Nonoliguria Non survivors Length of hospitalization (days) Hemoglobin (g/L) Baseline creatinine (μmol/L) Creatinine (μmol/L) BUN (mg/dL) Sodium (mmol/L) Potassium (mmol/L) Calcium (mmol/L) Phosphorus (mmol/L) Albümin (g/L) Uric acid (μmol/L) Lactate dehydrogenase (U/L) Bilirubin (μmol/L) Hs-CRP (mg/dL)
65.54 ± 16.65 111.70 ± 20.66 71.29 ± 14.78 3 (0–35) n (%) 327 (41.5)/461 (58.5) 209 (26.5) 579 (73.5) 291 (36.9) 253 (32.1) 101 (12.8) 46 (5.8) 54 (6.9) 43 (5.5) 173 (22) 356 (45.2) 190 (24.1) 62 (7.9) 7 (0.9) 16.50 ± 6.68 403 (51.1) 385 (48.9) 130 (16.5) 147 (18.7) 22 (2.8) 17 (2.2) 87 (10.9) 295 (37.4) 286 (36.3) 198 (25.1) 171 (21.7) 53 (6.7) 43 (5.5) 119 (15.1) 34 (3.7) 186 (23.6) 290 (36.8) 312 (39.6) 273 (34.6) Mean ± SD/ median (min-max) 10.00 (1–100) 113.4 ± 22.2 137.02 ± 62.76 289.95 ± 176.8 19.50 ± 9.76 135.48 ± 8.09 4.56 ± 0.97 2.10 ± 0.28 1.63 ± 0.82 33.4 ± 13.3 476.43 ± 173.08 469.49 (4–11 800) 10.26 (0–718.2) 5.30 (0–60)
Artif Organs, Vol. ••, No. ••, 2015
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S. ULUSOY ET AL. TABLE 2. Characteristics of KDIGO stages
Age (years) Gender (F/M) SBP (mm Hg) DBP (mm Hg) Monitoring unit ICU Non-ICU Infection Present None Infection type Urinary Pneumonia Sepsis More than one infection Other Comorbid disease HT DM CAD CHF COPD Malignancy CVE Urine output Anuria Oliguria Non survivors APACHE II Non survivors Dialysis Length of hospitalization (days)
Stage 1 n = 439
Stage 2 n = 104
Stage 3 n = 245
P1 (1–2)
P2 (1–3)
P3 (2–3)
67.31 ± 16.14 172/267 111.26 ± 20.82 70.96 ± 14.74
67.17 ± 14.26 42/62 110.99 ± 20.43 70.20 ± 15.06
61.65 ± 17.87 113/132 112.80 ± 20.50 72.35 ± 14.73
NS NS NS NS
Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
The Frequency and Outcome of Acute Kidney Injury in a Tertiary Hospital: Which Factors Affect Mortality? *Sukru Ulusoy, †Derya Arı, *Gulsum Ozkan, *Muammer Cansız, and *Kubra Kaynar Departments of *Nephrology and †Internal Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
Abstract: Acute kidney injury (AKI) is a major cause of mortality and morbidity in hospitalized patients. Incidence and mortality rates vary from country to country, and according to different in-hospital monitoring units and definitions of AKI. The aim of this study was to determine factors affecting frequency of AKI and mortality in our hospital. We retrospectively evaluated data for 1550 patients diagnosed with AKI and 788 patients meeting the Kidney Disease: Improving Global Outcomes (KDIGO) guideline AKI criteria out of a total of 174 852 patients hospitalized in our institution between January 1, 2007 and December 31, 2012. Staging was performed based on KDIGO Clinical Practice for Acute Kidney Injury and RIFLE (Risk, Injury, Failure, Loss of kidney function and End-stage renal failure). Demographic and biochemical data were recorded and correlations with mortality were assessed. The frequency of AKI in our hospital was 0.9%, with an in-hospital mortality rate of 34.6%. At multivariate analysis, diastolic blood pressure (OR 0.89, 95% CI 0.87– 0.92; P < 0.001), monitoring in the intensive care unit (OR
0.18, 95% CI 0.09–0.38; P < 0.001), urine output (OR 4.00, 95% CI 2.03–7.89; P < 0.001), duration of oliguria (OR 1.51, 95% CI 1.34–1.69; P < 0.001), length of hospitalization (OR 0.83, 95% CI 0.79–0.88; P < 0.001), dialysis requirement (OR 2.30, 95% CI 1.12–4.71; P < 0.05), APACHE II score (OR 1.16, 95% CI 1.09–1.24; P < 0.001), and albumin level (OR 0.32, 95% CI 0.21–0.50; P < 0.001) were identified as independent determinants affecting mortality. Frequency of AKI and associated mortality rates in our regional reference hospital were compatible with those in the literature. This study shows that KDIGO criteria are more sensitive in determining AKI. Mortality was not correlated with staging based on RIFLE or KDIGO. Nonetheless, our identification of urine output as one of the independent determinants of mortality suggests that this parameter should be used in assessing the correlation between staging and mortality. Key Words: Acute kidney injury—Kidney Disease: Improving Global Outcomes—Risk, Injury, Failure, Loss of kidney function and End-stage renal failure—Mortality.
Acute kidney injury (AKI) is a cause of serious mortality and morbidity. While the importance of AKI is well known, one major problem is the lack of consensus on diagnosis, with there being more than 30 definitions in existence (1). There are also variations in incidence and mortality rates. For example, the in-hospital incidence of AKI is 0.2–9.6%, while the incidence in intensive care units (ICUs) is 7–35% (2–7). The in-hospital mortality rate is approximately 20%, while the incidence and mortality rates in society and ICUs vary (2,5,6). Attempts are being
made to establish consensus on a universal definition of AKI (8). Currently, the most commonly accepted diagnostic criteria for AKI are, in order, RIFLE (Risk, Injury, Failure, Loss of kidney function and End-stage renal failure) (9), AKIN (Acute Kidney Injury Network) (10), and KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice for Acute Kidney Injury (11). RIFLE was developed by the Acute Dialysis Quality Initiative Group. Under this definition, renal dysfunction is assessed through changes in the estimated glomerular filtration rate (eGFR) and urine output per kilogram of body weight over a specific time interval. AKI staging is determined in light of these parameters (8,9). The second classification was developed by the AKIN. While this classification resembles RIFLE in terms of definition and stages, there are differences in the definition criteria, such as
doi:10.1111/aor.12449 Received May 2014; revised September 2014. Address correspondence and reprint requests to Dr. Sukru Ulusoy, Department of Nephrology, School of Medicine, Karadeniz Technical University, Tıp Fakültesi, Nefroloji Bilim Dalı, 61080 Trabzon, Turkey. E-mail: [email protected]
Artificial Organs 2015, ••(••):••–••
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S. ULUSOY ET AL.
creatinine increase in 48 h being ≥26.52 μmol/L and the removal of loss, failure, and eGFR from the staging process (10). Finally, the KDIGO Acute Kidney Injury Work Group recently published the KDIGO Clinical Practice for Acute Kidney Injury guideline. That definition of AKI is a combination of RIFLE and AKIN, and defines AKI as an increase of >26.52 μmol/L in serum creatinine (sCr) in 48 h or a >1.5-fold increase in sCr from the basal value (11). These definitions and stagings were intended to facilitate early detection of AKI and to reduce mortality. The aim of this study was to determine the frequency of AKI and associated mortality in our tertiary hospital and the factors affecting mortality. We also assessed the correlation between mortality and AKI stage using KDIGO and RIFLE. PATIENTS AND METHODS This retrospective observational study assessed the medical records and laboratory results for patients aged 18 or over and diagnosed with AKI throughout hospitalization at the Karadeniz Technical University Medical Faculty Hospital, Turkey, between January 1, 2007 and December 31, 2012. The study was approved by the local ethical committee, and informed consent was waived by the Institutional Review Board. This study was conducted in accordance with the Declaration of Helsinki guidelines. Over this 6-year period, the total number of patients hospitalized was 174 852, 1550 of whom were diagnosed with AKI. Seven hundred eighty-eight of these 1550 patients met the KDIGO AKI criteria and had fully accessible medical records (Fig. 1). AKI was defined and staged on the basis of KDIGO and RIFLE criteria (9,11). Presence of comorbidities accompanying the disease (hypertension [HT], diabetes mellitus [DM], congestive heart failure [CHF], coronary artery disease [CAD], chronic obstructive pulmonary disease [COPD], malignancy and cerebrovascular event [CVE]) was recorded. Hypovolemia, sepsis, cardiovascular event, and use of contrast material and nephrotoxic agents were determined to establish the etiology of AKI. sCr levels were recorded at the time of first visit and sCr, blood urea nitrogen (BUN), sodium, potassium, calcium, phosphorus, albumin, bilirubin, uric acid, lactate dehydrogenase (LDH), hemoglobin, high-sensitive C-reactive protein (Hs-CRP) levels, and blood pressure values were recorded in the process of hospitalization. Patients’ respiratory system (based on physical examination, history, and pulmonary radiography), cardiovascular system (based on electrocarArtif Organs, Vol. ••, No. ••, 2015
Total paƟents hospitalized (n = 174852)
PaƟents with AKI code (n = 1550 (0.9%))
Analyzed paƟents (n = 788)
KDIGO (n = 788)
RIFLE (n = 612)
Stage 1: 439
Risk: 268
Stage 2: 104
Injury: 100
Stage 3: 245
Failure: 244
FIG. 1. Flowchart showing the total cohort, patients enrolled and stratification by AKI severity grade according to the AKI criteria used (KDIGO or RIFLE).
diography and blood pressure), neurological system (based on physical examination findings), hepatic system (bilirubin elevation), and hematological system (presence of anemia) functions were assessed, and organ failure scoring was performed. One point was given for each organ failure. APACHE II scores were calculated for all patients. Patients with urine output less than 100 mL in 24 h at time of diagnosis were regarded as anuric, those with output of 100– 500 mL as oliguric, and those with output above 500 mL as nonoliguric. Duration of anuria and oliguria in anuric and oliguric patients was then recorded. Infection at time of or during hospitalization was recorded. Patients’ dialysis requirements, if any, were determined. Dialysis dose was estimated so as to be in line with patients’ electrolyte, acid base, solute and fluid balance, and for weekly Kt/V values to be 3.9 or above. Patients diagnosed with AKI were divided into two groups on the basis of whether or not the disease resulted in mortality. Statistical analysis intended to establish factors affecting mortality in patients with AKI was performed in light of these data.
ACUTE KIDNEY INJURY AND MORTALITY Statistical analysis Statistical analysis was performed on SPSS 13.0 (SPSS Inc., Chicago, IL, USA). Normal distribution of data was assessed using the Kolmogorov–Smirnov test. The two-sample test was used in comparisons between groups with normal distribution and the Mann–Whitney U-test for non-normally distributed data. The chi-square test was used to assess categorical data. Multivariate analysis was performed in the assessment of factors affecting mortality. ANOVA was used to assess RIFLE and KDIGO stages. The Kaplan–Meier analysis with log-rank test was used to compare survival rates between strata. Data were expressed as mean ± standard deviation, median (min-max). P < 0.05 was regarded as significant. RESULTS Demographic data The mean age of the 788 patients was 65.54 ± 16.65 years, and 58.5% were men. The three most significant comorbid diseases identified were HT, DM, and malignancy. Mean systolic blood pressure (SBP) was 111.70 ± 20.66 mm Hg, and mean diastolic blood pressure (DBP) was 71.29 ± 14.78 mm Hg. Median length of hospitalization was 10.00 (1–100) days. Monitoring took place in the ICU in 26.5% of patients and non-ICU in 73.5%. The mean length of hospitalization of the patients monitored in the ICU was 8 (1–70) days, compared with 10 (1–100) days for patients not monitored in the ICU. Length of hospital stay was significantly longer in the patients not monitored in the ICU (P < 0.001). At organ failure scoring, 22% of patients had no failure other than kidney, while one organ involvement in addition to the kidney was present in 45.2% of patients, two in 24.1%, three in 7.9%, and four in 0.9%. Mean APACHE II score of the patients monitored in the ICU was 22.76 ± 6.29. Infection was seen in 51.1% of patients, and dialysis was required in 37.4%. Intermittent hemodialysis was administered through a hemodialysis catheter to all patients requiring dialysis on the basis of daily physical examination, fluid intake, urine output, and biochemical parameters. Patients were classified into three groups: anuric, oliguric, or nonoliguric, on the basis of urine output; 23.6% of patients were anuric, 36.8% oliguric, and 39.6% nonoliguric. The median duration of oliguria was 3 (0–35) days. Patients’ demographic characteristics and laboratory data are given in Table 1. Patients were staged according to KDIGO and RIFLE criteria. While 788 patients were diagnosed with AKI on the basis of KDIGO criteria, 612 were diagnosed with AKI using RIFLE criteria. The mean
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TABLE 1. Characteristics of all patients Mean ± SD/ median (mean-max) Age (years) SBP (mm Hg) DBP (mm Hg) Duration of anuria/oliguria (day) Gender (F/M) Monitoring unit ICU Non-ICU AKI etiology Hypovolemia Infection and sepsis Cardiac causes Contrast media Nephrotoxic Unknown Organ failure 0 1 2 3 4 APACHE II Infection Present None Infection type Urinary infection Pneumonia Sepsis Other More than one infection Hemodialysis Comorbid disease HT DM CAD CHF COPD Malignancy CVE Urine output Anuria Oliguria Nonoliguria Non survivors Length of hospitalization (days) Hemoglobin (g/L) Baseline creatinine (μmol/L) Creatinine (μmol/L) BUN (mg/dL) Sodium (mmol/L) Potassium (mmol/L) Calcium (mmol/L) Phosphorus (mmol/L) Albümin (g/L) Uric acid (μmol/L) Lactate dehydrogenase (U/L) Bilirubin (μmol/L) Hs-CRP (mg/dL)
65.54 ± 16.65 111.70 ± 20.66 71.29 ± 14.78 3 (0–35) n (%) 327 (41.5)/461 (58.5) 209 (26.5) 579 (73.5) 291 (36.9) 253 (32.1) 101 (12.8) 46 (5.8) 54 (6.9) 43 (5.5) 173 (22) 356 (45.2) 190 (24.1) 62 (7.9) 7 (0.9) 16.50 ± 6.68 403 (51.1) 385 (48.9) 130 (16.5) 147 (18.7) 22 (2.8) 17 (2.2) 87 (10.9) 295 (37.4) 286 (36.3) 198 (25.1) 171 (21.7) 53 (6.7) 43 (5.5) 119 (15.1) 34 (3.7) 186 (23.6) 290 (36.8) 312 (39.6) 273 (34.6) Mean ± SD/ median (min-max) 10.00 (1–100) 113.4 ± 22.2 137.02 ± 62.76 289.95 ± 176.8 19.50 ± 9.76 135.48 ± 8.09 4.56 ± 0.97 2.10 ± 0.28 1.63 ± 0.82 33.4 ± 13.3 476.43 ± 173.08 469.49 (4–11 800) 10.26 (0–718.2) 5.30 (0–60)
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S. ULUSOY ET AL. TABLE 2. Characteristics of KDIGO stages
Age (years) Gender (F/M) SBP (mm Hg) DBP (mm Hg) Monitoring unit ICU Non-ICU Infection Present None Infection type Urinary Pneumonia Sepsis More than one infection Other Comorbid disease HT DM CAD CHF COPD Malignancy CVE Urine output Anuria Oliguria Non survivors APACHE II Non survivors Dialysis Length of hospitalization (days)
Stage 1 n = 439
Stage 2 n = 104
Stage 3 n = 245
P1 (1–2)
P2 (1–3)
P3 (2–3)
67.31 ± 16.14 172/267 111.26 ± 20.82 70.96 ± 14.74
67.17 ± 14.26 42/62 110.99 ± 20.43 70.20 ± 15.06
61.65 ± 17.87 113/132 112.80 ± 20.50 72.35 ± 14.73
NS NS NS NS
