Javier A. Neyra Xilong Li Fabrizio Canepa-Escaro Beverley Adams-Huet Robert D. Toto Jerry Yee S S. Hedayati
10-01-2016
OBJECTIVE: Incident acute kidney injury and prevalent chronic kidney disease are commonly encountered in septic patients. We examined the differential effect of acute kidney injury and chronic kidney ..
OBJECTIVE: Incident acute kidney injury and prevalent chronic kidney disease are commonly encountered in septic patients. We examined the differential effect of acute kidney injury and chronic kidney disease on the association between cumulative fluid balance and hospital mortality in critically ill septic patients. DESIGN: Retrospective cohort study. SETTING: Urban academic medical center ICU. PATIENTS: ICU adult patients with severe sepsis or septic shock and serum creatinine measured within 3 months prior to and 72 hours of ICU admission. Patients with estimated glomerular filtration rate less than 15 mL/min/1.73 m or receiving chronic dialysis were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 2,632 patients, 1,211 with chronic kidney disease, were followed up until hospital death or discharge. Acute kidney injury occurred in 1,525 patients (57.9%), of whom 679 (44.5%) had chronic kidney disease. Hospital mortality occurred in 603 patients (22.9%). Every 1-L increase in cumulative fluid balance at 72 hours of ICU admission was independently associated with hospital mortality in all patients (adjusted odds ratio, 1.06 [95% CI] 1.04-1.08; p CONCLUSIONS: Higher cumulative fluid balance at 72 hours of ICU admission was independently associated with hospital mortality regardless of acute kidney injury or chronic kidney disease presence. We characterized cumulative fluid balance cut-offs associated with hospital mortality based on acute kidney injury/chronic kidney disease status, underpinning the heterogeneity of fluid regulation in sepsis and kidney disease.
Neyra JA, Li X, Canepa-Escaro F, Adams-Huet B, Toto RD, Yee J, and Hedayati SS. Cumulative fluid balance and mortality in septic patients with or without acute kidney injury and chronic kidney disease..
Neyra JA, Li X, Canepa-Escaro F, Adams-Huet B, Toto RD, Yee J, and Hedayati SS. Cumulative fluid balance and mortality in septic patients with or without acute kidney injury and chronic kidney disease. Crit Care Med 2016; 44(10):1891-1900.
APACHE Academic Medical Centers Acute Kidney Injury Aged Aged, 80 and over Critical Illness Female Hospital Mortality Humans Intensive Care Units Kidney Function Tests Male Middle Aged Renal Insuffici..