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The effects of timing onset and progression of AKI on the clinical outcomes in AKI patients with sepsis: a prospective multicenter cohort study

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机构: [1]Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China. [2]Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China. [3]Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China. [4]Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China.
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关键词: Sepsis acute kidney injury major adverse kidney events in-hospital mortality intensive care unit

摘要:
Limited studies are available concerning on the earlier identification of AKI with sepsis. The aim of the study was to identify the risk factors of AKI early which depended on the timing onset and progression of AKI and investigate the effects of timing onset and progression of AKI on clinical outcomes.Patients who developed sepsis during their first 48-h admission to ICU were included. The primary outcome was major adverse kidney events (MAKE) consisted of all-cause mortality, RRT-dependence, or an inability to recover to 1.5 times of the baseline creatinine value up to 30 days. We determined MAKE and in-hospital mortality by multivariable logistic regression and explored the risk factors of early persistent-AKI. C statistics were used to evaluate model fit.58.7% sepsis patients developed AKI. According to the timing onset and progression of AKI, Early transient-AKI, early persistent-AKI, late transient-AKI, late persistent-AKI were identified. Clinical outcomes were quite different among subgroups. Early persistent-AKI had 3.0-fold (OR 3.04, 95% CI 1.61 - 4.62) risk of MAKE and 2.6-fold (OR 2.60, 95%CI 1.72 - 3.76) risk of in-hospital mortality increased compared with the late transients-AKI. Older age, underweight, obese, faster heart rate, lower MAP, platelet, hematocrit, pH and energy intake during the first 24 h on ICU admission could well predict the early persistent-AKI in patients with sepsis.Four AKI subphenotypes were identified based on the timing onset and progression of AKI. Early persistent-AKI showed higher risk of major adverse kidney events and in-hospital mortality.This study was registered in the Chinese Clinical Trials Registry (www.chictr.org/cn) under registration number ChiCTR-ECH-13003934.

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出版当年[2022]版:
大类 | 3 区 医学
小类 | 3 区 泌尿学与肾脏学
最新[2023]版:
大类 | 3 区 医学
小类 | 3 区 泌尿学与肾脏学
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出版当年[2021]版:
Q2 UROLOGY & NEPHROLOGY
最新[2023]版:
Q1 UROLOGY & NEPHROLOGY

影响因子: 最新[2023版] 最新五年平均 出版当年[2021版] 出版当年五年平均 出版前一年[2020版] 出版后一年[2022版]

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第一作者机构: [1]Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China. [2]Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China. [3]Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
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通讯机构: [1]Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China. [2]Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China. [3]Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China. [*1]Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China [*2]Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, No. 20 Fuxingmenwai Street, Xicheng District, Beijing, 100038, China [*3]Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, NO.45 Changchun Street, Xicheng District, Beijing, 010- 83922163, China
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