Evidence map›Paper›PMID 31892313›Full record

Observational studyBMC nephrology2019

Burden of acute kidney injury and 90-day mortality in critically ill patients.

Renske Wiersema, Ruben J Eck, Mikko Haapio, Jacqueline Koeze, Meri Poukkanen, Frederik Keus, Iwan C C van der Horst, Ville Pettilä, Suvi T Vaara

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC nephrology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed.

  1. Observational
  2. Review
  3. Therapeutic Effects ofPediatric discovery · 2025
    Article
  4. Article
  5. Observational
  6. Article
  7. Readmission and Mortality After Hospitalization With Acute Kidney Injury.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2023
    Article
  8. Article
  9. Evaluation of Predictors, Kinetics of Renal Recovery and Outcomes of COVID-19 Patients with Acute Kidney Injury Admitted to Intensive Care Unit: An Observational Study.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2022
    Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Observational
  17. Acute kidney injury in critically ill adults: A cross-sectional study.International journal of critical illness and injury science
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Renske WiersemaDepartment of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. r.wiersema@umcg.nl.ORCID 0000-0003-2413-2852
Ruben J EckDepartment of Internal medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Mikko HaapioNephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Jacqueline KoezeDepartment of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Meri PoukkanenDepartment of Anaesthesia and Intensive Care, Lapland Central Hospital, Rovaniemi, Finland.
Frederik KeusDepartment of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Iwan C C van der HorstDepartment of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Ville PettiläDivision of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Suvi T VaaraDivision of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Funding

Academy of Finland 317061Helsinki University Hospital TYH2013343, TYH2016243, TYH 2017241
6 · The paper itself

Abstract

backgroundMortality rates associated with acute kidney injury (AKI) vary among critically ill patients. Outcomes are often not corrected for severity or duration of AKI. Our objective was to analyse whether a new variable, AKI burden, would outperform 1) presence of AKI, 2) highest AKI stage, or 3) AKI duration in predicting 90-day mortality.

methodsKidney Diseases: Improving Global Outcomes (KDIGO) criteria using creatinine, urine output and renal replacement therapy were used to diagnose AKI. AKI burden was defined as AKI stage multiplied with the number of days that each stage was present (maximum five), divided by the maximum possible score yielding a proportion. The AKI burden as a predictor of 90-day mortality was assessed in two independent cohorts (Finnish Acute Kidney Injury, FINNAKI and Simple Intensive Care Studies I, SICS-I) by comparing four multivariate logistic regression models that respectively incorporated either the presence of AKI, the highest AKI stage, the duration of AKI, or the AKI burden.

resultsIn the FINNAKI cohort 1096 of 2809 patients (39%) had AKI and 90-day mortality of the cohort was 23%. Median AKI burden was 0.17 (IQR 0.07-0.50), 1.0 being the maximum. The model including AKI burden (area under the receiver operator curve (AUROC) 0.78, 0.76-0.80) outperformed the models using AKI presence (AUROC 0.77, 0.75-0.79, p = 0.026) or AKI severity (AUROC 0.77, 0.75-0.79, p = 0.012), but not AKI duration (AUROC 0.77, 0.75-0.79, p = 0.06). In the SICS-I, 603 of 1075 patients (56%) had AKI and 90-day mortality was 28%. Median AKI burden was 0.19 (IQR 0.08-0.46). The model using AKI burden performed better (AUROC 0.77, 0.74-0.80) than the models using AKI presence (AUROC 0.75, 0.71-0.78, p = 0.001), AKI severity (AUROC 0.76, 0.72-0.79. p = 0.008) or AKI duration (AUROC 0.76, 0.73-0.79, p = 0.009).

conclusionAKI burden, which appreciates both severity and duration of AKI, was superior to using only presence or the highest stage of AKI in predicting 90-day mortality. Using AKI burden or other more granular methods may be helpful in future epidemiological studies of AKI.

Indexed as

Patient AcuityAcute Kidney InjuryAgedArea Under CurveCreatinineCritical IllnessFemaleHumansMaleMiddle AgedMultivariate AnalysisPrognosisProspective StudiesRenal Replacement TherapySeverity of Illness IndexUrineCreatinineAcute kidney injuryBurdenCritically illMortalityPrediction models

Identifiers

PMID31892313
PMCPMC6938017

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.