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Factors Related to Middle-Long-Term Mortality in Acute Kidney Injury

Yıl 2024, Cilt: 34 Sayı: 4, 445 - 449, 31.08.2024
https://doi.org/10.54005/geneltip.1360137

Öz

Aim: To determine the clinical and laboratory parameters that affect the mid-long term mortality of patients hospitalized for AKI.
Material and method: Patients hospitalized with the diagnosis of AKI in the intensive care unit and clinic of Nephrology for four years were retrospectively screened. The files of these patients were scanned. Demographic data, comorbidities, vital signs and laboratory parameters were scanned. It was determined in terms of factors affecting mortality in these patients (living and dying) over a 4-year period.
Results: The effects of the variables found to be significant (age, presence of hypertension and coronary artery disease (CAD), sedimentation, C-reactive protein (CRP), urea, potassium (K), magnesium (Mg), pH and CRP-albumin ratio (CAR) by univariate analysis on mortality was performed using multiple logistic regression analysis, which was used to identify the independent risk factors of mortality. Multiple logistic regression analysis using Stepwise selection method revealed that increasing age (IQR=1.04, 95% CI=1.01 – 1.07, p=.004), presence of CAD (IQR =2.16, 95% CI=1.16 – 4.02, p=.016), increased Mg (IQR =2.64, 95% CI=1.18 – 5.92, p=.018) and K (IQR =1.70, 95% CI=1.21 – 2.41, p=.002) were independent risk factors for mortality. The accuracy rate for the predictive performance of this prediction model in predicting mortality was 71.1%, with a sensitivity of 26.5%, a specificity of 90%, and an AUC of 0.753.
Conclusion: In our predictive model, in the medium-long term, we found old age, the presence of coronary artery disease, increased K and Mg as the independent risk factors for mortality in AKI patients.

Kaynakça

  • Waikar SS, Curhan GC, Wald R, McCarthy EP, Chertow GM. Declining mortality in patients with acute renal failure, 1988 to 2002. Journal of the American Society of Nephrology : JASN. Apr 2006;17(4):1143-1150.
  • Siew ED, Davenport A. The growth of acute kidney injury: a rising tide or just closer attention to detail? Kidney international. Jan 2015;87(1):46-61.
  • Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. American journal of kidney diseases : the official journal of the National Kidney Foundation. Jun 2009;53(6):961-973.
  • Pôncio L, Balbi AL, Rocha É P, Dias DB, Ponce D. The long-term outcome after acute kidney injury: a narrative review. Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia. Jan-Mar 2015;37(1):115-120.
  • Kung CW, Chou YH. Acute kidney disease: an overview of the epidemiology, pathophysiology, and management. Kidney research and clinical practice. May 11 2023.
  • Susantitaphong P, Cruz DN, Cerda J, et al. World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol. Sep 2013;8(9):1482-1493.
  • Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive care medicine. Aug 2015;41(8):1411-1423.
  • Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. Jama. Aug 17 2005;294(7):813-818.
  • Xue JL, Daniels F, Star RA, et al. Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. Journal of the American Society of Nephrology : JASN. Apr 2006;17(4):1135-1142.
  • Loef BG, Epema AH, Smilde TD, et al. Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. Journal of the American Society of Nephrology : JASN. Jan 2005;16(1):195-200.
  • Stevens PE, Tamimi NA, Al-Hasani MK, et al. Non-specialist management of acute renal failure. QJM : monthly journal of the Association of Physicians. Oct 2001;94(10):533-540.
  • Gallagher M, Cass A, Bellomo R, et al. Long-term survival and dialysis dependency following acute kidney injury in intensive care: extended follow-up of a randomized controlled trial. PLoS Med. Feb 2014;11(2):e1001601.
  • Gursu M, Yegenaga I, Tuglular S, et al. Acute kidney injury in Turkey: epidemiological characteristics, etiology, clinical course, and prognosis. BMC nephrology. Oct 5 2022;23(1):326.
  • Zhou L, Chu L. Prediction Models for One-Year Survival of Adult Patients with Acute Kidney Injury: A Longitudinal Study Based on the Data from the Medical Information Mart for Intensive Care III Database. 2022;2022:5902907.
  • Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Archives of internal medicine. Mar 22 2004;164(6):659-663.
  • Xie Z, Mo Z, Chen J, et al. Prevalence of Concomitant Coronary Artery Disease and Its Impact on Acute Kidney Injury for Chinese Adult Patients Undergoing Valvular Heart Surgery. Cardiology. 2019;144(1-2):60-68.
  • Li Q, Li Y, Zhou F. Association of serum potassium level with early and late mortality in very elderly patients with acute kidney injury. Journal of intensive medicine. Jan 2022;2(1):50-55.
  • Chávez-Íñiguez JS, Maggiani-Aguilera P, Aranda-García de Quevedo A, et al. Serum potassium trajectory during AKI and mortality risk. Nephron. Feb 17 2023.
  • Thongprayoon C, Sy-Go JPT, Nissaisorakarn V. Machine Learning Consensus Clustering Approach for Hospitalized Patients with Dysmagnesemia. Nov 15 2021;11(11).
  • Haider DG, Lindner G, Ahmad SS, et al. Hypermagnesemia is a strong independent risk factor for mortality in critically ill patients: results from a cross-sectional study. European journal of internal medicine. Sep 2015;26(7):504-507.
  • Ribeiro HS, Burdmann EA, Vieira EA, Ferreira ML, Ferreira AP, Inda-Filho AJ. Association of magnesium abnormalities at intensive care unit admission with kidney outcomes and mortality: a prospective cohort study. Clinical and experimental nephrology. Oct 2022;26(10):997-1004.

Akut Böbrek Hasarında Orta-Uzun Dönem Mortaliteyle İlişkili Faktörler

Yıl 2024, Cilt: 34 Sayı: 4, 445 - 449, 31.08.2024
https://doi.org/10.54005/geneltip.1360137

Öz

Amaç: ABH nedeniyle hastaneye yatırılan hastaların orta-uzun dönem mortalitesini etkileyen klinik ve laboratuvar parametrelerini belirlemek.
Gereç ve yöntem: AKI tanısıyla yoğun bakım ünitesinde ve Nefroloji kliniğinde dört yıl boyunca yatan hastaların dosyaları geriye dönük olarak tarandı.Demografik veriler, komorbiditeler, vital ve laboratuvar parametreleri incelendi. Bu hastalarda 4 yıllık süreçte mortaliteyi etkileyen faktörler açısından belirlendi.
Bulgular: Tek değişkenli analiz ile anlamlı bulunan değişkenlerin (yaş, hipertansiyon ve koroner arter hastalığı (KAH) varlığı, sedimantasyon, C-reaktif protein (CRP), üre, potasyum (K), magnezyum (Mg), pH ve CRP-albümin oranı (CAR)) mortalite üzerine etkileri , mortalitenin bağımsız risk faktörlerini belirlemek için kullanılan çoklu lojistik regresyon analizi kullanılarak yapıldı. Multipl lojistik regresyon analizi sonucu artan yaş (IQR=1.04, %95 CI=1,01 – 1,07, p=0,004), KAH varlığı (IQR =2,16, 95% CI=1,16 – 4,02, p=0,016), artmış Mg (IQR =2,64, %95 CI=1,18 – 5,92, p) =0,018) ve K (IQR =1,70, 95% GA=1,21 – 2,41, p=0,002) mortalite için bağımsız risk faktörleri olarak saptandı. Bu tahmin modelinin mortaliteyi öngörmedeki prediktif değeri %71,1, sensitivitesi %26,5, sensitivitesi %90 ve AUC 0,753 idi.
Sonuç: Prediktif modelimizde orta-uzun vadede AKI hastalarında ileri yaş, koroner arter hastalığı varlığı, K ve Mg artışını mortalite için bağımsız risk faktörleri olarak bulduk.

Kaynakça

  • Waikar SS, Curhan GC, Wald R, McCarthy EP, Chertow GM. Declining mortality in patients with acute renal failure, 1988 to 2002. Journal of the American Society of Nephrology : JASN. Apr 2006;17(4):1143-1150.
  • Siew ED, Davenport A. The growth of acute kidney injury: a rising tide or just closer attention to detail? Kidney international. Jan 2015;87(1):46-61.
  • Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. American journal of kidney diseases : the official journal of the National Kidney Foundation. Jun 2009;53(6):961-973.
  • Pôncio L, Balbi AL, Rocha É P, Dias DB, Ponce D. The long-term outcome after acute kidney injury: a narrative review. Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia. Jan-Mar 2015;37(1):115-120.
  • Kung CW, Chou YH. Acute kidney disease: an overview of the epidemiology, pathophysiology, and management. Kidney research and clinical practice. May 11 2023.
  • Susantitaphong P, Cruz DN, Cerda J, et al. World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol. Sep 2013;8(9):1482-1493.
  • Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive care medicine. Aug 2015;41(8):1411-1423.
  • Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. Jama. Aug 17 2005;294(7):813-818.
  • Xue JL, Daniels F, Star RA, et al. Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. Journal of the American Society of Nephrology : JASN. Apr 2006;17(4):1135-1142.
  • Loef BG, Epema AH, Smilde TD, et al. Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. Journal of the American Society of Nephrology : JASN. Jan 2005;16(1):195-200.
  • Stevens PE, Tamimi NA, Al-Hasani MK, et al. Non-specialist management of acute renal failure. QJM : monthly journal of the Association of Physicians. Oct 2001;94(10):533-540.
  • Gallagher M, Cass A, Bellomo R, et al. Long-term survival and dialysis dependency following acute kidney injury in intensive care: extended follow-up of a randomized controlled trial. PLoS Med. Feb 2014;11(2):e1001601.
  • Gursu M, Yegenaga I, Tuglular S, et al. Acute kidney injury in Turkey: epidemiological characteristics, etiology, clinical course, and prognosis. BMC nephrology. Oct 5 2022;23(1):326.
  • Zhou L, Chu L. Prediction Models for One-Year Survival of Adult Patients with Acute Kidney Injury: A Longitudinal Study Based on the Data from the Medical Information Mart for Intensive Care III Database. 2022;2022:5902907.
  • Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Archives of internal medicine. Mar 22 2004;164(6):659-663.
  • Xie Z, Mo Z, Chen J, et al. Prevalence of Concomitant Coronary Artery Disease and Its Impact on Acute Kidney Injury for Chinese Adult Patients Undergoing Valvular Heart Surgery. Cardiology. 2019;144(1-2):60-68.
  • Li Q, Li Y, Zhou F. Association of serum potassium level with early and late mortality in very elderly patients with acute kidney injury. Journal of intensive medicine. Jan 2022;2(1):50-55.
  • Chávez-Íñiguez JS, Maggiani-Aguilera P, Aranda-García de Quevedo A, et al. Serum potassium trajectory during AKI and mortality risk. Nephron. Feb 17 2023.
  • Thongprayoon C, Sy-Go JPT, Nissaisorakarn V. Machine Learning Consensus Clustering Approach for Hospitalized Patients with Dysmagnesemia. Nov 15 2021;11(11).
  • Haider DG, Lindner G, Ahmad SS, et al. Hypermagnesemia is a strong independent risk factor for mortality in critically ill patients: results from a cross-sectional study. European journal of internal medicine. Sep 2015;26(7):504-507.
  • Ribeiro HS, Burdmann EA, Vieira EA, Ferreira ML, Ferreira AP, Inda-Filho AJ. Association of magnesium abnormalities at intensive care unit admission with kidney outcomes and mortality: a prospective cohort study. Clinical and experimental nephrology. Oct 2022;26(10):997-1004.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Nefroloji
Bölüm Original Article
Yazarlar

Yasemin Coşkun Yavuz 0000-0003-1733-9003

Zeynep Bıyık 0000-0002-1332-398X

Muslu Kazım Körez 0000-0001-9524-6115

Lütfullah Altıntepe 0000-0003-1303-5440

Erken Görünüm Tarihi 30 Ağustos 2024
Yayımlanma Tarihi 31 Ağustos 2024
Gönderilme Tarihi 15 Eylül 2023
Yayımlandığı Sayı Yıl 2024 Cilt: 34 Sayı: 4

Kaynak Göster

Vancouver Coşkun Yavuz Y, Bıyık Z, Körez MK, Altıntepe L. Factors Related to Middle-Long-Term Mortality in Acute Kidney Injury. Genel Tıp Derg. 2024;34(4):445-9.