Original Report: Laboratory Investigation
Variation in Risk and Mortality of Acute Kidney Injury in Critically Ill Patients: A Multicenter StudySrisawat N.a, b · Sileanu F.E.a, c · Murugan R.a · Bellomo R.d · Calzavacca P.d · Cartin-Ceba R.e · Cruz D.f · Finn J.g · Hoste E.A.h · Kashani K.e · Ronco C.i · Webb S.j · Kellum J.A.a · on behalf of the Acute Kidney Injury-6 Study Group
aThe Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa., USA; bExcellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross and Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; cDepartment of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa., USA; dDepartment of Intensive Care and Department of Medicine, Austin Hospital and University of Melbourne, Melbourne, Australia; eDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn., fDivision of Nephrology-Hypertension, University of California, San Diego, Calif., USA; gPrehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Perth, Australia; hDepartment of Intensive Care Medicine, University Hospital, Ghent University, Ghent, and Research Foundation-Flanders, Brussels, Belgium; iInternational Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy; jIntensive Care Unit, Royal Perth Hospital, Wellington Street, Perth, Australia
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Background: Despite standardized definitions of acute kidney injury (AKI), there is wide variation in the reported rates of AKI and hospital mortality for patients with AKI. Variation could be due to actual differences in disease incidence, clinical course, or a function of data ascertainment and application of diagnostic criteria. Using standard criteria may help determine and compare the risk and outcomes of AKI across centers. Methods: In this cohort study of critically ill patients admitted to the intensive care units at six hospitals in four countries, we used KDIGO criteria to define AKI. The main outcomes were the occurrence of AKI and hospital mortality. Results: Of the 15,132 critically ill patients, 32% developed AKI based on serum creatinine criteria. After adjusting for differences in age, sex, and severity of illness, the odds ratio for AKI continued to vary across centers (odds ratio (OR), 2.57-6.04, p < 0.001). The overall, crude hospital mortality of patients with AKI was 27%, which also varied across centers after adjusting for KDIGO stage, differences in age, sex, and severity of illness (OR, 1.13-2.20, p < 0.001). The severity of AKI was associated with incremental mortality risk across centers. Conclusions: In this study, the absolute and severity-adjusted rates of AKI and hospital mortality rates for AKI varied across centers. Future studies should examine whether variation in the risk of AKI among centers is due to differences in clinical practice or process of care or residual confounding due to unmeasured factors.
© 2015 S. Karger AG, Basel
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