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2015 ; 19
(1
): 125
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Predicting one-year mortality of critically ill patients with early acute kidney
injury: data from the prospective multicenter FINNAKI study
#MMPMID25887685
Poukkanen M
; Vaara ST
; Reinikainen M
; Selander T
; Nisula S
; Karlsson S
; Parviainen I
; Koskenkari J
; Pettilä V
Crit Care
2015[Mar]; 19
(1
): 125
PMID25887685
show ga
INTRODUCTION: No predictive models for long-term mortality in critically ill
patients with acute kidney injury (AKI) exist. We aimed to develop and validate
two predictive models for one-year mortality in patients with AKI based on data
(1) on intensive care unit (ICU) admission and (2) on the third day (D3) in the
ICU. METHODS: This substudy of the FINNAKI study comprised 774 patients with
early AKI (diagnosed within 24 hours of ICU admission). We selected predictors a
priori based on previous studies, clinical judgment, and differences between
one-year survivors and non-survivors in patients with AKI. We validated the
models internally with bootstrapping. RESULTS: Of 774 patients, 308 (39.8%, 95%
confidence interval (CI) 36.3 to 43.3) died during one year. Predictors of
one-year mortality on admission were: advanced age, diminished premorbid
functional performance, co-morbidities, emergency admission, and resuscitation or
hypotension preceding ICU admission. The area under the receiver operating
characteristic curve (AUC) (95% CI) for the admission model was 0.76 (0.72 to
0.79) and the mean bootstrap-adjusted AUC 0.75 (0.74 to 0.75). Advanced age, need
for mechanical ventilation on D3, number of co-morbidities, higher modified SAPS
II score, the highest bilirubin value by D3, and the lowest base excess value on
D3 remained predictors of one-year mortality on D3. The AUC (95% CI) for the D3
model was 0.80 (0.75 to 0.85) and by bootstrapping 0.79 (0.77 to 0.80).
CONCLUSIONS: The prognostic performance of the admission data-based model was
acceptable, but not good. The D3 model for one-year mortality performed fairly
well in patients with early AKI.