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Article ; Online: Fluid management in patients with acute kidney injury - A post-hoc analysis of the FINNAKI study.

Inkinen, Nina / Jukarainen, Sakari / Wiersema, Renske / Poukkanen, Meri / Pettilä, Ville / Vaara, Suvi T

2021 Volume 64, Page(s) 205–210

Abstract: Purpose: Whether positive fluid balance among patients with acute kidney injury (AKI) stems from decreased urine output, overzealous fluid administration, or both is poorly characterized.: Materials and methods: This was a post hoc analysis of the ... ...

Abstract	Purpose: Whether positive fluid balance among patients with acute kidney injury (AKI) stems from decreased urine output, overzealous fluid administration, or both is poorly characterized. Materials and methods: This was a post hoc analysis of the prospective multicenter observational Finnish Acute Kidney Injury study including 824 AKI and 1162 non-AKI critically ill patients. Results: We matched 616 AKI (diagnosed during the three first intensive care unit (ICU) days) and non-AKI patients using propensity score. During the three first ICU days, AKI patients received median [IQR] of 11.4 L [8.0-15.2]L fluids and non-AKI patients 10.2 L [7.5-13.7]L, p < 0.001 while the fluid output among AKI patients was 4.7 L [3.0-7.2]L and among non-AKI patients 5.8 L [4.1-8.0]L, p < 0.001. In AKI patients, the median [IQR] cumulative fluid balance was 2.5 L [-0.2-6.0]L compared to 0.9 L [-1.4-3.6]L among non-AKI patients, p < 0.001. Among the 824 AKI patients, smaller volumes of fluid input with a multivariable OR of 0.90 (0.88-0.93) and better fluid output (multivariable OR 1.12 (1.07-1.18)) associated with enhanced change of resolution of AKI. Conclusions: AKI patients received more fluids albeit having lower fluid output compared to matched critically ill non-AKI patients. Smaller volumes of fluid input and higher fluid output were associated with better AKI recovery.
MeSH term(s)	Acute Kidney Injury/therapy ; Critical Illness ; Fluid Therapy ; Humans ; Intensive Care Units ; Prospective Studies ; Water-Electrolyte Balance
Language	English
Publishing date	2021-05-06
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2021.05.002
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Zs.A 2152: Show issues

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Article ; Online: Early prolonged neutrophil activation in critically ill patients with sepsis.

Törnblom, Sanna / Nisula, Sara / Vaara, Suvi T / Poukkanen, Meri / Andersson, Sture / Pettilä, Ville / Pesonen, Eero

Innate immunity

2021 Volume 27, Issue 2, Page(s) 192–200

Abstract: We hypothesised that plasma concentrations of biomarkers of neutrophil activation and pro-inflammatory cytokines differ according to the phase of rapidly evolving sepsis. In an observational study, we measured heparin-binding protein (HBP), ... ...

Abstract	We hypothesised that plasma concentrations of biomarkers of neutrophil activation and pro-inflammatory cytokines differ according to the phase of rapidly evolving sepsis. In an observational study, we measured heparin-binding protein (HBP), myeloperoxidase (MPO), IL-6 and IL-8 in 167 sepsis patients on intensive care unit admission. We prospectively used the emergence of the first sepsis-associated organ dysfunction (OD) as a surrogate for the sepsis phase. Fifty-five patients (of 167, 33%) developed the first OD > 1 h before, 74 (44%) within ± 1 h, and 38 (23%) > 1 h after intensive care unit admission. HBP and MPO were elevated at a median of 12 h before the first OD, remained high up to 24 h, and were not associated with sepsis phase. IL-6 and IL-8 rose and declined rapidly close to OD emergence. Elevation of neutrophil activation markers HBP and MPO was an early event in the evolution of sepsis, lasting beyond the subsidence of the pro-inflammatory cytokine reaction. Thus, as sepsis biomarkers, HBP and MPO were not as prone as IL-6 and IL-8 to the effect of sample timing.
MeSH term(s)	Aged ; Antimicrobial Cationic Peptides/blood ; Biomarkers/blood ; Blood Proteins ; Critical Illness ; Female ; Humans ; Intensive Care Units ; Interleukin-6/blood ; Interleukin-8/blood ; Male ; Middle Aged ; Neutrophil Activation ; Neutrophils/immunology ; Peroxidase/blood ; Sepsis/immunology
Chemical Substances	AZU1 protein, human ; Antimicrobial Cationic Peptides ; Biomarkers ; Blood Proteins ; Interleukin-6 ; Interleukin-8 ; Peroxidase (EC 1.11.1.7)
Language	English
Publishing date	2021-01-18
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2381250-3
ISSN	1753-4267 ; 1753-4259
ISSN (online)	1753-4267
ISSN	1753-4259
DOI	10.1177/1753425920980078
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Article ; Online: Neutrophil activation in septic acute kidney injury: A post hoc analysis of the FINNAKI study.

Törnblom, Sanna / Nisula, Sara / Vaara, Suvi T / Poukkanen, Meri / Andersson, Sture / Pettilä, Ville / Pesonen, Eero

Acta anaesthesiologica Scandinavica

2019 Volume 63, Issue 10, Page(s) 1390–1397

Abstract: Background: Inflammation, reflected by high plasma interleukin-6 concentration, is associated with acute kidney injury (AKI) in septic patients. Neutrophil activation has pathophysiological significance in experimental septic AKI. We hypothesized that ... ...

Abstract	Background: Inflammation, reflected by high plasma interleukin-6 concentration, is associated with acute kidney injury (AKI) in septic patients. Neutrophil activation has pathophysiological significance in experimental septic AKI. We hypothesized that neutrophil activation is associated with AKI in critically ill sepsis patients. Methods: We measured plasma (n = 182) and urine (n = 118) activin A (a rapidly released cytosolic neutrophil protein), interleukin-8 (a chemotactic factor for neutrophils), myeloperoxidase (a neutrophil biomarker released in tissues), and interleukin-6 on intensive care unit admission (plasma and urine) and 24 hours later (plasma) in sepsis patients manifesting their first organ dysfunction between 24 hours preceding admission and the second calendar day in intensive care unit. AKI was defined by the Kidney Disease: Improving Global Outcomes criteria. Results: Plasma admission interleukin-8 (240 [60-971] vs 50 [19-164] pg/mL, P < .001) and activin A (845 [554-1895] vs 469 [285-862] pg/mL, P < .001) were but myeloperoxidase (169 [111-300] vs 144 [88-215] ng/mL, P = .059) was not higher among patients with AKI compared with those without. Urine admission interleukin-8 (50.4 [19.8-145.3] vs 9.5 [2.7-28.7] ng/mL, P < .001) and myeloperoxidase (7.7 [1.5-12.6] vs 1.9 [0.4-6.9] ng/mL, P < .001) were but activin A (9.7 [1.4-42.6] vs 4.0 [0.0-33.0] ng/mL, P = .064) was not higher in AKI than non-AKI patients. Urine myeloperoxidase correlated with urine interleukin-8 (R = .627, P < .001) but not with plasma myeloperoxidase (R = .131, P = .158). Conclusion: Interleukin-8 in plasma and urine was associated with septic AKI. Elevated plasma activin A indicates intravascular neutrophil activation in septic AKI. Concomitant plasma and urine myeloperoxidase measurements suggest neutrophil accumulation into injured kidneys.
MeSH term(s)	Activins/analysis ; Acute Kidney Injury/immunology ; Aged ; Female ; Humans ; Interleukin-8/analysis ; Male ; Middle Aged ; Neutrophil Activation ; Peroxidase/analysis ; Sepsis/complications
Chemical Substances	Interleukin-8 ; activin A ; Activins (104625-48-1) ; Peroxidase (EC 1.11.1.7)
Language	English
Publishing date	2019-08-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80002-8
ISSN	1399-6576 ; 0001-5172
ISSN (online)	1399-6576
ISSN	0001-5172
DOI	10.1111/aas.13451
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Article: Heparin-binding protein (HBP) improves prediction of sepsis-related acute kidney injury.

Tverring, Jonas / Vaara, Suvi T / Fisher, Jane / Poukkanen, Meri / Pettilä, Ville / Linder, Adam

Annals of intensive care

2017 Volume 7, Issue 1, Page(s) 105

Abstract: Background: Sepsis-related acute kidney injury (AKI) accounts for major morbidity and mortality among the critically ill. Heparin-binding protein (HBP) is a promising biomarker in predicting development and prognosis of severe sepsis and septic shock ... ...

Abstract	Background: Sepsis-related acute kidney injury (AKI) accounts for major morbidity and mortality among the critically ill. Heparin-binding protein (HBP) is a promising biomarker in predicting development and prognosis of severe sepsis and septic shock that has recently been proposed to be involved in the pathophysiology of AKI. The objective of this study was to investigate the added predictive value of measuring plasma HBP on admission to the intensive care unit (ICU) regarding the development of septic AKI. Methods: We included 601 patients with severe sepsis or septic shock from the prospective, observational FINNAKI study conducted in seventeen Finnish ICUs during a 5-month period (1 September 2011-1 February 2012). The main outcome measure was the development of KDIGO AKI stages 2-3 from 12 h after admission up to 5 days. Statistical analysis for the primary endpoint included construction of a clinical risk model, area under the receiver operating curve (ROC area), category-free net reclassification index (cfNRI) and integrated discrimination improvement (IDI) with 95% confidence intervals (95% CI). Results: Out of 511 eligible patients, 101 (20%) reached the primary endpoint. The addition of plasma HBP to a clinical risk model significantly increased ROC area (0.82 vs. 0.78, p = 0.03) and risk classification scores: cfNRI 62.0% (95% CI 40.5-82.4%) and IDI 0.053 (95% CI 0.029-0.075). Conclusions: Plasma HBP adds predictive value to known clinical risk factors in septic AKI. Further studies are warranted to compare the predictive performance of plasma HBP to other novel AKI biomarkers.
Language	English
Publishing date	2017-10-18
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2617094-2
ISSN	2110-5820
ISSN	2110-5820
DOI	10.1186/s13613-017-0330-1
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Article ; Online: Two subphenotypes of septic acute kidney injury are associated with different 90-day mortality and renal recovery.

Wiersema, Renske / Jukarainen, Sakari / Vaara, Suvi T / Poukkanen, Meri / Lakkisto, Päivi / Wong, Hector / Linder, Adam / van der Horst, Iwan C C / Pettilä, Ville

Critical care (London, England)

2020 Volume 24, Issue 1, Page(s) 150

Abstract: Background: The pathophysiology of septic acute kidney injury is inadequately understood. Recently, subphenotypes for sepsis and AKI have been derived. The objective of this study was to assess whether a combination of comorbidities, baseline clinical ... ...

Abstract	Background: The pathophysiology of septic acute kidney injury is inadequately understood. Recently, subphenotypes for sepsis and AKI have been derived. The objective of this study was to assess whether a combination of comorbidities, baseline clinical data, and biomarkers could classify meaningful subphenotypes in septic AKI with different outcomes. Methods: We performed a post hoc analysis of the prospective Finnish Acute Kidney Injury (FINNAKI) study cohort. We included patients admitted with sepsis and acute kidney injury during the first 48 h from admission to intensive care (according to Kidney Disease Improving Global Outcome criteria). Primary outcomes were 90-day mortality and renal recovery on day 5. We performed latent class analysis using 30 variables obtained on admission to classify subphenotypes. Second, we used logistic regression to assess the association of derived subphenotypes with 90-day mortality and renal recovery on day 5. Results: In total, 301 patients with septic acute kidney injury were included. Based on the latent class analysis, a two-class model was chosen. Subphenotype 1 was assigned to 133 patients (44%) and subphenotype 2 to 168 patients (56%). Increased levels of inflammatory and endothelial injury markers characterized subphenotype 2. At 90 days, 29% of patients in subphenotype 1 and 41% of patients in subphenotype 2 had died. Subphenotype 2 was associated with a lower probability of short-term renal recovery and increased 90-day mortality. Conclusions: In this post hoc analysis, we identified two subphenotypes of septic acute kidney injury with different clinical outcomes. Future studies are warranted to validate the suggested subphenotypes of septic acute kidney injury.
MeSH term(s)	Acute Kidney Injury/etiology ; Acute Kidney Injury/physiopathology ; Aged ; Biomarkers/analysis ; Biomarkers/blood ; Chi-Square Distribution ; Female ; Finland ; Humans ; Logistic Models ; Male ; Middle Aged ; Phenotype ; Recovery of Function/physiology ; Sepsis/blood ; Sepsis/complications ; Sepsis/genetics ; Statistics, Nonparametric
Chemical Substances	Biomarkers
Language	English
Publishing date	2020-04-15
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-020-02866-x
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Zs.A 5517: Show issues

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Article ; Online: Evolution of Blood Lactate and 90-Day Mortality in Septic Shock. A Post Hoc Analysis of the FINNAKI Study.

Varis, Elina / Pettilä, Ville / Poukkanen, Meri / Jakob, Stephan M / Karlsson, Sari / Perner, Anders / Takala, Jukka / Wilkman, Erika

Shock (Augusta, Ga.)

2017 Volume 47, Issue 5, Page(s) 574–581

Abstract: Hyperlactatemia predicts mortality in patients with sepsis and septic shock, and its normalization is a potential treatment goal. We investigated the association of blood lactate and its changes over time with 90-day mortality in septic shock. We ... ...

Abstract	Hyperlactatemia predicts mortality in patients with sepsis and septic shock, and its normalization is a potential treatment goal. We investigated the association of blood lactate and its changes over time with 90-day mortality in septic shock. We performed a post hoc analysis of 513 septic shock patients with admission blood lactate measurements in the prospective, observational, multicenter FINNAKI study. Repetitive lactate measurements were available in 496 patients for analyses of change in lactate values during intensive care unit stay.The 90-day mortality for all patients was 33.3%. Patients with admission lactate >2 mmol/L had higher 90-day mortality than those with admission lactate ≤2 mmol/L (43.4% vs. 22.6%, P < 0.001). Patients with persistent hyperlactatemia (>2 mmol/L) at ≥72 h had higher 90-day mortality compared with those with a lactate value of ≤2.0 mmol/L (52.0% vs. 24.3%, P < 0.001). Time-weighted mean lactate values were higher in non-survivors than in survivors, (median [IQR] 2.05 [1.38-4.22] mmol/L vs. 1.29 [0.98-1.77] mmol/L, P < 0.001). Time to normalization of lactate was comparable for 90-day non-survivors and survivors (median [IQR] 17.0 [3.5-43.5] vs. 15.0 [5.0-35.0] h, P = 0.67). In separate models, time-weighted mean lactate, lactate value at ≥72 h, and hyperlactatemia at ≥72 h were independently associated with 90-day mortality, but admission lactate and time to normalization of lactate were not. These findings may inform future clinical trials using combined surrogate endpoints for mortality in septic shock patients.
MeSH term(s)	Aged ; Female ; Hemodynamics/physiology ; Humans ; Lactic Acid/blood ; Male ; Middle Aged ; Prospective Studies ; Sepsis/blood ; Sepsis/mortality ; Shock, Septic/blood ; Shock, Septic/mortality ; Time Factors
Chemical Substances	Lactic Acid (33X04XA5AT)
Language	English
Publishing date	2017-05
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	1185432-7
ISSN	1540-0514 ; 1073-2322
ISSN (online)	1540-0514
ISSN	1073-2322
DOI	10.1097/SHK.0000000000000772
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Zs.A 3985: Show issues

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Article ; Online: Predictive value of urine interleukin-18 in the evolution and outcome of acute kidney injury in critically ill adult patients.

Nisula, S / Yang, R / Poukkanen, M / Vaara, S T / Kaukonen, K M / Tallgren, M / Haapio, M / Tenhunen, J / Korhonen, A M / Pettilä, V

British journal of anaesthesia

2015 Volume 114, Issue 3, Page(s) 460–468

Abstract: Background: Interleukin-18 (IL-18) is a pro-inflammatory protein, which mediates ischaemic tubular injury, and has been suggested to be a sensitive and specific biomarker for acute kidney injury (AKI). The predictive value of IL-18 in the diagnosis, ... ...

Abstract	Background: Interleukin-18 (IL-18) is a pro-inflammatory protein, which mediates ischaemic tubular injury, and has been suggested to be a sensitive and specific biomarker for acute kidney injury (AKI). The predictive value of IL-18 in the diagnosis, evolution, and outcome of AKI in critically ill patients is still unclear. Methods: We measured urine IL-18 from critically ill patients at intensive care unit (ICU) admission and 24 h. We evaluated the association of IL-18 with developing new AKI, renal replacement therapy (RRT), and 90-day mortality. We calculated areas under receiver operating characteristics curves (AUCs), best cut-off values, and positive likelihood ratios (LR+) for IL-18 concerning these endpoints. Additionally, we compared the predictive value of IL-18 at ICU admission to that of urine neutrophil gelatinase-associated lipocalin (NGAL). Results: In this study population of 1439 patients the highest urine IL-18 during the first 24 h in the ICU associated with the development of AKI with an AUC [95% confidence interval (CI)] of 0.586 (0.546-0.627) and with the development of Stage 3 AKI with an AUC (95% CI) of 0.667 (0.591-0.774). IL-18 predicted the initiation of RRT with an AUC (95% CI) of 0.655 (0.572-0.739), and 90-day mortality with an AUC (95% CI) of 0.536 (0.497-0.574). Conclusions: IL-18 had poor-to-moderate ability to predict AKI, RRT, or 90-day mortality in this large cohort of critically ill patients. Thus, it should be used with caution for diagnostic or predictive purposes in the critically ill.
MeSH term(s)	Acute Kidney Injury/mortality ; Acute Kidney Injury/therapy ; Acute Kidney Injury/urine ; Aged ; Area Under Curve ; Biomarkers/urine ; Critical Illness ; Female ; Follow-Up Studies ; Humans ; Intensive Care Units ; Interleukin-18/urine ; Male ; Middle Aged ; Patient Outcome Assessment ; Predictive Value of Tests ; Prospective Studies ; ROC Curve ; Renal Replacement Therapy/statistics & numerical data
Chemical Substances	Biomarkers ; Interleukin-18
Language	English
Publishing date	2015-03
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1093/bja/aeu382
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Uk I Zs.80: Show issues

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Article ; Online: Burden of acute kidney injury and 90-day mortality in critically ill patients.

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

BMC nephrology

2019 Volume 21, Issue 1, Page(s) 1

Abstract: Background: Mortality 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 ...

Abstract	Background: Mortality 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. Methods: Kidney 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. Results: In 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). Conclusion: AKI 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.
MeSH term(s)	Acute Kidney Injury/classification ; Acute Kidney Injury/mortality ; Acute Kidney Injury/therapy ; Aged ; Area Under Curve ; Creatinine/blood ; Critical Illness/mortality ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Patient Acuity ; Prognosis ; Prospective Studies ; Renal Replacement Therapy ; Severity of Illness Index ; Urine
Chemical Substances	Creatinine (AYI8EX34EU)
Language	English
Publishing date	2019-12-31
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2041348-8
ISSN	1471-2369 ; 1471-2369
ISSN (online)	1471-2369
ISSN	1471-2369
DOI	10.1186/s12882-019-1645-y
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Article ; Online: Predicting one-year mortality of critically ill patients with early acute kidney injury: data from the prospective multicenter FINNAKI study.

Poukkanen, Meri / Vaara, Suvi T / Reinikainen, Matti / Selander, Tuomas / Nisula, Sara / Karlsson, Sari / Parviainen, Ilkka / Koskenkari, Juha / Pettilä, Ville

Critical care (London, England)

2015 Volume 19, Page(s) 125

Abstract: 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 ...

Abstract	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.
MeSH term(s)	Acute Kidney Injury/mortality ; Acute Kidney Injury/therapy ; Aged ; Critical Illness ; Female ; Finland ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; ROC Curve ; Respiration, Artificial/methods ; Severity of Illness Index
Language	English
Publishing date	2015-03-27
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2051256-9
ISSN	1466-609X ; 1466-609X
ISSN (online)	1466-609X
ISSN	1466-609X
DOI	10.1186/s13054-015-0848-2
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Article ; Online: Acute kidney injury in patients with severe sepsis in Finnish Intensive Care Units.

Poukkanen, M / Vaara, S T / Pettilä, V / Kaukonen, K-M / Korhonen, A-M / Hovilehto, S / Inkinen, O / Laru-Sompa, R / Kaminski, T / Reinikainen, M / Lund, V / Karlsson, S

Acta anaesthesiologica Scandinavica

2013 Volume 57, Issue 7, Page(s) 863–872

Abstract: Background: Severe sepsis is one of the leading causes of acute kidney injury (AKI). Patients with sepsis-associated AKI demonstrate high-hospital mortality. We evaluated the incidence of severe sepsis-associated AKI and its association with outcome in ... ...

Abstract	Background: Severe sepsis is one of the leading causes of acute kidney injury (AKI). Patients with sepsis-associated AKI demonstrate high-hospital mortality. We evaluated the incidence of severe sepsis-associated AKI and its association with outcome in intensive care units (ICUs) in Finland. Methods: This was a predetermined sub-study of the prospective, observational, multicentre FINNAKI study conducted in 17 ICUs during 1 September 2011 and 1 February 2012. All emergency ICU admissions and elective admissions exceeding 24 hours in the ICU were screened for presence of severe sepsis and AKI up to 5 days in ICU. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria and severe sepsis according to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) criteria. Results: Of the 2901 included patients, severe sepsis was diagnosed in 918 (31.6%, 95% confidence interval [CI] 29.9-33.4%) patients. Of these 918 patients, 488 (53.2% [95% CI 49.9-56.5%]) had AKI. The 90-day mortality rate was 38.1% (95% CI 33.7-42.5%) for severe sepsis patients with AKI and 24.7% (95% CI 20.5-28.8%) for those without AKI. After adjusting for covariates, KDIGO stage 3 AKI was associated with an increased risk for 90-day mortality with an adjusted odds ratio (OR) of 1.94 (95% CI 1.28-2.94), but stages 1 and 2 were not. Conclusions: More than half of the patients with severe sepsis had AKI according to the KDIGO classification, and AKI stage 3 was independently associated with 90-day mortality.
MeSH term(s)	Acute Kidney Injury/epidemiology ; Acute Kidney Injury/etiology ; Acute Kidney Injury/therapy ; Aged ; Colloids/therapeutic use ; Comorbidity ; Creatinine/blood ; Female ; Finland/epidemiology ; Hospital Mortality ; Humans ; Incidence ; Intensive Care Units/statistics & numerical data ; Length of Stay/statistics & numerical data ; Male ; Mass Screening ; Middle Aged ; Multiple Organ Failure/epidemiology ; Prospective Studies ; Renal Replacement Therapy/utilization ; Sepsis/complications ; Sepsis/epidemiology ; Sepsis/microbiology ; Treatment Outcome
Chemical Substances	Colloids ; Creatinine (AYI8EX34EU)
Language	English
Publishing date	2013-08
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	80002-8
ISSN	1399-6576 ; 0001-5172
ISSN (online)	1399-6576
ISSN	0001-5172
DOI	10.1111/aas.12133
Database	MEDical Literature Analysis and Retrieval System OnLINE

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