Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study
The aim of this study is to evaluate the association between acute serum creatinine changes in acute renal failure (ARF), before specialized treatment begins, and in-hospital mortality, recovery of renal function, and overall mortality at 6 months, on an equal degree of ARF seve...
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| Format: | info:eu-repo/semantics/article |
| Language: | eng |
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BioMed Central
2012
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| Online Access: | https://hdl.handle.net/10171/23386 |
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| author | Perez-Valdivieso, J.R. (José Ramón) Bes-Rastrollo, M. (Maira) Monedero, P. (Pablo) Irala, J. (Jokin) de Lavilla, F.J. (Francisco Javier) |
| author_facet | Perez-Valdivieso, J.R. (José Ramón) Bes-Rastrollo, M. (Maira) Monedero, P. (Pablo) Irala, J. (Jokin) de Lavilla, F.J. (Francisco Javier) |
| author_sort | Perez-Valdivieso, J.R. (José Ramón) |
| collection | DSpace |
| description | The aim of this study is to evaluate the association between acute
serum creatinine changes in acute renal failure (ARF), before specialized
treatment begins, and in-hospital mortality, recovery of renal function, and
overall mortality at 6 months, on an equal degree of ARF severity, using the
RIFLE criteria, and comorbid illnesses. METHODS: Prospective cohort study of 1008
consecutive patients who had been diagnosed as having ARF, and had been admitted
in an university-affiliated hospital over 10 years. Demographic, clinical
information and outcomes were measured. After that, 646 patients who had
presented enough increment in serum creatinine to qualify for the RIFLE criteria
were included for subsequent analysis. The population was divided into two groups
using the median serum creatinine change (101%) as the cut-off value.
Multivariate non-conditional logistic and linear regression models were used.
RESULTS: A >or= 101% increment of creatinine respect to its baseline before
nephrology consultation was associated with significant increase of in-hospital
mortality (35.6% vs. 22.6%, p < 0.001), with an adjusted odds ratio of 1.81 (95%
CI: 1.08-3.03). Patients who required continuous renal replacement therapy in the
>or= 101% increment group presented a higher increase of in-hospital mortality
(62.7% vs 46.4%, p = 0.048), with an adjusted odds ratio of 2.66 (95% CI:
1.00-7.21). Patients in the >or= 101% increment group had a higher mean serum
creatinine level with respect to their baseline level (114.72% vs. 37.96%) at
hospital discharge. This was an adjusted 48.92% (95% CI: 13.05-84.79) more serum
creatinine than in the < 101% increment group. CONCLUSION: In this cohort,
patients who had presented an increment in serum level of creatinine of >or= 101%
with respect to basal values, at the time of nephrology consultation, had
increased mortality rates and were discharged from hospital with a more
deteriorated renal function than those with similar Liano scoring and the same
RIFLE classes, but with a < 101% increment. This finding may provide more
information about the factors involved in the prognosis of ARF. Furthermore, the
calculation of relative serum creatinine increase could be used as a practical
tool to identify those patients at risk, and that would benefit from an intensive
therapy. |
| format | info:eu-repo/semantics/article |
| id | oai:dadun.unav.edu:10171-23386 |
| institution | Universidad de Navarra |
| language | eng |
| publishDate | 2012 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oai:dadun.unav.edu:10171-233862020-03-03T21:22:26Z Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study Perez-Valdivieso, J.R. (José Ramón) Bes-Rastrollo, M. (Maira) Monedero, P. (Pablo) Irala, J. (Jokin) de Lavilla, F.J. (Francisco Javier) Acute Kidney Injury/blood/mortality/therapy Biological Markers/blood Nephrology/statistics & numerical data The aim of this study is to evaluate the association between acute serum creatinine changes in acute renal failure (ARF), before specialized treatment begins, and in-hospital mortality, recovery of renal function, and overall mortality at 6 months, on an equal degree of ARF severity, using the RIFLE criteria, and comorbid illnesses. METHODS: Prospective cohort study of 1008 consecutive patients who had been diagnosed as having ARF, and had been admitted in an university-affiliated hospital over 10 years. Demographic, clinical information and outcomes were measured. After that, 646 patients who had presented enough increment in serum creatinine to qualify for the RIFLE criteria were included for subsequent analysis. The population was divided into two groups using the median serum creatinine change (101%) as the cut-off value. Multivariate non-conditional logistic and linear regression models were used. RESULTS: A >or= 101% increment of creatinine respect to its baseline before nephrology consultation was associated with significant increase of in-hospital mortality (35.6% vs. 22.6%, p < 0.001), with an adjusted odds ratio of 1.81 (95% CI: 1.08-3.03). Patients who required continuous renal replacement therapy in the >or= 101% increment group presented a higher increase of in-hospital mortality (62.7% vs 46.4%, p = 0.048), with an adjusted odds ratio of 2.66 (95% CI: 1.00-7.21). Patients in the >or= 101% increment group had a higher mean serum creatinine level with respect to their baseline level (114.72% vs. 37.96%) at hospital discharge. This was an adjusted 48.92% (95% CI: 13.05-84.79) more serum creatinine than in the < 101% increment group. CONCLUSION: In this cohort, patients who had presented an increment in serum level of creatinine of >or= 101% with respect to basal values, at the time of nephrology consultation, had increased mortality rates and were discharged from hospital with a more deteriorated renal function than those with similar Liano scoring and the same RIFLE classes, but with a < 101% increment. This finding may provide more information about the factors involved in the prognosis of ARF. Furthermore, the calculation of relative serum creatinine increase could be used as a practical tool to identify those patients at risk, and that would benefit from an intensive therapy. 2012-10-15T15:01:27Z 2012-10-15T15:01:27Z 2007 info:eu-repo/semantics/article https://hdl.handle.net/10171/23386 eng http://www.biomedcentral.com/content/pdf/1471-2369-8-14.pdf info:eu-repo/semantics/openAccess application/pdf BioMed Central |
| spellingShingle | Acute Kidney Injury/blood/mortality/therapy Biological Markers/blood Nephrology/statistics & numerical data Perez-Valdivieso, J.R. (José Ramón) Bes-Rastrollo, M. (Maira) Monedero, P. (Pablo) Irala, J. (Jokin) de Lavilla, F.J. (Francisco Javier) Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study |
| title | Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study |
| title_full | Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study |
| title_fullStr | Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study |
| title_full_unstemmed | Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study |
| title_short | Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study |
| title_sort | prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study |
| topic | Acute Kidney Injury/blood/mortality/therapy Biological Markers/blood Nephrology/statistics & numerical data |
| url | https://hdl.handle.net/10171/23386 |
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