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dc.contributor.authorBhatraju, Pavan K.en_US
dc.contributor.authorMukherjee, Paramitaen_US
dc.contributor.authorRobinson-Cohen, Cassianneen_US
dc.contributor.authorO’Keefe, Grant E.en_US
dc.contributor.authorFrank, Angela J.en_US
dc.contributor.authorChristie, Jason D.en_US
dc.contributor.authorMeyer, Nuala J.en_US
dc.contributor.authorLiu, Kathleen D.en_US
dc.contributor.authorMatthay, Michael A.en_US
dc.contributor.authorCalfee, Carolyn S.en_US
dc.contributor.authorChristiani, David C.en_US
dc.contributor.authorHimmelfarb, Jonathanen_US
dc.contributor.authorWurfel, Mark M.en_US
dc.date.accessioned2016-12-02T15:26:14Z
dc.date.issued2016en_US
dc.identifier.citationBhatraju, P. K., P. Mukherjee, C. Robinson-Cohen, G. E. O’Keefe, A. J. Frank, J. D. Christie, N. J. Meyer, et al. 2016. “Acute kidney injury subphenotypes based on creatinine trajectory identifies patients at increased risk of death.” Critical Care 20 (1): 372. doi:10.1186/s13054-016-1546-4. http://dx.doi.org/10.1186/s13054-016-1546-4.en
dc.identifier.issn1364-8535en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:29626205
dc.description.abstractBackground: Acute kidney injury (AKI) is common among intensive care unit (ICU) patients. AKI is highly heterogeneous, with variable links to poor outcomes. Current approaches to classify AKI severity and identify patients at highest risk for poor outcomes focus on the maximum change in serum creatinine (SCr) values. However, these scores are hampered by the need for a reliable baseline SCr value and the absence of a component differentiating transient from persistent rises in SCr. We hypothesized that identification of resolving or nonresolving AKI subphenotypes based on the early trajectory of SCr values in the ICU would better differentiate patients at risk of hospital mortality. Methods: We performed a secondary analysis of two prospective studies of ICU patients admitted to a trauma ICU (group 1; n = 1914) or general medical-surgical ICUs (group 2; n = 1867). In group 1, we tested definitions for resolving and nonresolving AKI subphenotypes and selected the definitions resulting in subphenotypes with the greatest separation in risk of death relative to non-AKI controls. We applied this definition to group 2 and tested whether the subphenotypes were independently associated with hospital mortality after adjustment for AKI severity. Results: AKI occurred in 46% and 69% of patients in groups 1 and 2, respectively. In group 1, a resolving AKI subphenotype (defined as a decrease in SCr of 0.3 mg/dl or 25% from maximum in the first 72 h of study enrollment) was associated with a low risk of death. A nonresolving AKI subphenotype (defined as all AKI cases not meeting the “resolving” definition) was associated with a high risk of death. In group 2, the resolving AKI subphenotype was not associated with increased mortality (relative risk [RR] 0.86, 95% CI 0.63–1.17), whereas the nonresolving AKI subphenotype was associated with higher mortality (RR 1.68, 95% CI 1.15–2.44) even after adjustment for AKI severity stage. Conclusions: The trajectory of SCr levels identifies AKI subphenotypes with different risks for death, even among AKI cases of similar severity. These AKI subphenotypes might better define the patients at risk for poor outcomes who might benefit from novel interventions. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1546-4) contains supplementary material, which is available to authorized users.en
dc.language.isoen_USen
dc.publisherBioMed Centralen
dc.relation.isversionofdoi:10.1186/s13054-016-1546-4en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112626/pdf/en
dash.licenseLAAen_US
dc.subjectCritical careen
dc.subjectAcute kidney injuryen
dc.subjectMortalityen
dc.subjectSubphenotypesen
dc.subjectTrajectoryen
dc.subjectIntensive care uniten
dc.titleAcute kidney injury subphenotypes based on creatinine trajectory identifies patients at increased risk of deathen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalCritical Careen
dash.depositing.authorFrank, Angela J.en_US
dc.date.available2016-12-02T15:26:14Z
dc.identifier.doi10.1186/s13054-016-1546-4*
dash.authorsorderedfalse
dash.contributor.affiliatedFrank, Angela
dash.contributor.affiliatedChristiani, David


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