Acute kidney injury subphenotypes based on creatinine trajectory identifies patients at increased risk of death

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Acute kidney injury subphenotypes based on creatinine trajectory identifies patients at increased risk of death

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dc.contributor.author Bhatraju, Pavan K. en_US
dc.contributor.author Mukherjee, Paramita en_US
dc.contributor.author Robinson-Cohen, Cassianne en_US
dc.contributor.author O’Keefe, Grant E. en_US
dc.contributor.author Frank, Angela J. en_US
dc.contributor.author Christie, Jason D. en_US
dc.contributor.author Meyer, Nuala J. en_US
dc.contributor.author Liu, Kathleen D. en_US
dc.contributor.author Matthay, Michael A. en_US
dc.contributor.author Calfee, Carolyn S. en_US
dc.contributor.author Christiani, David C. en_US
dc.contributor.author Himmelfarb, Jonathan en_US
dc.contributor.author Wurfel, Mark M. en_US
dc.date.accessioned 2016-12-02T15:26:14Z
dc.date.issued 2016 en_US
dc.identifier.citation Bhatraju, 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.issn 1364-8535 en
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:29626205
dc.description.abstract Background: 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.iso en_US en
dc.publisher BioMed Central en
dc.relation.isversionof doi:10.1186/s13054-016-1546-4 en
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112626/pdf/ en
dash.license LAA en_US
dc.subject Critical care en
dc.subject Acute kidney injury en
dc.subject Mortality en
dc.subject Subphenotypes en
dc.subject Trajectory en
dc.subject Intensive care unit en
dc.title Acute kidney injury subphenotypes based on creatinine trajectory identifies patients at increased risk of death en
dc.type Journal Article en_US
dc.description.version Version of Record en
dc.relation.journal Critical Care en
dash.depositing.author Frank, Angela J. en_US
dc.date.available 2016-12-02T15:26:14Z

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