Journal Article

Value of Kidney Disease Improving Global Outcomes Urine Output Criteria in Critically III Patients： A Secondary Analysis of a Multicenter Prospective Cohort Study

Jun-Ping Qin Xiang-You Yu Chuan-Yun Qian Shu-Sheng Li Tie-He Qin Er-Zhen Chen Jian-Dong Lin Yu-Hang Ai Da-Wei Wu De-Xin Liu Ren-Hua Sun Zhen-Jie Hu Xiang-Yuan Cao Fa-Chun Zhou Zhen-Yang He Li-Hua Zhou You-Zhong An Yan Kang Xiao-Chun Ma Ming-Yan Zhao Li Jiang Yuan Xu Bin Du

2016

Overview

Background： Urine output （UO） is an essential criterion of the Kidney Disease Improving Global Outcomes （KD1GO） definition and classification system tbr acute kidney injury （AKI）, of which the diagnostic value has not been extensively studied. We aimed to determine whether AKI based on KDIGO UO criteria （KDtGOLro） could improve the diagnostic and prognostic accuracy, compared with KDIGO serum creatinine criteria （KDIGOscr）.Methods： We conducted a secondary analysis of the database of a previous study conducted by China Critical Care Clinical Trial Group （CCCCTG）, which was a 2-month prospective cohort study （July 1,2009 to August 31,2009） involving 3063 patients in 22 tertiary Intensive Care Units in Mainland of China. AKI was diagnosed and classified separately based on KDIGOt,o and KDlGOsc,. Hospital mortality of patients with more severe AKI classification based on KDIGOvo was compared with other patients by univariate and multivariate regression analyses. Results： The prevalence of AKl increased from 52.4% based on KDIGOscr to 55.4% based on KD1GOsc~ combined with KDIGOuo. KDIGOv~~ also restllted in an upgrade of AKI classification in 7.3% of patients, representing those with more severe AK1 classification based on KDIGOvo. Compared with non-AKI patients or those with maximum AKI classification by KDIGOscr, those with maximum AKI classification by KDIGOuo had a significantly higher hospital mortality of 58.4% （odds ratio [OR]： 7.580, 95% confidence interval [CI]： 4.141-13.873, P 〈 0.001）. In a multivariate logistic regression analysis, AKI based on KDIGOuo （OR： 2.891, 95% CI： 1.964-4.254, P 〈 0.001）, but not based on KDIGOscr （OR： 1.322, 95% CI： 0.902-1.939, P = 0.152）, was an independent risk factor for hospital mortality. Conclusion： UO was a criterion with additional value beyond creatinine criterion for AKI diagnosis and classification, which can help identify a group of patients with high risk of death.

• Publisher: Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China%Department of Critical Care Medicine, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, China%Department of Emergency Medicine and Medical Intensive Care Unit, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China%Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China%Department of Critical Care Medicine, Guangdong General Hospital, Guangzhou, Guangdong 510080, China%Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200025, China%Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China,Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing 100730, China
• Subject: Logistic回归分析 / 分类标准 / 多中心 / 尿量 / 患者 / 肾脏疾病 / 队列研究 / 预后判断