Background
Methods
Data sources
Study population
Outcome
Feature extraction
Statistical analysis
Results
MIMIC-IV (4197) | eICU (3963) | p-value | |
---|---|---|---|
Age (years) | 70 (59, 80) | 67 (59, 78) | 0.001 |
Male (%) | 2577 (61%) | 2228 (56%) | < 0.001 |
Race (%) | < 0.001 | ||
White | 2883 (69%) | 3171 (80%) | |
Black | 375 (9%) | 434 (11%) | |
Hispanic | 139 (3%) | 64 (2%) | |
Others | 800 (19%) | 294 (7%) | |
Height (cm) | 170 (163, 178) | 170 (163, 178) | 0.07 |
Weight (kg) | 80 (68, 96) | 84.7 (70, 104) | < 0.001 |
Underlying diseases (%) | |||
Diabetes mellitus | 951 (23%) | 467 (12%) | < 0.001 |
Congestive heart failure | 968 (23%) | 560 (14%) | < 0.001 |
Arrhythmia | 774 (18%) | 587 (15%) | < 0.001 |
Chronic lung disease | 620 (15%) | 379 (10%) | < 0.001 |
Liver disease | 328 (8%) | 180 (5%) | < 0.001 |
Laboratorya | |||
Hemoglobin (g/dL) | 8.4 (7.5, 9.6) | 8.8 (7.6, 10.2) | < 0.001 |
Hematocrit (%) | 25 (23, 29) | 27 (23, 31) | < 0.001 |
White blood cell count (× 109/L) | 15.4 (11.5, 20.5) | 15.3 (11.3, 20.8) | 0.54 |
Platelet (× 1000/mm3) | 123 (82, 180) | 130 (85, 185) | 0.02 |
PT | 16 (14, 20) | 17 (14, 22) | < 0.001 |
PTT | 37 (31, 55) | 38 (32, 55) | 0.22 |
INR | 1.5 (1.3, 1.9) | 1.4 (1.2, 2) | 0.001 |
BUN (mg/dL) | 38 (26, 57) | 44 (31, 61) | < 0.001 |
Sodium (mmo/L) | 142 (139, 145) | 142 (139, 146) | < 0.001 |
Potassium (mmo/L) | 4.8 (4.4, 5.2) | 4.7 (4.3, 5.1) | < 0.001 |
Chloride (mmo/L) | 109 (106, 113) | 109 (105, 114) | 0.97 |
Bicarbonate (mmo/L) | 20 (17, 23) | 20 (16, 23) | 0.01 |
Calcium (mg/dL) | 8.6 (8.2, 9) | 8.6 (8.1, 9) | < 0.001 |
SGOT (U/L) | 54 (28, 137) | 46 (25, 118) | < 0.001 |
SGPT (U/L) | 34 (18, 100) | 31 (18, 79) | 0.01 |
ALP (U/L) | 86 (62, 129) | 84 (61, 125) | 0.21 |
Albumin (d/dL) | 2.9 (2.4, 3.2) | 2.5 (2.1, 2.9) | < 0.001 |
Glucose (mg/dL) | 171 (140, 229) | 183 (147, 246) | < 0.001 |
pH | 7.30 (7.24, 7.35) | 7.31 (7.24, 7.37) | < 0.001 |
pO2 | 64 (40, 87) | 75 (62, 95) | < 0.001 |
pCO2 | 47 (42, 55) | 43 (37, 52) | < 0.001 |
pO2/FiO2 | 319 (234, 414) | 310 (217, 376) | < 0.001 |
Lactate (mg/dL) | 2.4 (1.7, 3.7) | 2 (1.3, 3.6) | < 0.001 |
Baseline creatinine (mg/dL)b | 1 (0.8, 1.2) | 0.98 (0.8, 1) | < 0.001 |
First AKI staging (%) | < 0.001 | ||
1 | 2755 (66%) | 2047 (52%) | |
2 | 667 (16%) | 1114 (28%) | |
3 | 775 (18%) | 802 (20%) | |
MAX AKI Staging (%) | < 0.001 | ||
1 | 2421 (58%) | 1508 (38%) | |
2 | 788 (19%) | 1204 (30%) | |
3 | 988 (23%) | 1251 (32%) | |
MAX SOFA score | 7 (5, 10) | 8 (5, 10) | < 0.001 |
Vasopressor use (%)c | 2603 (62%) | 1019 (26%) | < 0.001 |
Vasopressor duration (minutes) | 1285 (419, 3101) | 2731 (960, 4906) | < 0.001 |
Nephrotoxins (%) | 1441 (34%) | 2883 (73%) | < 0.001 |
MIMIC-IV (4197) | eICU (3963) | p-value | |
---|---|---|---|
Outcomes | |||
AKD day 7 (%) | 674 (16%) | 1000 (25%) | < 0.001 |
Death within 7 days (%) | 198 (5%) | 184 (5%) | 0.87 |
In hospital mortality (%) | 591 (14%) | 512 (13%) | 0.12 |
Composite of AKD and death by day 7 (%) | 872 (21%) | 1184 (30%) | < 0.001 |
Composite of AKD or in-hospital mortality by hospital discharge (%) | 772 (18%) | 1008 (25%) | < 0.001 |
ICU length of stay (days) | 3.9 (2, 7.2) | 4.1 (2.2, 7.4) | 0.004 |
Hospital length of stay after ICU admission (days) | 9.2 (6.1, 15.4) | 9.1 (6.3, 14.4) | 0.002 |
Classification of AKI in critically ill patients with sepsis based on early creatinine trajectories
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Class 1. Transient AKI—Creatinine trajectory in this class showed a minor nadir from baseline on ICU admission, followed by a mild rise that peaked at AKI stage 1 on day 2–3, with subsequent recovery.
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Class 2. Minor Transient AKI—Creatinine trajectory in this class started with a minor decrease from baseline, followed by a mild rise in creatinine that peaked on day 1, with subsequent recovery of AKI.
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Class 3. Early Mild AKI with Persistence—Creatinine trajectory in this class started with stage I AKI at ICU admission with continued rise in creatinine till day 1 to 2, followed by a sustained decline but persistence of AKI.
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Class 4. Early Mild AKI followed by Recovery—Creatinine trajectory in this class started with an initial stage 1 AKI on admission to ICU which then showed a sustained decline to AKI resolution.
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Class 5. Late Mild AKI with persistence—This class had a mild rise in creatinine on ICU admission that continued worsening with peak at AKI stage 1 by day 2, followed by a sustained decline but persistence of AKI.
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Class 6. Late Mild AKI with persistence and worsening—This class had a mildly elevated creatinine on ICU admission that then showed a sustained increase.
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Class 7. Moderate AKI with persistence—This class had stage II AKI on ICU admission with continued increased in creatinine for a peak of AKI stage 2–3 by day 2–3. This was followed by a mild decline but with persistence of AKI.
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Class 8. Severe AKI with mild improvement but persistence—This class had AKI stage 3 on ICU admission followed by a small, sustained decline thereafter but with continued persistence of AKI.
Classification of AKI in critically ill patients with sepsis based on early creatinine trajectories and outcomes in the development cohort (MIMIC-IV)
Development of AKD
AKD | AKD or mortality by day 7 | AKD at discharge or in-hospital mortality | |||||||
---|---|---|---|---|---|---|---|---|---|
OR | 95% CI | p | HR | 95% CI | p | HR | 95% CI | p | |
Class 1 (reference group) | 1 | 1 | 1 | ||||||
Class 2 | 0.99 | 0.60, 1.63 | 0.97 | 0.99 | 0.68, 1.47 | 0.99 | 1.14 | 0.82, 1.58 | 0.43 |
Class 3 | 3.99 | 2.87, 5.55 | < 0.001 | 2.31 | 1.75, 3.04 | < 0.001 | 1.51 | 1.17, 1.94 | 0.001 |
Class 4 | 1.30 | 0.85, 2.01 | 0.23 | 0.85 | 0.58, 1.23 | 0.38 | 0.57 | 0.39, 0.83 | 0.003 |
Class 5 | 2.52 | 1.80, 3.55 | < 0.001 | 1.92 | 1.45, 2.54 | < 0.001 | 1.32 | 1.02, 1.70 | 0.03 |
Class 6 | 7.11 | 4.81, 10.53 | < 0.001 | 4.98 | 3.60, 6.89 | < 0.001 | 3.48 | 2.56, 4.74 | < 0.001 |
Class 7 | 5.59 | 3.99, 7.83 | < 0.001 | 3.02 | 2.28, 3.99 | < 0.001 | 1.79 | 1.37, 2.33 | < 0.001 |
Class 8 | 9.02 | 5.94, 13.69 | < 0.001 | 3.38 | 2.36, 4.85 | < 0.001 | 1.93 | 1.31, 2.82 | < 0.001 |
Composite of AKD or mortality in seven days
Composite of AKD or total all-cause in-hospital mortality by discharge
Validation of creatinine trajectories in independent external cohort (eICU)
AKD | AKD or mortality by day 7 | AKD at discharge or in-hospital mortality | |||||||
---|---|---|---|---|---|---|---|---|---|
OR | 95% CI | p | HR | 95% CI | p | HR | 95% CI | p | |
Class 1 (reference group) | 1 | 1 | 1 | ||||||
Class 2 | 0.39 | 0.05, 3.21 | 0.38 | 0.90 | 0.33, 2.44 | 0.84 | 1.24 | 0.49, 3.16 | 0.65 |
Class 3 | 7.58 | 3.38, 17.01 | < 0.001 | 3.57 | 1.96, 6.49 | < 0.001 | 3.46 | 1.95, 6.16 | < 0.001 |
Class 4 | 2.53 | 1.07, 5.95 | 0.03 | 1.47 | 0.77, 2.82 | 0.24 | 1.16 | 0.61, 2.21 | 0.65 |
Class 5 | 3.69 | 1.61, 8.45 | 0.002 | 1.92 | 1.03, 3.58 | 0.04 | 2.25 | 1.24, 4.09 | 0.007 |
Class 6 | 9.26 | 3.85, 22.32 | < 0.001 | 4.47 | 2.28, 8.76 | < 0.001 | 4.59 | 2.37, 8.88 | < 0.001 |
Class 7 | 13.32 | 5.95, 29.83 | < 0.001 | 4.23 | 2.33, 7.69 | < 0.001 | 3.61 | 2.03, 6.42 | < 0.001 |
Class 8 | 19.97 | 8.79, 45.4 | < 0.001 | 4.66 | 2.52, 8.62 | < 0.001 | 4.82 | 2.66, 8.74 | < 0.001 |