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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Nephrology 1/2017

Hospital acquired Acute Kidney Injury is associated with increased mortality but not increased readmission rates in a UK acute hospital

Zeitschrift:
BMC Nephrology > Ausgabe 1/2017
Autoren:
Nerissa Jurawan, Tanya Pankhurst, Charles Ferro, Peter Nightingale, Jamie Coleman, David Rosser, Simon Ball
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12882-017-0729-9) contains supplementary material, which is available to authorized users.

Abstract

Background

Acute Kidney Injury (AKI) has evoked much interest over the past decade and is reported to be associated with high inpatient mortality. Preventable death and increased readmission rates related to AKI have been the focus of considerable interest.

Methods

We studied hospital acquired AKI in all emergency hospital admissions, except transfers from ICU to ICU or patients known to renal services, to ascertain mortality and readmission rates, and trackable modifiable factors for death, using cox regression and Kaplan Meier survival curves. Data was extracted from the electronic patient records and a series of case notes reviewed. Admissions were included between April 2006 and March 2010 (and patients followed up until September 2011).

Results

Overall incidence of AKI was 2.2%, (AKI stage 1, 61%, stage 2,27% and stage 3, 12%). In patients who sustain in-hospital AKI, 34% die in hospital, 42% are dead at 90 days and 48% at 1 year post discharge, compared to 12% 1 year mortality in patients without AKI. In multivariable analyses, AKI is an independent risk factor for in-hospital mortality (Hazard Ratio 1.6: 95% confidence intervals 1.43–1.75: P < 0.001), death within 90 days of discharge (Hazard Ratio 1.5: 95% confidence intervals 1.3–1.9: P < 0.001) and subsequent mortality beyond 90 days (Hazard Ratio 2.9: 95% confidence intervals 2.7–3.1: P < 0.001) after adjustment for co-morbidities and peak C-reactive protein.
Thirty percent of the patients who died in the first 90 days post discharge and had AKI, also had malignancy. Readmission rates at 30 and 90 days were not increased by AKI after adjustment for co-morbidities and peak C-reactive protein.

Conclusions

A significant proportion of deaths in the first 90 days post-discharge may not be avoidable, due to malignancy and other end-stage disease. Readmission rates were not higher in patients who had had AKI.
Zusatzmaterial
Additional file 1: Medications within respective drug classes. (DOCX 14 kb)
12882_2017_729_MOESM1_ESM.docx
Additional file 2: ICD 10 diagnoses. (DOCX 15 kb)
12882_2017_729_MOESM2_ESM.docx
Additional file 3: Integrated codes for composite of infections. (DOCX 14 kb)
12882_2017_729_MOESM3_ESM.docx
Additional file 4: Cox regression for in-hospital mortality AKI stage and adjusted for age, gender, co-morbidity and CRP. (DOCX 19 kb)
12882_2017_729_MOESM4_ESM.docx
Additional file 5: Cox regression for Post Discharge death after 90 Days for AKI and adjusted for age, gender, co-morbidity and CRP. (DOCX 20 kb)
12882_2017_729_MOESM5_ESM.docx
Additional file 6: Cox regression for Post Discharge death after 90 Days for AKI stage and adjusted for age, gender, co-morbidity and CRP. (DOCX 14 kb)
12882_2017_729_MOESM6_ESM.docx
Additional file 7: Odds Ratio for all-cause in hospital mortality associated with post index admission AKI. (DOCX 14 kb)
12882_2017_729_MOESM7_ESM.docx
Additional file 8: Logistic regression for readmission within 90 days for AKI stage and adjusted for age, gender, co-morbidity and CRP. (DOCX 18 kb)
12882_2017_729_MOESM8_ESM.docx
Additional file 9: Cox regression for time to readmission from 1st admission dependent on AKI, excluding patients who died, and adjusted for age, gender, co-morbidity and CRP. (DOCX 21 kb)
12882_2017_729_MOESM9_ESM.docx
Additional file 10: Comparison of comorbidities between the differing populations of patients: those who died in the first admission, those who survived and were readmitted and those who survived and weren’t readmitted. (DOCX 15 kb)
12882_2017_729_MOESM10_ESM.docx
Additional file 11: Univariable and restricted multivariable analyses by Cox regression, for CRP effect on inpatient mortality, 90 day mortality and mortality beyond 90 days. (DOCX 33 kb)
12882_2017_729_MOESM11_ESM.docx
Literatur
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