Introduction
Methods
Ethical approval and research transparency
Source of data
Outcomes
Prediction model development
Characteristic | Delayed strategy | Early strategy |
---|---|---|
n = 550 | n = 557 | |
Study | ||
AKIKI | 308 (56.0) | 311 (55.8) |
IDEAL-ICU | 242 (44.0) | 246 (44.2) |
Age—year | 67.7 (13.2) | 66.5 (13.3) |
Weight—kg | 81.6 (22.2) | 82.4 (22.2) |
Male sex | 352 (64.0) | 351 (63.0) |
Pre-existing conditions | ||
Heart failure | 52 (9.5) | 44 (7.9) |
Hypertension | 304 (55.3) | 306 (54.9) |
Diabetes mellitus | 92 (16.7) | 112 (20.1) |
Cirrhosis | 54 (9.8) | 54 (9.7) |
Respiratory disease | 54 (9.8) | 62 (11.1) |
Cancer | 100 (18.2) | 91 (16.3) |
Hemopathy | 27 (4.9) | 34 (6.1) |
AIDS | 2 (0.4) | 5 (0.9) |
Non-corticosteroid immunosuppressive drug | 36 (6.5) | 32 (5.7) |
Organ graft | 17 (3.1) | 5 (0.9) |
Severity at enrollment | ||
SOFA score (0 to 24) | 11.5 (3.1) | 11.4 (3.2) |
Respiratory SOFA (0 to 4) | 2.1 (1.1) | 1.9 (1.1) |
Hemodynamic SOFA (0 to 4) | 3.5 (1.2) | 3.5 (1.2) |
Liver SOFA (0 to 4) | 0.8 (1.1) | 0.8 (1.1) |
Coagulation SOFA (0 to 4) | 2.1 (1.6) | 2.2 (1.6) |
Neurologic SOFA (0 to 4) | 1.3 (1.5) | 1.2 (1.5) |
Laboratory values | ||
Baseline creatinine (IQR), μmol/L* | 88 (71–97) | 84 (71–97) |
Creatinine at enrollment (IQR), μmol/L | 268 (211–343) | 267 (198–352) |
Blood urea nitrogen at enrollment (IQR), mmol/L | 19 (14–26) | 19 (13–26) |
Potassium at enrollment, mmol/L | 4.4 (0.8) | 4.4 (0.8) |
Bicarbonate at enrollment, mmol/L | 18 (5) | 18 (5) |
Arterial blood pH at enrollment | 7.30 (0.10) | 7.30 (0.10) |
Risk categorization
Results
Prediction model for RRT initiation
Variable | Univariable analysis | Full model | Final model | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
OR | (95% CI) | P | OR | (95% CI) | P | OR | (95% CI) | P | ||||
Age (year) | 0.993 | 0.979 | 1.008 | 0.361 | 1.004 | 0.986 | 1.022 | 0.694 | – | – | – | – |
Sex (male vs female) | 1.257 | 0.834 | 1.894 | 0.276 | 1.188 | 0.755 | 1.868 | 0.456 | – | – | – | – |
Potassium at enrollment (mmol/L) | 1.728 | 1.343 | 2.224 | < .001 | 1.381 | 1.048 | 1.821 | 0.022 | 1.391 | 1.057 | 1.831 | 0.019 |
Creatinine at enrollment over creatinine at baseline (unitless) | 1.181 | 1.058 | 1.318 | 0.003 | 1.068 | 0.931 | 1.225 | 0.350 | – | – | – | – |
Urine output (< 200 ml/day vs > = 200 ml/day) | 1.792 | 1.183 | 2.714 | 0.006 | 1.129 | 0.699 | 1.823 | 0.621 | – | – | – | – |
SOFA at enrollment (unitless) | 1.151 | 1.079 | 1.227 | < .001 | 1.123 | 1.041 | 1.210 | 0.003 | 1.139 | 1.063 | 1.221 | < .001 |
Weight at enrollment (kg) | 1.012 | 1.003 | 1.021 | 0.006 | 1.013 | 1.003 | 1.023 | 0.010 | 1.013 | 1.004 | 1.022 | 0.007 |
Heart failure (yes vs no) | 0.792 | 0.395 | 1.588 | 0.512 | 0.845 | 0.399 | 1.788 | 0.659 | – | – | – | – |
Hypertension (yes vs no) | 0.831 | 0.564 | 1.224 | 0.350 | 0.847 | 0.541 | 1.326 | 0.468 | – | – | – | – |
Diabetes mellitus (yes vs no) | 1.153 | 0.695 | 1.913 | 0.582 | 0.985 | 0.558 | 1.741 | 0.960 | – | – | – | – |
Cirrhosis (yes vs no) | 1.179 | 0.628 | 2.213 | 0.608 | 1.135 | 0.549 | 2.346 | 0.733 | – | – | – | – |
Non-corticosteroid immunosuppressive drug (yes vs no) | 2.023 | 1.005 | 4.074 | 0.049 | 1.971 | 0.928 | 4.185 | 0.078 | 1.973 | 0.936 | 4.159 | 0.075 |
Blood urea nitrogen at enrollment (mmol/L) | 1.029 | 1.009 | 1.050 | 0.004 | 1.022 | 0.998 | 1.047 | 0.076 | 1.026 | 1.004 | 1.048 | 0.021 |
pH at enrollment (OR for an increase of 0.01) | 0.945 | 0.925 | 0.966 | < .001 | 0.954 | 0.932 | 0.978 | < .001 | 0.954 | 0.932 | 0.977 | < .001 |