Comparison of impact on death and critical care admission of acute kidney injury between common medical and surgical diagnoses

Abstract

Background: Acute Kidney Injury (AKI) is common and associated with increased morbidity and mortality. This retrospective analysis quantified and compared the association between AKI and the risk of death and admission to critical care in acute admissions of different aetiology.

Methods: Data were extracted anonymously from the Trust 'data warehouse' for admissions between 2011and 2017. We applied KDIGO AKI criteria to establish AKI stage. Odds ratios (OR) for death and critical care admission were calculated for patients with AKI stage 3 (compared to all other patients), and patients with any stage AKI (compared to non-AKI admissions). Analyses were performed using logistic regression, adjusted for age, pre-existing CKD, co-morbid index, and gender.

Results: There were 26,052 medical and 12,560 surgical patient episodes within sixteen common diagnoses with 3823 medical and 1520 surgical patients with AKI events. The likelihood of AKI was highest in sepsis (31.8%), and the likelihood of death in AKI 3 highest in femoral neck fracture (54.5%). AKI 3 has a OR for death for acute coronary syndrome of 12.8 and a OR of 24.6 in femoral neck fracture. Admission to critical care for any AKI in medical patients has a OR of 9.6, but increases to OR 37.2 for heart failure.

Conclusion: The clinical impact of AKI differs across medical and surgical diagnoses, but is a significant contributor to the risk for death and critical care admission. This body of work may indicate a benefit to a more diagnosis-specific stratified approach to AKI care.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Percentage of patients with any acute kidney injury (AKI) or AKI 3 in each medical diagnosis, ordered by increasing frequency of AKI.

Figure key: HF–heart failure, ACS–acute coronary syndrome, CAP–community acquired pneumonia, COPD–chronic obstructive pulmonary disease, UTI–urinary tract infection, ALD–alcoholic liver disease, GIB–gastro-intestinal bleed, sepsis–sepsis (any source). % pts with AKI = percentage of patients with each diagnosis with AKI or AKI 3.

Fig 2. Percentage of patients with any acute kidney injury (AKI) or AKI 3 in each surgical diagnosis, ordered by increasing frequency of AKI.

Figure key: Chole—Cholecystitis/cholangitis, TICB—Traumatic Intra Cranial Bleed, NTICB- Non-Traumatic Intra Cranial Bleed, abscess–abscess (any source), Panc—acute pancreatitis, appendix—acute appendicitis, ENT (ear, nose and throat)–ENT (any source), NOF—Fractured (neck of femur) NOF. % pts with AKI = percentage of patients with each diagnosis with AKI or AKI 3.