A unique study on AKI mortality

A group of Danish doctors have published a unique Study on AKI. Denmark has (along with other Scandinavian countries) a truly remarkable public hospital system, where all ICU are at the public hospitals, that and the fact that all danish nationals have a cpr-number – a 10 digitcode unique to each individual consisting 6 numbers – namely of the day, month and year of your birth and a four digits identifying your sex (even numbers female uneven male) provides the danish researchers with statistical options that other regions/countries can only dream about. That, in combination with a pretty homogenous  population (a crosscut of each region is pretty similar to the other regions) gives ideal ground for a “true and balanced” Study.

The data obtained in the Study was based on  30,762 adults admitted to an ICU in Northern Denmark (who has approx 1,5 million inhabitants) during the six-year observation period from 2005 to 2011, after excluding 192 (0.6%) patients receiving chronic dialysis or with a previous kidney transplant, and 1,578 (4.9%) patients lacking information on plasma creatinine level at ICU admission. Patients without a creatinine measurement were younger and had less preexisting comorbidity and shorter hospital stays compared with patients with a creatinine measurement. Total time of follow up were 23,850 person years

The study is a retrospective study based on available info , and is therefor not including novel Biomarkers such as NGAL – but uses the hitherto accepted standard of SerumCreatinine.

Those who had/developped AKI had a high mortality rate . The one-year mortality was 48.7% (95% CI: 46.5-50.9%) for the “AKI-Risk” group, 57.4% (95% CI: 54.8-60.1%) for the “AKI-Injury” group and 54.7% (95% CI: 52.1-57.2%) for the “AKI-Failure” group, compared with 22.1% (95% CI: 21.6-22.7) for the patients without AKI

how do these numbers translate into plain english, well the key messages are:

The increased risk of death in patients with AKI at ICU admission is evident throughout the first year after ICU admission. The association is evident regardless of age, CKD, preexisting comorbidity, diagnostic category, and surgical status.

The relative 30-day mortality is highest in younger age groups, elective surgical ICU patients, and acute cardiac surgical ICU patients.

http://ccforum.com/content/pdf/cc11420.pdf