title: Severity of acute kidney injury and two-year outcomes in critically ill patients.
abstract: BACKGROUND
  The association between levels of acute kidney injury (AKI) during ICU admission and long-term mortality are not well defined.
  
  
  METHODS
  We examined medical records of adult patients admitted to a large tertiary medical center with no history of end-stage renal disease who survived 60 days from ICU admission between 2001 and 2007. Demographic, clinical, physiologic, and date of death data were extracted.
  
  
  RESULTS
  Among 15,048 patients, 12,399 (82.4%) survived 60 days from ICU admission and comprised the study population. AKI did not develop in 5,663 (45.7%) during ICU admission, whereas progressively severe levels of AKI as defined by Acute Kidney Injury Network (AKIN) criteria AKIN 1, AKIN 2, and AKIN 3 developed in 4,589 (37.0%), 1,613 (13.0%), and 534 (4.3%), respectively. Only 42.5% of patients with AKIN 3 survived 2 years from ICU admission. Patients with AKIN 3 had a 61% higher mortality risk 2 years from ICU discharge compared with patients in whom AKI did not develop. Patients with AKIN 1 and AKIN 2 had similar increased mortality risk 2 years from ICU admission (hazard ratio, 1.26 and 1.28, respectively). The level of estimated glomerular filtration rate on ICU discharge and chronic kidney disease were associated with long-term mortality.
  
  
  CONCLUSIONS
  Patients in whom AKI develops during ICU admission have significantly increased risks of death that extend beyond their high ICU mortality rates. These increased risks of death continue for at least 2 years after the index ICU admission.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. Electronic address: liorfuchs@gmail.com.
authors.forename: Lior
authors.initials: L
authors.lastname: Fuchs
authors.affiliation: Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA; School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Joon
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Victor
authors.initials: V
authors.lastname: Novack
authors.affiliation: Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Baumfeld
authors.affiliation: Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Scott
authors.affiliation: Department of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA.
authors.forename: Leo
authors.initials: L
authors.lastname: Celi
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: Tal
authors.initials: T
authors.lastname: Mandelbaum
authors.affiliation: Department of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Howell
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Talmor
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult