title: Variation in risk and mortality of acute kidney injury in critically ill patients: a multicenter study.
abstract: BACKGROUND
  Despite standardized definitions of acute kidney injury (AKI), there is wide variation in the reported rates of AKI and hospital mortality for patients with AKI. Variation could be due to actual differences in disease incidence, clinical course, or a function of data ascertainment and application of diagnostic criteria. Using standard criteria may help determine and compare the risk and outcomes of AKI across centers.
  
  
  METHODS
  In this cohort study of critically ill patients admitted to the intensive care units at six hospitals in four countries, we used KDIGO criteria to define AKI. The main outcomes were the occurrence of AKI and hospital mortality.
  
  
  RESULTS
  Of the 15,132 critically ill patients, 32% developed AKI based on serum creatinine criteria. After adjusting for differences in age, sex, and severity of illness, the odds ratio for AKI continued to vary across centers (odds ratio (OR), 2.57-6.04, p < 0.001). The overall, crude hospital mortality of patients with AKI was 27%, which also varied across centers after adjusting for KDIGO stage, differences in age, sex, and severity of illness (OR, 1.13-2.20, p < 0.001). The severity of AKI was associated with incremental mortality risk across centers.
  
  
  CONCLUSIONS
  In this study, the absolute and severity-adjusted rates of AKI and hospital mortality rates for AKI varied across centers. Future studies should examine whether variation in the risk of AKI among centers is due to differences in clinical practice or process of care or residual confounding due to unmeasured factors.
authors: The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa., USA.
authors: Nattachai
authors: N
authors: Srisawat
authors: Florentina E
authors: FE
authors: Sileanu
authors: Raghavan
authors: R
authors: Murugan
authors: Rinaldo
authors: R
authors: Bellomod
authors: Paolo
authors: P
authors: Calzavacca
authors: Rodrigo
authors: R
authors: Cartin-Ceba
authors: Dinna
authors: D
authors: Cruz
authors: Judith
authors: J
authors: Finn
authors: Eric E J
authors: EE
authors: Hoste
authors: Kianoush
authors: K
authors: Kashani
authors: Claudio
authors: C
authors: Ronco
authors: Steve
authors: S
authors: Webb
authors: John A
authors: JA
authors: Kellum
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D000368:Aged; D001315:Australia / Q000453:epidemiology; D003404:Creatinine / Q000097:blood; D016638:Critical Illness; D005060:Europe / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D016017:Odds Ratio; D011446:Prospective Studies; D012720:Severity of Illness Index; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014556:Urine
chemical_list: D003404:Creatinine