title: Predicting one-year mortality of critically ill patients with early acute kidney injury: data from the prospective multicenter FINNAKI study.
abstract: BACKGROUND
  No predictive models for long-term mortality in critically ill patients with acute kidney injury (AKI) exist. We aimed to develop and validate two predictive models for one-year mortality in patients with AKI based on data (1) on intensive care unit (ICU) admission and (2) on the third day (D3) in the ICU.
  
  
  METHODS
  This substudy of the FINNAKI study comprised 774 patients with early AKI (diagnosed within 24 hours of ICU admission). We selected predictors a priori based on previous studies, clinical judgment, and differences between one-year survivors and non-survivors in patients with AKI. We validated the models internally with bootstrapping.
  
  
  RESULTS
  Of 774 patients, 308 (39.8%, 95% confidence interval (CI) 36.3 to 43.3) died during one year. Predictors of one-year mortality on admission were: advanced age, diminished premorbid functional performance, co-morbidities, emergency admission, and resuscitation or hypotension preceding ICU admission. The area under the receiver operating characteristic curve (AUC) (95% CI) for the admission model was 0.76 (0.72 to 0.79) and the mean bootstrap-adjusted AUC 0.75 (0.74 to 0.75). Advanced age, need for mechanical ventilation on D3, number of co-morbidities, higher modified SAPS II score, the highest bilirubin value by D3, and the lowest base excess value on D3 remained predictors of one-year mortality on D3. The AUC (95% CI) for the D3 model was 0.80 (0.75 to 0.85) and by bootstrapping 0.79 (0.77 to 0.80).
  
  
  CONCLUSIONS
  The prognostic performance of the admission data-based model was acceptable, but not good. The D3 model for one-year mortality performed fairly well in patients with early AKI.
authors.affiliation: Department of Anaesthesia and Intensive Care, Lapland Central Hospital, PL 8041, Ounasrinteentie 22, Rovaniemi, 96 101, Finland. meri.poukkanen@lshp.fi.
authors.forename: Meri
authors.initials: M
authors.lastname: Poukkanen
authors.affiliation: Intensive Care Units, Division of Anaesthesia and Intensive Care Medicine, Department of Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki, 00 029, Finland. suvi.vaara@hus.fi.|Department of Anaesthesiology and Intensive Care, North Karelia Central Hospital, Tikkamäentie 16, Joensuu, 80 210, Finland. suvi.vaara@hus.fi.
authors.forename: Suvi T
authors.initials: ST
authors.lastname: Vaara
authors.affiliation: Department of Anaesthesiology and Intensive Care, North Karelia Central Hospital, Tikkamäentie 16, Joensuu, 80 210, Finland. matti.reinikainen@pkssk.fi.
authors.forename: Matti
authors.initials: M
authors.lastname: Reinikainen
authors.affiliation: Science Service Center, Kuopio University Hospital and Kuopio University, Puijonlaaksontie 2, Kuopio, 70 210, Finland. tuomas.selander@kuh.fi.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Selander
authors.affiliation: Intensive Care Units, Division of Anaesthesia and Intensive Care Medicine, Department of Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki, 00 029, Finland. sara.nisula@hus.fi.
authors.forename: Sara
authors.initials: S
authors.lastname: Nisula
authors.affiliation: Department of Intensive Care Medicine, Tampere University Hospital, PL 2000, Tampere, 33 521, Finland. sari.karlsson@pshp.fi.
authors.forename: Sari
authors.initials: S
authors.lastname: Karlsson
authors.affiliation: Department of Intensive Care, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 70 210, Finland. ilkka.parviainen@kuh.fi.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Parviainen
authors.affiliation: Department of Anaesthesiology, Division of Intensive Care, Oulu University Hospital and Medical Research Center Oulu, Kajaanintie 50, Oulu, 90 220, Finland. juha.koskenkari@ppshp.fi.
authors.forename: Juha
authors.initials: J
authors.lastname: Koskenkari
authors.affiliation: Intensive Care Units, Division of Anaesthesia and Intensive Care Medicine, Department of Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki, 00 029, Finland. ville.pettila@hus.fi.
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy; D000368:Aged; D016638:Critical Illness; D005260:Female; D005387:Finland; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012121:Respiration, Artificial / Q000379:methods; D012720:Severity of Illness Index