title: Transient and Persistent Acute Kidney Injury and the Risk of Hospital Mortality in Critically Ill Patients: Results of a Multicenter Cohort Study.
abstract: OBJECTIVE
  To assess the prognostic impact of transient and persistent acute kidney injury in critically ill patients.
  
  
  METHODS
  Retrospective analysis of prospectively collected patient data
  
  
  METHODS
  : Six hospital ICUs.
  
  
  METHODS
  Critically-ill patients with ICU stay longer than three days.
  
  
  METHODS
  None.
  
  
  RESULTS
  Assessment of hospital survival with respect to acute kidney injury duration. A total of 447 patients were included in this study, including 283 patients (63.3%) with an acute kidney injury at admission (175 and 108 patients with persistent and transient acute kidney injury, respectively). Patients with persistent acute kidney injury more frequently had stage 3 acute kidney injury (42.9% vs 30.6%; p = 0.04). Hospital survival was 76.2% (n = 125) in patients without acute kidney injury, 70.4% (n = 76) in patients with transient acute kidney injury, and 61.1% (n = 107) in patients with persistent acute kidney injury. After adjustment for confounding factors, the factors associated with lower hospital survival were the need for vasopressors (odds ratio, 0.65; 95% CI, 0.43-0.98) and the presence of persistent acute kidney injury (odds ratio, 0.58; 95% CI, 0.36-0.95). When included in the final model, stage 3 acute kidney injury was independently associated with a lower hospital survival (odds ratio, 0.83; 95% CI, 0.70-0.98), and persistent acute kidney injury was no longer associated with outcome.
  
  
  CONCLUSIONS
  Two thirds of the critically ill patients with acute kidney injury have persistent acute kidney injury. Although mortality increased progressively with the duration of acute kidney injury, we found no independent association between this duration and patient outcome when the acute kidney injury severity is taken into account. Our results suggest that the classical "prerenal acute kidney injury" and "acute tubular necrosis" paradigm might be of limited interest from a pathophysiological or prognostic point of view.
authors.affiliation: 1Medical-Surgical Intensive Care Unit, Saint-Etienne University Hospital, Jean Monnet University, Saint-Etienne, France. 2Medical-Surgical Intensive Care Unit, Le Raincy-Montfermeil Hospital, Montfermeil, France. 3Medical ICU, Clermont-Ferrand University Hospital, Clermont-Ferrand, France. 4UFR de Médecine, Clermont-Ferrand University, Clermont-Ferrand, France. 5Medical Intensive Care Unit, Archet University Hospital, Nice, France. 6UFR de Médecine, Nice University, Nice, France. 7Nephrology, Dialysis and Renal Transplantation, Saint-Etienne University Hospital, Jean Monnet University, Saint-Etienne, France. 8Thrombosis Research Group, EA 3065, Saint-Etienne University Hospital and Saint-Etienne Medical School, Saint-Etienne, France. 9Department of Emergency Medicine, Saint-Etienne University Hospital, Jean Monnet University, Saint-Etienne, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Perinel
authors.forename: François
authors.initials: F
authors.lastname: Vincent
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lautrette
authors.forename: Jean
authors.initials: J
authors.lastname: Dellamonica
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariat
authors.forename: Fabrice
authors.initials: F
authors.lastname: Zeni
authors.forename: Yves
authors.initials: Y
authors.lastname: Cohen
authors.forename: Bernard
authors.initials: B
authors.lastname: Tardy
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy; D000368:Aged; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017582:Renal Replacement Therapy / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents