title: Prognostic robustness of serum creatinine based AKI definitions in patients with sepsis: a prospective cohort study.
abstract: BACKGROUND
  It is unclear how modifications in the way to calculate serum creatinine (sCr) increase and in the cut-off value applied, influences the prognostic value of Acute Kidney Injury (AKI). We wanted to evaluate whether these modifications alter the prognostic value of AKI for prediction of mortality at 3 months, 1 and 2 years.
  
  
  METHODS
  We prospectively included 195 septic patients and evaluated the prognostic value of AKI by using three different algorithms to calculate sCr increase: either as the difference between the highest value in the first 24 h after ICU admission and a pre-admission historical (ΔHIS) or an estimated (ΔEST) baseline value, or by subtracting the ICU admission value from the sCr value 24 h after ICU admission (ΔADM). Different cut-off levels of sCr increase (0.1, 0.2, 0.3, 0.4 and 0.5 mg/dl) were evaluated.
  
  
  RESULTS
  Mortality at 3 months, 1 and 2 years in AKI defined as ΔADM > 0.3 mg/dl was 48.1 %, 63.0 % and 63.0 % vs 27.7 %, 39.8 % and 47.6 % in no AKI respectively (OR(95%CI): 2.42(1.06-5.54), 2.58(1.11-5.97) and 1.87(0.81-4.33); 0.3 mg/dl was the lowest cut-off value that was discriminatory. When AKI was defined as ΔHIS > 0.3 mg/dl or ΔEST > 0.3 mg/dl, there was no significant difference in mortality between AKI and no AKI.
  
  
  CONCLUSIONS
  The prognostic value of a 0.3 mg/dl increase in sCr, on mortality in sepsis, depends on how this sCr increase is calculated. Only if the evolution of serum creatinine over the first 24 h after ICU admission is taken into account, an association with mortality is found.
authors.affiliation: Renal Division, Ghent University Hospital, Nephrology section, 0 K12, University Hospital, De Pintelaan 185, B9000, Ghent, Belgium. Jill.Vanmassenhove@ugent.be.
authors.forename: Jill
authors.initials: J
authors.lastname: Vanmassenhove
authors.affiliation: Renal Division, Ghent University Hospital, Nephrology section, 0 K12, University Hospital, De Pintelaan 185, B9000, Ghent, Belgium. Norbert.Lameire@ugent.be.
authors.forename: Norbert
authors.initials: N
authors.lastname: Lameire
authors.affiliation: Renal Division, Ghent University Hospital, Nephrology section, 0 K12, University Hospital, De Pintelaan 185, B9000, Ghent, Belgium. Annemie.Dhondt@ugent.be.
authors.forename: Annemieke
authors.initials: A
authors.lastname: Dhondt
authors.affiliation: Renal Division, Ghent University Hospital, Nephrology section, 0 K12, University Hospital, De Pintelaan 185, B9000, Ghent, Belgium. Raymond.Vanholder@ugent.be.
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
authors.affiliation: Renal Division, Ghent University Hospital, Nephrology section, 0 K12, University Hospital, De Pintelaan 185, B9000, Ghent, Belgium. wim.vanbiesen@ugent.be.
authors.forename: Wim
authors.initials: W
authors.lastname: Van Biesen
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000150:complications; D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D003404:Creatinine / Q000097:blood*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood* / Q000150:complications / Q000401:mortality*; D015996:Survival Rate
chemical_list: D003404:Creatinine