title: Serum Creatinine Trajectories for Community- versus Hospital-Acquired Acute Kidney Injury.
abstract: BACKGROUND
  Patterns of acute kidney injury (AKI) can be distinguished by the rate of changes in the serum creation concentrations during hospitalizations. We hypothesized that the timing and values of minimum and maximum serum creatinine (sCr) could be used to distinguish between transient hospital-associated AKI (THA-AKI) and hospital-acquired AKI (HA-AKI).
  
  
  METHODS
  We evaluated adults admitted to 2 regionally distinct academic medical centers. Peak sCr during the hospitalization was used to define AKI, using absolute changes and timing from the minimum sCr. sCr trajectories were derived based on the rate of change between the minimum and peak creatinine concentrations.
  
  
  RESULTS
  Peak creatinine followed the minimum creatinine for HA-AKI, while the peak creatinine preceded the minimum creatinine for THA-AKI. There were 82,403 patients included in the analyses, and 53,882 (65%) did not have AKI during the index hospitalization. There were 2,611 inpatient deaths; HA-AKI had a 4.8-fold increased risk relative to those without AKI (p < 0.01), and transient AKI had a 1.6-fold increased risk for inpatient mortality relative to inpatients without AKI (p < 0.01).
  
  
  CONCLUSIONS
  Patients with hospital-associated AKI are at an increased risk for inpatient mortality. Creatinine trajectories can be used to describe the rate of development as well as recovery from inpatient AKI. The 24- and 48-hour interval slopes may be early indicators of developing AKI. © 2016 S. Karger AG, Basel.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala., USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Warnock
authors.forename: T Clark
authors.initials: TC
authors.lastname: Powell
authors.forename: Edward D
authors.initials: ED
authors.lastname: Siew
authors.forename: John P
authors.initials: JP
authors.lastname: Donnelly
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
authors.forename: Ravindra L
authors.initials: RL
authors.lastname: Mehta
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood*; D000328:Adult; D000368:Aged; D017714:Community-Acquired Infections / Q000097:blood*; D003404:Creatinine / Q000097:blood*; D003428:Cross Infection / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D003404:Creatinine