title: Acute Kidney Injury as a Risk Factor for Delirium and Coma during Critical Illness.
abstract: Acute kidney injury may contribute to distant organ dysfunction. Few studies have examined kidney injury as a risk factor for delirium and coma.
  
  
  
  To examine whether acute kidney injury is associated with delirium and coma in critically ill adults.
  
  
  
  In a prospective cohort study of intensive care unit patients with respiratory failure and/or shock, we examined the association between acute kidney injury and daily mental status using multinomial transition models adjusting for demographics, nonrenal organ failure, sepsis, prior mental status, and sedative exposure. Acute kidney injury was characterized daily using the difference between baseline and peak serum creatinine and staged according to Kidney Disease Improving Global Outcomes criteria. Mental status (normal vs. delirium vs. coma) was assessed daily with the Confusion Assessment Method for the ICU and Richmond Agitation-Sedation Scale.
  
  
  
  Among 466 patients, stage 2 acute kidney injury was a risk factor for delirium (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.07-2.26) and coma (OR, 2.04; 95% CI, 1.25-3.34) as was stage 3 injury (OR for delirium, 2.56; 95% CI, 1.57-4.16) (OR for coma, 3.34; 95% CI, 1.85-6.03). Daily peak serum creatinine (adjusted for baseline) values were also associated with delirium (OR, 1.35; 95% CI, 1.18-1.55) and coma (OR, 1.44; 95% CI, 1.20-1.74). Renal replacement therapy modified the association between stage 3 acute kidney injury and daily peak serum creatinine and both delirium and coma.
  
  
  
  Acute kidney injury is a risk factor for delirium and coma during critical illness.
authors.affiliation: 1 Division of Nephrology and Hypertension and.|2 Department of Medicine.|3 Vanderbilt Center for Kidney Disease.|4 Geriatric Research, Education and Clinical Center Service.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Siew
authors.affiliation: 1 Division of Nephrology and Hypertension and.|2 Department of Medicine.
authors.forename: William H
authors.initials: WH
authors.lastname: Fissell
authors.affiliation: 5 Department of Biostatistics.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Tripp
authors.affiliation: 5 Department of Biostatistics.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Blume
authors.affiliation: 2 Department of Medicine.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Wilson
authors.affiliation: 6 Department of Pediatrics.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Clark
authors.affiliation: 1 Division of Nephrology and Hypertension and.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Vincz
authors.affiliation: 7 Division of Allergy, Pulmonary, and Critical Care Medicine.|2 Department of Medicine.|8 Center for Health Services Research, and.|4 Geriatric Research, Education and Clinical Center Service.|9 Medical Service, and.
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.affiliation: 10 Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.|11 Anesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee; and.
authors.forename: Pratik P
authors.initials: PP
authors.lastname: Pandharipande
authors.affiliation: 12 Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Timothy D
authors.identifier: 0000-0002-9833-4871
authors.initials: TD
authors.lastname: Girard
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology*; D000368:Aged; D015984:Causality; D015331:Cohort Studies; D003128:Coma / Q000097:blood / Q000453:epidemiology*; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D016638:Critical Illness / Q000453:epidemiology; D003693:Delirium / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000097:blood / Q000453:epidemiology; D012307:Risk Factors; D012769:Shock / Q000097:blood / Q000453:epidemiology
chemical_list: D003404:Creatinine
keywords: acute kidney injury; coma; critical illness; delirium