Acute Kidney Injury and Subsequent Frailty Status in Survivors of Critical Illness: A Secondary Analysis.
Acute Kidney Injury and Subsequent Frailty Status in Survivors of Critical Illness: A Secondary Analysis.
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DOI：
10.1097/ccm.0000000000003003
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发表时间：
2018-05
影响因子：
8.8
通讯作者：
Siew ED
中科院分区：
文献类型：
--
作者：
Abdel-Kader K;Girard TD;Brummel NE;Saunders CT;Blume JD;Clark AJ;Vincz AJ;Ely EW;Jackson JC;Bell SP;Archer KR;Ikizler TA;Pandharipande PP;Siew ED
Acute kidney injury (AKI) frequently complicates critical illness and is associated with high morbidity and mortality. Frailty is common in critical illness survivors, but little is known about the impact of AKI. We examined the association of AKI and frailty within a year of hospital discharge in survivors of critical illness. Secondary analysis of a prospective cohort study Medical/surgical ICU of a US tertiary care medical center 317 participants with respiratory failure and/or shock None AKI was determined using Kidney Disease Improving Global Outcomes stages. Clinical frailty status was determined using the Clinical Frailty Scale (CFS) at 3 and 12 months following discharge. Covariates included mean ICU sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation II (APACHE II) score as well as baseline comorbidity (i.e., Charlson Comorbidity Index), kidney function, and CFS score. Of 317 patients, 243 (77%) had AKI and 1 in 4 patients with AKI were frail at baseline. In adjusted models, AKI stages 1, 2, and 3 were associated with higher frailty scores at 3 months (OR 1.92, 95% CI 1.14, 3.24; OR 2.40, 95% CI 1.31, 4.42; OR 4.41, 95% CI 2.20, 8.82; respectively). At 12 months, a similar association of AKI stages 1, 2, and 3 and higher CFS score was noted (OR 1.87, 95% CI 1.11, 3.14; OR 1.81, 95% CI 0.94, 3.48; OR 2.76, 95% CI 1.34, 5.66; respectively). In supplemental and sensitivity analyses, analogous patterns of association were observed. AKI in survivors of critical illness predicted worse frailty status 3 and 12 months post-discharge. These findings have important implications on clinical decision making among AKI survivors and underscore the need to understand the drivers of frailty to improve patient-centered outcomes.
