The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care units
Abstract Background Sepsis has high incidence and fatality rates in intensive care units, often leading to renal failure. The effectiveness of continuous renal replacement therapy (CRRT) in sepsis-associated acute kidney injury (S-AKI) patients is currently uncertain. Aim Joint model was used to det...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-02-01
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| Series: | BMC Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12873-022-00589-6 |
| _version_ | 1818920603026980864 |
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| author | Zichen Wang Luming Zhang Fengshuo Xu Didi Han Jun Lyu |
| author_facet | Zichen Wang Luming Zhang Fengshuo Xu Didi Han Jun Lyu |
| author_sort | Zichen Wang |
| collection | DOAJ |
| description | Abstract Background Sepsis has high incidence and fatality rates in intensive care units, often leading to renal failure. The effectiveness of continuous renal replacement therapy (CRRT) in sepsis-associated acute kidney injury (S-AKI) patients is currently uncertain. Aim Joint model was used to determine the association between CRRT and the lactate trajectory trend and how it correlated to 28-day mortality for S-AKI patient in ICU. Methods A retrospective study was applied to patients with sepsis and AKI, which were extracted from the MIMIC-III public database, with the endpoint being 28-day mortality. Every lactate level measurement within 28 days was observed and calculated using logarithms. Joint model combined the longitudinal analysis of the natural logarithm of the lactate level [log(lactate)] in longitudinal submodel and Cox regression by trajectory function, demonstrating the effects of CRRT on 28-day survival and log(lactate) changes, and its final relationship with the event status. Results Among the 717 S-AKI patients, 157 received CRRT. CRRT was not associated with 28-day mortality. After adjustments, the relationship between CRRT use and log(lactate) elevation was statistically significant. The parameter estimation of CRRT and log(lactate) indicated that using CRRT will increase log(lactate) by 0.041 in S-AKI patients. The joint model also instigated a fixed association between changes in the lactate level and the event result, revealing an exp value of (0.755) = 2.12, indicating that an increase of one unit in log(lactate) will increase the risk of 28-day mortality 2.12-times. Conclusion There was no significant association between CRRT use and 28-day survival in S-AKI patients, and JM showed that CRRT use might be associated with elevation of longitudinal lactate levels. Therefore, additional attention should be paid to other treatments to control lactate levels when providing renal support for patients with S-AKI. |
| first_indexed | 2024-12-20T01:24:22Z |
| format | Article |
| id | doaj.art-2155d4ec28994fe7a9f9dea5273ea0d3 |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-12-20T01:24:22Z |
| publishDate | 2022-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-2155d4ec28994fe7a9f9dea5273ea0d32022-12-21T19:58:17ZengBMCBMC Emergency Medicine1471-227X2022-02-012211710.1186/s12873-022-00589-6The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care unitsZichen Wang0Luming Zhang1Fengshuo Xu2Didi Han3Jun Lyu4Department of Intensive Care Unit, The First Affiliated Hospital of Jinan UniversityDepartment of Intensive Care Unit, The First Affiliated Hospital of Jinan UniversityDepartment of Clinical Research, The First Affiliated Hospital of Jinan UniversityDepartment of Clinical Research, The First Affiliated Hospital of Jinan UniversityDepartment of Clinical Research, The First Affiliated Hospital of Jinan UniversityAbstract Background Sepsis has high incidence and fatality rates in intensive care units, often leading to renal failure. The effectiveness of continuous renal replacement therapy (CRRT) in sepsis-associated acute kidney injury (S-AKI) patients is currently uncertain. Aim Joint model was used to determine the association between CRRT and the lactate trajectory trend and how it correlated to 28-day mortality for S-AKI patient in ICU. Methods A retrospective study was applied to patients with sepsis and AKI, which were extracted from the MIMIC-III public database, with the endpoint being 28-day mortality. Every lactate level measurement within 28 days was observed and calculated using logarithms. Joint model combined the longitudinal analysis of the natural logarithm of the lactate level [log(lactate)] in longitudinal submodel and Cox regression by trajectory function, demonstrating the effects of CRRT on 28-day survival and log(lactate) changes, and its final relationship with the event status. Results Among the 717 S-AKI patients, 157 received CRRT. CRRT was not associated with 28-day mortality. After adjustments, the relationship between CRRT use and log(lactate) elevation was statistically significant. The parameter estimation of CRRT and log(lactate) indicated that using CRRT will increase log(lactate) by 0.041 in S-AKI patients. The joint model also instigated a fixed association between changes in the lactate level and the event result, revealing an exp value of (0.755) = 2.12, indicating that an increase of one unit in log(lactate) will increase the risk of 28-day mortality 2.12-times. Conclusion There was no significant association between CRRT use and 28-day survival in S-AKI patients, and JM showed that CRRT use might be associated with elevation of longitudinal lactate levels. Therefore, additional attention should be paid to other treatments to control lactate levels when providing renal support for patients with S-AKI.https://doi.org/10.1186/s12873-022-00589-6Continuous renal replacement therapySepsisAcute kidney injuryLactateJoint model |
| spellingShingle | Zichen Wang Luming Zhang Fengshuo Xu Didi Han Jun Lyu The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care units BMC Emergency Medicine Continuous renal replacement therapy Sepsis Acute kidney injury Lactate Joint model |
| title | The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care units |
| title_full | The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care units |
| title_fullStr | The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care units |
| title_full_unstemmed | The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care units |
| title_short | The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care units |
| title_sort | association between continuous renal replacement therapy as treatment for sepsis associated acute kidney injury and trend of lactate trajectory as risk factor of 28 day mortality in intensive care units |
| topic | Continuous renal replacement therapy Sepsis Acute kidney injury Lactate Joint model |
| url | https://doi.org/10.1186/s12873-022-00589-6 |
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