Article Figures & Data
Figures
- Figure 1.
Rates of dialysis, death, and the combined endpoint in the full cohort (n=6119). Patients initiated on dialysis are considered to be AKIN stage 3 at initiation. Patient-days are analyzed distinctly, allowing patients to contribute to multiple AKIN stages. AKIN, Acute Kidney Injury Network.
Tables
- Table 1.
Baseline characteristics and unadjusted analyses of patients in the derivation and validation cohorts
Characteristic Derivation Cohort HUP (n=4263) Validation PAH (n=758) Validation PMC (n=1098) P Value HUP versus PAH HUP versus PMC Male sex 2366 (55.5) 332 (43.8) 561 (51.1) <0.001 0.01 Black 1011 (23.7) 238 (31.4) 445 (40.5) <0.001 <0.001 Surgical service 2355 (55.2) 278 (36.7) 217 (19.8) <0.001 <0.001 HIV/AIDS 63 (1.5) 33 (4.4) 46 (4.2) <0.001 <0.001 Malignancy 408 (9.6) 144 (19.0) 135 (12.3) <0.001 0.01 Congestive heart failure 1478 (34.7) 239 (31.5) 501 (45.6) 0.09 <0.001 Cardiovascular disease 433 (10.2) 49 (6.5) 121 (11.0) 0.001 0.40 Dementia 22 (0.5) 7 (0.9) 31 (2.8) 0.17 <0.001 Diabetes mellitus 1037 (24.3) 227 (29.9) 388 (35.3) 0.001 <0.001 Hemiplegia 1112 (2.6) 19 (2.5) 22 (2.0) 0.84 0.24 Metastatic solid tumor 399 (9.4) 89 (11.7) 65 (5.9) 0.04 <0.001 Myocardial infarction 538 (12.6) 109 (14.4) 219 (19.9) 0.18 <0.001 Liver disease 847 (19.9) 102 (13.5) 140 (12.8) <0.001 <0.001 Pulmonary disease 302 (7.1) 195 (25.7) 414 (37.7) <0.001 <0.001 Peripheral vascular disease 594 (13.9) 94 (12.4) 167 (15.2) 0.26 0.28 Rheumatic disease 124 (2.9) 31 (4.1) 41 (3.7) 0.08 0.16 Peptic ulcer disease 113 (2.7) 17 (2.2) 27 (2.5) 0.52 0.72 Age (SD) 59.1 (16.3) 64.0 (16.5) 65.6 (14.9) <0.001 <0.001 Baseline creatinine, mg/dl (SD) 0.80 (0.26) 0.79 (0.26) 0.84 (0.26) 0.35 <0.001 Hospital stay before AKI (d), median (IQR) 3 (2–8) 3 (2–7) 3 (1–6) 0.26 <0.001 Onset of AKI to doubling of creatinine (d), median (IQR) 1 (0–2) 1 (0–1) 1 (0–2) <0.001 0.15 Time from AKI to RRT( d), median (IQR)a 4 (1–9) 6 (2–9) 3.5 (1–9) 0.09 0.39 Data expressed as n (%) except where noted. HUP, Hospital of the University of Pennsylvania; PAH, Pennsylvania Hospital; PMC, Presbyterian Medical Center; RRT, renal replacement therapy.
↵a Among patients receiving RRT.
- Table 2.
Intention-to-treat Cox proportional hazards model of associations between key covariates and time to initiation of dialytic therapy
Covariate Univariable Analysis, Derivation Cohort Parsimonious Multivariable Model, Derivation Cohort Short Multivariable Model, Derivation Cohort HR (95% CI) P Value HR (95% CI) P Value HR (95% CI) P Value Demographics Age (per 10 yr) 0.96 (0.90–1.02) 0.20 Male sex 1.52 (1.20–1.92) 0.001 Black (versus other races) 0.53 (0.39–0.74) <0.001 0.63 (0.46–0.86) 0.004 Hospital location Surgical service (versusmedical service) 1.05 (0.83–1.33) 0.66 0.70 (0.55–0.90) 0.01 ICU (versus other hospital location) 5.68 (4.55–7.09) <0.001 1.93 (1.52–2.45) <0.001 2.98 (2.35–3.78) <0.001 Comorbidities (present at admission) HIV 0.15 (0.03–0.76) 0.02 Congestive heart failure 1.19 (0.95–1.50) 0.13 Diabetes 1.06 (0.82–1.37) 0.64 1.27 (1.00–1.62) 0.05 Liver disease 3.70 (2.95–4.63) <0.001 2.45 (1.94–3.09) <0.001 2.75 (2.18–3.47) <0.001 Malignancy 0.72 (0.46–1.11) 0.14 Metastatic solid tumor 0.86 (0.53–1.42) 0.56 Myocardial infarction 1.13 (0.82–1.55) 0.46 Peptic ulcer disease 2.15 (1.32–3.50) 0.002 Peripheral vascular disease 1.10 (0.81–1.49) 0.54 Pulmonary disease 0.73 (0.45–1.20) 0.22 Laboratory values Baseline creatinine (per 0.1 mg/dl) 1.19 (1.14–1.24) <0.001 Bicarbonate (per mEq/L) 0.86 (0.84–0.88) <0.001 0.95 (0.93–0.98) <0.001 BUN (per 10 mg/dl) 1.27 (1.24–1.30) <0.001 1.07 (1.03–1.10) <0.001 Change in creatinine from day prior (per 0.1 mg/dl) 1.09 (1.08–1.11) <0.001 1.02 (1.02–1.03) <0.001 1.02 (1.01–1.03) <0.001 Creatinine (per mg/dl) 1.86 (1.75–1.99) <0.001 1.53 (1.41–1.67) <0.001 1.64 (1.54–1.76) <0.001 Potassium (per mEq/L) 2.08 (1.94–2.23) <0.001 1.27 (1.16–1.40) <0.001 1.35 (1.23–1.48) <0.001 Medications Number of sedatives (per drug) 1.81 (1.68–1.94) <0.001 1.14 (1.04–1.26) 0.01 Prior aminoglycoside exposure 1.20 (0.95–1.53) 0.13 Number of antibiotics (per drug) 1.42 (1.35–1.49) <0.001 1.12 (1.06–1.19) <0.001 Number of pressors (per drug) 2.12 (1.98–2.26) <0.001 1.28 (1.18–1.40) <0.001 1.44 (1.33–1.55) <0.001 Paralytic exposure 4.55 (3.50–5.92) <0.001 1.40 (1.03–1.90) 0.03 Thiazide diuretic 2.25 (1.83–2.76) <0.001 1.63 (1.33–2.00) <0.001 Other orders Ventilated 3.71 (3.07–4.49) <0.001 1.22 (0.99–1.51) 0.06 n=35,462 patient-days, 3951 patients, and 471 outcome events. Data were censored at discharge, death, or 14 days from the onset of AKI, whichever came first. Data excludes patient-days after placement of a do not resuscitate order. HR, hazard ratio; CI, confidence interval; ICU, intensive care unit.
- Table 3.
Intention-to-treat Cox proportional hazards model of associations between key covariates and time to all-cause mortality
Covariate Univariable Analysis, Derivation Cohort Parsimonious Multivariable Model, Derivation Cohort Short Multivariable Model, Derivation Cohort HR (95% CI) P Value HR (95% CI) P Value HR (95% CI) P Value Demographics Age (per 10 yr) 1.05 (0.99–1.12) 0.08 1.11 (1.04–1.19) 0.003 Male sex 1.19 (0.99–1.43) 0.06 Black (versus other races) 0.70 (0.55–0.89) 0.003 0.81 (0.63–1.03) 0.09 Hospital location Surgical service (versus medical service) 0.51 (0.42–0.61) <0.001 0.39 (0.32–0.47) <0.001 0.36 (0.30–0.43) <0.001 ICU (versus other hospital location) 4.39 (3.70–5.21) <0.001 2.07 (1.69–2.53) <0.001 2.97 (2.46–3.59) <0.001 Comorbidities (present at admission) HIV 0.87 (0.36–2.09) 0.75 Congestive heart failure 0.93 (0.77–1.12) 0.45 0.80 (0.65–0.99) 0.04 Diabetes 0.75 (0.59–0.94) 0.01 Liver disease 1.90 (1.56–2.32) <0.001 1.48 (1.21–1.81) <0.001 Malignancy 1.91 (1.47–2.48) <0.001 1.31 (0.99–1.73) 0.06 Metastatic solid tumor 2.64 (2.06–3.40) <0.001 2.18 (1.67–2.84) <0.001 2.79 (2.16–3.61) <0.001 Myocardial infarction 1.13 (0.87–1.48) 0.35 Peptic ulcer disease 1.23 (0.71–2.12) 0.46 Peripheral vascular disease 1.02 (0.78–1.33) 0.91 Pulmonary disease 0.95 (0.92–0.99) 0.02 Laboratory values Baseline creatinine (per 0.1 mg/dl) 1.04 (1.00–1.08) 0.05 Bicarbonate (per mEq/L) 0.88 (0.86–0.89) <0.001 0.95 (0.93–0.97) <0.001 BUN (per 10 mg/dl) 1.18 (1.16–1.21) <0.001 1.14 (1.10–1.18) <0.001 1.12 (1.09–1.15) <0.001 Change in creatinine from day prior (per 0.1 mg/dl) 1.06 (1.05–1.07) <0.001 1.05 (1.04–1.06) <0.001 1.05 (1.04–1.05) <0.001 Creatinine (per mg/dl) 1.31 (1.24–1.39) <0.001 0.81 (0.73–0.90) <0.001 Potassium (per mEq/L) 1.70 (1.57–1.83) <0.001 1.16 (1.06–1.26) 0.001 Medications Number of sedatives (per drug) 1.69 (1.59–1.79) <0.001 Prior aminoglycoside exposure 0.92 (0.74–1.13) 0.42 0.77 (0.61–0.96) 0.01 Number of antibiotics (per drug) 1.42 (1.36–1.48) <0.001 1.08 (1.02–1.14) 0.01 Number of pressors (per drug) 1.83 (1.72–1.94) <0.001 1.38 (1.26–1.50) <0.001 1.55 (1.43–1.67) <0.001 Paralytic exposure 4.60 (3.64–5.80) <0.001 1.95 (1.53–2.50) <0.001 Thiazide diuretic 0.67 (0.52–0.87) 0.002 0.60 (0.47–0.78) <0.001 Other orders Ventilated 3.65 (3.12–4.27) <0.001 1.43 (1.20–1.70) <0.001 n=35,028 patient-days, 3901 patients, and 778 outcome events. Data were censored at 14 days from the onset of AKI or August 31, 2010, whichever came first. Data excludes patient-days after initiation of dialysis or placement of a do not resuscitate order. HR, hazard ratio; CI, confidence interval; ICU, intensive care unit.
- Table 4.
Intention-to-treat Cox proportional hazards model of associations between key covariates and time to all-cause mortality or initiation of dialysis
Covariate Univariable Analysis, Derivation Cohort Parsimonious Multivariable Model, Derivation Cohort Short Multivariable Model, Derivation Cohort HR (95% CI) P Value HR (95% CI) P Value HR (95% CI) P Value Demographics Age (per 10 yr) 1.01 (0.96–1.06) 0.89 1.05 (0.99–1.11) 0.08 Male sex 1.31 (1.12–1.54) 0.001 Black (versus other races) 0.60 (0.49–0.74) <0.001 0.68 (0.55–0.84) <0.001 Hospital location Surgical service (versus medical service) 0.68 (0.58–0.79) <0.001 0.48 (0.41–0.57) <0.001 0.45 (0.39–0.53) <0.001 ICU (versus other hospital location) 4.82 (4.16–5.57) <0.001 1.91 (1.61–2.27) <0.001 3.12 (2.67–3.65) <0.001 Comorbidities (present at admission) HIV 0.47 (0.20–1.08) 0.22 Congestive heart failure 1.07 (0.91–1.25) 0.37 0.86 (0.73–1.02) 0.08 Diabetes 0.93 (0.77–1.11) 0.23 Liver disease 2.61 (2.22–3.07) <0.001 1.92 (1.63–2.27) <0.001 2.12 (1.81–2.50) <0.001 Malignancy 1.35 (1.06–1.72) 0.01 Metastatic solid tumor 1.78 (1.40–2.26) <0.001 1.67 (1.31–2.13) <0.001 Myocardial infarction 1.13 (0.91–1.42) 0.33 Peptic ulcer disease 1.61 (1.08–2.39) 0.02 Peripheral vascular disease 1.11 (0.89–1.37) 0.61 Pulmonary disease 0.82 (0.59–1.13) 0.25 Laboratory values Baseline creatinine (per 0.1 mg/dl) 1.11 (1.07–1.14) <0.001 Bicarbonate (per mEq/L) 0.87 (0.85–0.88) <0.001 0.96 (0.94–0.97) <0.001 BUN (per 10 mg/dl) 1.23 (1.21–1.26) <0.001 1.09 (1.06–1.12) <0.001 Change in creatinine from day prior (per 0.1 mg/dl) 1.08 (1.07–1.10) <0.001 1.04 (1.03–1.04) <0.001 1.04 (1.03–1.05) <0.001 Creatinine (per mg/dl) 1.66 (1.58–1.76) <0.001 1.26 (1.17–1.35) <0.001 1.42 (1.35–1.50) <0.001 Potassium (per mEq/L) 1.92 (1.81–2.03) <0.001 1.24 (1.16–1.33) <0.001 Medications Number of sedatives (per drug) 1.73 (1.64–1.82) <0.001 1.08 (1.01–1.16) 0.02 Prior aminoglycoside exposure 1.03 (0.86–1.22) 0.83 Number of antibiotics (per drug) 1.42 (1.37–1.47) <0.001 1.09 (1.05–1.14) <0.001 Number of pressors (per drug) 1.98 (1.88–2.09) <0.001 1.32 (1.24–1.42) <0.001 1.52 (1.44–1.61) <0.001 Paralytic exposure 4.39 (3.60–5.34) <0.001 1.61 (1.30–1.99) <0.001 Thiazide diuretic 1.35 (1.13–1.61) 0.002 Other orders Ventilated 3.62 (3.17–4.14) <0.001 1.34 (1.15–1.56) <0.001 n=35,462 patient-days, 3951 patients, and 1031 outcome events. Data censored at 14 days from the onset of AKI or August 31, 2010, whichever came first. Data exclude patient-days after placement of a do not resuscitate order. HR, hazard ratio; CI, confidence interval; ICU, intensive care unit.
- Table 5.
c-statistics for derivation and validation cohorts, stratified by outcome of prediction
Parsimonious Model (95% CI) Short Model (95% CI) P Value (Short versus Parsimonious) Dialysis Derivation cohort (HUP 2004–2010) 0.89 (0.88–0.91) 0.88 (0.87–0.89) <0.001a Validation (PAH 2006–2010) 0.89 (0.85–0.93) 0.89 (0.85–0.93) 0.48 Validation (PMC 2004–2010) 0.89 (0.86–0.92) 0.88 (0.85–0.91) 0.23 Death Derivation cohort (HUP 2004–2010) 0.83 (0.82–0.84) 0.80 (0.79–0.81) <0.001a Validation (PAH 2006–2010) 0.83 (0.80–0.86) 0.79 (0.76–0.83) <0.001 Validation (PMC 2004–2010) 0.82 (0.79–0.85) 0.79 (0.75–0.82) <0.001 Dialysis or death Derivation cohort (HUP 2004–2010) 0.85 (0.84–0.86) 0.82 (0.81–0.83) <0.001a Validation (PAH 2006–2010) 0.83 (0.80–0.86) 0.77 (0.73–0.80) <0.001 Validation (PMC 2004–2010) 0.84 (0.82–0.86) 0.80 (0.78–0.83) <0.001 P value reflects difference in predictive ability between short and parsimonious models. CI, confidence interval; HUP, Hospital of the University of Pennsylvania; PAH, Pennsylvania Hospital; PMC, Presbyterian Medical Center.
↵a P values may be unreliable in cohort from which model was derived
- Table 6.
Intention-to-treat Cox proportional hazards model of associations between key covariates and time to all-cause mortality or initiation of dialysis based on covariates measured on the day creatinine doubled from baseline (AKIN stage 2 criteria)
Covariate Univariable Analysis, Derivation Cohort Parsimonious Multivariable Model, Derivation Cohort Short Multivariable Model, Derivation Cohort HR (95% CI) P Value HR (95% CI) P Value HR (95% CI) P Value Demographics Age (per 10 yr) 1.00 (0.96–1.04) 0.98 Male sex 1.33 (1.17–1.52) <0.001 Black (versus other races) 0.64 (0.55–0.76) <0.001 0.80 (0.67–0.95) 0.01 Hospital location Surgical service (versus medical service) 0.82 (0.72–0.93) 0.002 0.57 (0.49–0.66) <0.001 0.64 (0.55–0.74) <0.001 ICU (versus other hospital location) 4.48 (3.86–5.19) <0.001 1.82 (1.51–2.20) <0.001 Comorbidities (present at admission) HIV 0.64 (0.33–1.22) 0.17 Congestive heart failure 1.17 (1.03–1.33) 0.02 0.88 (0.76–1.01) 0.06 Diabetes 0.85 (0.73–0.99) 0.04 Liver disease 2.37 (2.08–2.69) <0.001 1.60 (1.39–1.85) <0.001 1.61 (1.40–1.86) <0.001 Malignancy 1.47 (1.22–1.78) <0.001 Metastatic solid tumor 1.57 (1.31–1.89) <0.001 1.58 (1.25–2.01) <0.001 Myocardial infarction 1.28 (1.07–1.52) <0.001 Peptic ulcer disease 1.73 (1.27–2.34) <0.001 Peripheral vascular disease 1.18 (1.00–1.40) 0.06 Pulmonary disease 0.84 (0.65–1.09) 0.19 Laboratory values Baseline creatinine (per 0.1 mg/dl) 1.12 (1.10–1.14) <0.001 Bicarbonate (per mEq/L) 0,86 (0,85–0.87) <0.001 0.93 (0.92–0.95) <0.001 0.91 (0.89–0.92) <0.001 BUN (per 10 mg/dl) 1.17 (1.15–1.20) <0.001 1.12 (1.09–1.15) <0.001 1.15 (1.12–1.18) <0.001 Change in creatinine from day prior (per 0.1 mg/dl) 1.05 (1.04–1.06) <0.001 1.03 (1.02–1.04) <0.001 1.03 (1.02–1.04) <0.001 Creatinine (per mg/dl) 1.58 (1.44–1.73) <0.001 Potassium (per mEq/L) 1.80 (1.69–1.91) <0.001 1.23 (1.13–1.33) <0.001 Medications Number of sedatives (per drug) 1.66 (1.57–1.74) <0.001 Prior aminoglycoside exposure 1.19 (1.03–1.38) 0.02 Number of antibiotics (per drug) 1.39 (1.34–1.44) <0.001 1.07 (1.02–1.12) 0.003 Number of pressors (per drug) 1.87 (1.78–1.97) <0.001 1.34 (1.25–1.44) <0.001 1.69 (1.59–1.80) <0.001 Paralytic exposure 3.53 (2.89–4.30) <0.001 1.48 (1.19–1.85) <0.001 Thiazide diuretic 1.17 (0.98–1.40) 0.09 Other orders Ventilated 3.78 (3.33–4.28) <0.001 1.58 (1.35–1.86) <0.001 n=3848 patient-days, 3848 patients, and 954 outcome events. Data were censored at 14 days from the onset of AKI or August 31, 2010, whichever came first. AKIN, Acute Kidney Injury Network; HR, hazard ratio; CI, confidence interval; ICU, intensive care unit.
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