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Original article
Morbidity and mortality of acute renal failure in the Critical Care Unit of a regional hospital
Morbimortalidad del fracaso renal agudo en la Unidad de Cuidados Críticos de un hospital comarcal
M.E. Esteban Cirianoa,
Corresponding author
pebares@yahoo.es

Corresponding author.
, J.M. Peña Portab, C. Vicente de Vera Floristánc, S. Olagorta Garcíad, R. Álvarez Lipeb, J.M. Vicente de Vera Floristána
a Servicio de Anestesia, Hospital Reina Sofía, Tudela, Navarra, Spain
b Servicio de Nefrología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Aragón, Spain
c Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Aragón, Spain
d Servicio de Anestesia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Aragón, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The local hospital where this study was performed has a catchment population of 150&#44;000&#46; At the time of the study&#44; the hospital had a Critical Care Unit &#40;CCU&#41; overseen by anaesthesiologists&#44; where both medical and surgical critically ill patients are admitted&#46; Patients who require diagnostic techniques or specialists that are unavailable in our hospital are admitted to the CCU and stabilised before being transferred to the reference centre&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The CCU is the hospital&#39;s Intensive Care Unit &#40;ICU&#41;&#46; It has 5 fully equipped single-bed cubicles where patients receive medical and nursing care&#46; Although it has both basic and advanced monitoring devices&#44; it cannot perform renal replacement&#46; Patients needing this therapy are treated in the CCU by the hospital&#39;s Haemodialysis Unit&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Registry of all epidemiological and biostatistical data is compulsory in the CCU&#46; Our autonomous community uses electronic health records both in hospitals and in primary care&#46; This computer-based system allowed us to collect data from patients after hospital discharge&#44; even when transferred to other centres&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In view of our access to such records&#44; we decided to study the clinical and epidemiological profile of critical patients admitted to our CCU&#46; We determined the epidemiological profile and survival prognosis of the patients in our series using the Charlson Comorbidity Index &#40;CCI&#41;&#46; The CCI has been widely used in different multivariable prognostic models&#44; and its consistency and validity have been confirmed in numerous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Another reason for undertaking this study is the apparent absence of studies describing the management of acute kidney injury &#40;AKI&#41; in CCUs such as ours&#44; despite an abundance of reports on AKI in the ICU setting&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The documented incidence of AKI is increasing rapidly&#46; This may be due&#44; in part&#44; to an increased awareness of this pathology among clinicians&#44; a greater degree of diagnostic consensus&#44; and the development of widely used classification scales&#46; Much effort has been invested in recent years in agreeing on a universal definition and classification system for AKI&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In a patient with elevated blood nitrogen products&#44; it can be difficult to distinguish between chronic or acute kidney failure in the absence of previous kidney function tests&#46; If these data are not available&#44; diagnosis will rely on the patient history of symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In 2012&#44; the Kidney Disease Improving Global Outcomes &#40;KDIGO&#41; published its definition of AKI &#8211; a synthesis of the 2 existing AKI classification systems&#44; namely&#44; the Risk&#44; Injury&#44; Failure&#44; Loss of Kidney Function&#44; and End-stage Kidney Disease &#40;RIFLE&#41; system&#44; published in 2004&#44; and the Acute Kidney Injury Network &#40;AKIN&#41; system&#44; published in 2007&#46; Several studies have shown that KDIGO can accurately identify acute kidney injury in critically ill patients with a high risk of mortality<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The scales developed for the diagnosis of specific diseases are now considered the best tools for estimating prognosis&#46; In the case of AKI&#44; we have the KDIGO classification and Lia&#241;o&#39;s Individual Severity Index &#40;ISI&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We have focused on AKI because of the impact of prognosis on the cost of patient care and therapeutic outcomes&#44; in terms of morbidity and mortality&#46; Prognosis in AKI is important in order to estimate the clinical evolution of each patient with this disease&#44; the evolution of disease severity&#44; and the effectiveness of the treatments used&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A number of early prognosis systems have been evaluated&#44; but the ISI has been shown to have the greatest prognostic power for tubular necrosis&#46; Various studies have compared the prognostic accuracy of the ISI in critical AKI patients with other severity scales &#40;SAPS II&#44; APACHE II&#41;&#46; Good correlation was observed between all the scales studied&#44; but the ISI was found to be the most practical instrument&#46; Earlier studies have confirmed this simple AKI-specific index to be a valid and reliable method of correctly determining the prognosis of patients with AKI&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;9</span></a> The ISI can also be used repeatedly after diagnosis to re-evaluate the patient&#39;s progress&#44; severity&#44; and response to treatment during their hospital stay&#46; The following parameter-based formula is used to calculate the ISI scale&#58;ISI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;032&#40;age in decades&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#40;if sex<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>male&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#46;11&#40;if toxic AKI&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;11&#40;if oliguria&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;12&#40;if jaundice&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;15&#40;if coma&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#46;15&#40;if normal consciousness&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;18&#40;if mechanical ventilation&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;21</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and method</span><p id="par0060" class="elsevierStylePara elsevierViewall">Retrospective observational study of 1115 patients admitted to the CCU for any reason from 1 January 2012 to 1 January&#47;2015&#46; Patients were followed-up until death or the end of the study &#40;15&#47;07&#47;2015&#41;&#46; Mean follow-up was 18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;24 months&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The following variables were analysed&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Clinical&#8211;epidemiological&#58; age&#44; gender&#44; medical specialty&#44; medical&#47;surgical cause of CCU admission&#44; average stay in CCU &#40;days&#41;&#44; onset of AKI&#44; KDIGO stage of AKI&#44; need for haemodialysis&#44; death in CCU&#44; date of last evaluation&#44; status at last evaluation&#44; CCI<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2</span></a> score&#44; ISI score in patient with AKI&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">10&#44;11</span></a> presence of shock&#44; need for mechanical ventilation&#44; inotropes&#44; diuretics&#44; presence of previous chronic kidney disease &#40;CKD&#41; and KDIGO stages of CKD &#40;stage 5 was excluded from the analysis&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Historical&#58; diabetes&#44; heart failure&#44; COPD&#44; ischaemic heart disease&#44; liver disease&#44; dementia&#44; hypertension&#44; stroke&#44; peripheral vascular disease&#44; ulcerative disease&#44; cancer and AIDS&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Analytical&#58; baseline creatinine &#40;defined as the mean of all determinations in the previous 365 &#8211; 7 days&#41;&#44; creatinine on hospital admission&#44; peak creatinine in CCU&#44; creatinine at CCU discharge&#44; creatinine at discharge home&#44; bilirubin&#44; albumin&#44; haemoglobin&#44; leukocytes&#44; segmented neutrophils&#44; platelets&#44; sodium&#44; potassium&#44; chlorine&#44; pH&#44; bicarbonate and glomerular filtration rate &#40;GFR&#41; estimated according to the CKD-EPI formula calculated at baseline and at CCU discharge&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Liver function parameters&#58; baseline pre-admission GFR calculated using the CKD-EPI formula to establish the pre-admission stage of CKD according to the KDIGO scale&#44; severity of AKI according to KDIGO criteria &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; ISI score during the AKI episode&#44; and need for dialysis up to 15 July 2015&#46;</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">Clinical&#8211;epidemiological and analytical variables were tested using descriptive statistical methods&#46; The qualitative variables were the absolute &#40;<span class="elsevierStyleItalic">n</span>&#41; and relative &#40;&#37;&#41; frequencies of all valid cases&#44; and the quantitative variables were the mean and standard deviation of these frequencies if they followed a normal distribution &#40;Kolmogorov&#8211;Smirnov test&#41;&#46; In the case of non-normal variables&#44; the median was used as a measure of central tendency and the quartiles were also calculated&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Univariate data were analysed with hypothesis testing&#44; comparing proportions when both variables were qualitative &#40;Chi square&#44; Fisher&#39;s test&#44; and in the case of multiple comparisons&#44; the Bonferroni method&#41;&#44; comparing means when one variable was quantitative &#40;Student&#39;s <span class="elsevierStyleItalic">T</span>&#44; ANOVA&#41;&#44; and comparing distribution functions in the case of non-normally distributed variables &#40;<span class="elsevierStyleItalic">U</span> Mann&#8211;Whitney or Kruskal&#8211;Wallis test&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A multivariate logistic regression analysis was performed to select the variables associated with the onset of AKI during the CCU stay&#44; using AKI as a dependent variable&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The impact of onset of AKI on mortality both in the CCU and after post-discharge follow-up was tested using a multivariate Cox regression model&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Variables showing statistically significant differences in previous tests or in other studies were used as independent variables&#46; Finally&#44; a concordance analysis &#40;kappa index&#41; was performed on the different AKI classification criteria&#58; RIFLE&#44; AKIN and KDIGO&#46; The statistical analysis was performed using the Statistical Package for the Social Sciences &#40;SPSS&#41; 21&#44; Chicago&#44; Illinois&#46; Significance was set at &#60;0&#46;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0115" class="elsevierStylePara elsevierViewall">Most &#40;61&#46;3&#37;&#41; of the 1115 patients included in the study were men&#46; The mean age was 69&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15 years &#40;range 18&#8211;102&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the clinical and analytical variables of study patients according to whether or not they presented AKI during their CCU stay&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The percentage of men was similar in both groups&#46; Patients presenting AKI were older &#40;average 6&#46;6 years older&#41; and presented higher baseline creatinine values&#44; and lower levels of albumin and haemoglobin on analytical tests&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The mean CCI score was 6&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9&#46; Patients with a CCI score of <span class="elsevierStyleMonospace">&#62;</span>6 were twice as likely &#40;56&#46;9&#37;&#41; to develop AKI compared to patients with score of &#8804;6 &#40;28&#46;1&#37;&#41;&#46; This difference was statistically significant&#46; The average length of CCU stay in these patients was higher&#44; and their average survival was lower&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">A total of 953 patients &#40;85&#46;47&#37;&#41; were admitted through the emergency department&#44; and 162 &#40;14&#46;52&#37;&#41; were scheduled admissions&#59; in this group&#44; 427 &#40;44&#46;80&#37;&#41; and 59 &#40;36&#46;40&#37;&#41; patients&#44; respectively&#44; developed AKI&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Most patients were cardiac &#40;33&#46;8&#37;&#41;&#44; general surgery &#40;24&#46;1&#37;&#41; and internal medicine &#40;20&#46;6&#37;&#41; cases&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A total of 738 patients &#40;66&#46;18&#37;&#41; were admitted for medical reasons&#44; and 377 &#40;33&#46;72&#37;&#41; for surgical reasons&#59; in this group&#44; 309 &#40;41&#46;86&#37;&#41; and 177 patients &#40;46&#46;94&#37;&#41;&#44; respectively&#44; developed AKI&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Of the 1115 study patients&#44; 486 &#40;43&#46;6&#37;&#41; met the KDIGO criteria for AKI&#46; Among patients who developed AKI&#44; the greater proportion were admitted for cardiorespiratory arrest &#40;72&#46;7&#37;&#41;&#44; septic shock &#40;57&#46;80&#37;&#41; and cardiac arrhythmias &#40;55&#46;6&#37;&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In most cases&#44; AKI was attributed to prerenal factors and acute tubular necrosis&#44; bearing in mind that these aetiologies were established retrospectively&#46; However&#44; the presumptive diagnosis was based on individual evolution&#58; patients showing rapid recovery were included in the pre-renal group&#44; while those with slower evolution were included in the acute tubular necrosis group&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Good concordance was observed between all the AKI classification systems&#46; The concordance between the AKIN vs RIFLE showed a kappa index of 1&#46; The concordance between KDIGO vs RIFLE and AKIN showed a kappa of 0&#46;96&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The distribution of AKI stages &#40;KDIGO criteria&#41; was as follows&#58; stage I<span class="elsevierStyleSmallCaps">&#44;</span> 21&#46;1&#37; &#40;235 patients&#41;&#59; stage I<span class="elsevierStyleSmallCaps">I</span>&#44; 13&#46;8&#37; &#40;154 patients&#41;&#44; and stage <span class="elsevierStyleSmallCaps">III</span>&#44; 8&#46;7&#37; &#40;97 patients&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">A total of 307 patients &#40;27&#46;53&#37;&#41; had a history of CKD&#58; 141 patients with stage 3A&#44; 97 patients with stage 3B&#44; 53 with stage 4&#44; and 16 with stage 5&#59; the latter were excluded from the analysis&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows how the incidence of AKI increased almost linearly in parallel with the decrease in baseline GFR&#46; Episodes of AKI were particularly common in patients with GFR &#60;60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">A total of 35 patients &#40;7&#46;2&#37; of cases with AKI&#41; required haemodialysis&#59; in 23 of these&#44; follow-up showed the need for long term haemodialysis&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The main predictor of onset of AKI in the CCU was a history of CKD&#44; which increased the risk 6-fold&#44; followed by shock&#44; admission due to surgery&#44; male gender&#44; and finally&#44; CCI score &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">The variables age&#44; diabetes&#44; heart failure&#44; albumin&#44; haemoglobin and COPD were shown to be non-significant in the univariate study&#44; and were therefore not included in the logistic regression model&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The average CCU stay for non-AKI patients was 7&#46;141<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;273 days&#44; while that of patients with KDIGO stage <span class="elsevierStyleSmallCaps">I</span> was 7&#46;421<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;432 days&#44; stage <span class="elsevierStyleSmallCaps">II</span>was 9&#46;123<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;350 days&#44; and stage <span class="elsevierStyleSmallCaps">III</span> was 9&#46;608<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;382 days &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; no AKI versus the other groups&#41;&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">CCU stay among patients that developed AKI was on average 1&#46;256 days longer than those in the non-AKI group&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In total&#44; 72&#46;7&#37; of patients were transferred to the ward&#44; 21&#46;1&#37; were referred to another hospital &#40;17&#46;9&#37; due to catheterisation&#41;&#44; and the rest died in the CCU &#40;5&#46;6&#37;&#41; or were discharged home &#40;0&#46;6&#37;&#41;&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Sixty-five patients &#40;5&#46;83&#37;&#41; died during their stay in the CCU&#44; of whom 60 presented an episode of AKI&#46; By the end of follow-up &#40;mean 18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;24 months&#41;&#44; 262 patients had died&#44; of whom 194 &#40;74&#46;05&#37;&#41; had presented an episode of AKI in the CCU&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">By the end of the study&#44; the percentage of non-survivors was significantly lower in the non-AKI vs AKI group&#44; and death rates increased progressively in parallel with the severity of AKI &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0220" class="elsevierStylePara elsevierViewall">By the end of post-discharge follow-up&#44; survival was 6&#46;4 months lower in the group of patients that developed AKI during their stay in the CCU vs non-AKI patients &#40;AKI 15&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;5 months vs no AKI 21&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;3 months&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0225" class="elsevierStylePara elsevierViewall">We used a multivariate Cox regression model to analyse the impact of AKI on mortality&#46; Variables showing statistically significant differences in previous tests&#58; AKI &#40;KDIGO&#41;&#47;no AKI&#44; CCI&#44; ISI&#44; haemoglobin&#44; albumin &#40;&#60;2&#46;5 vs <span class="elsevierStyleMonospace">&#62;</span>2&#46;5&#41;&#44; CKD&#44; gender and age &#40;years&#41;&#44; were included in this model&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">The likelihood of surviving the CCU decreased in patients with AKI &#40;HR&#58; 5&#46;44&#59; 95&#37; CI 1&#46;70&#8211;17&#46;39&#41;&#44; and also decreased in parallel with an increase in severity &#40;ISI&#41; &#40;HR&#58; 10&#46;29&#59; 95&#37; CI 3&#46;34&#8211;31&#46;76&#41;&#46; This means that presentation of AKI and ISI score were predictors of mortality&#46; Diabetes&#44; CKD&#44; haemoglobin&#44; gender&#44; CCI score&#44; albumin and age at admission did not affect survival&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">By the end of follow-up&#44; we observed that the probability of survival decreased in patients with AKI &#40;HR&#58; 1&#46;72&#59; 95&#37; CI 1&#46;14&#8211;2&#46;61&#41;&#44; with higher ISI score &#40;HR&#58; 9&#46;6&#59; 95&#37; CI 5&#46;07&#8211;18&#46;20&#41;&#44; with a CCI score of <span class="elsevierStyleMonospace">&#62;</span>6 &#40;HR&#58; 1&#46;09&#59; 95&#37; CI 1&#46;03&#8211;1&#46;15&#41;&#44; incrementally for each year over 70 years &#40;HR&#58; 1&#46;03&#59; 95&#37; CI 1&#46;01&#8211;1&#46;04&#41;&#44; with albuminaemia <span class="elsevierStyleMonospace">&#62;</span>2&#46;5 &#40;HR&#58; 1&#46;69&#59; 95&#37; CI 1&#46;13&#8211;2&#46;53&#41;&#44; male gender &#40;HR&#58; 1&#46;38&#59; 95&#37; CI 1&#46;06&#8211;1&#46;79&#41; and with previous CKD &#40;HR&#58; 1&#46;56&#59; 95&#37; CI 1&#46;02&#8211;2&#46;38&#41;&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">At the end of the study&#44; a history of CKD and onset of AKI in the CCU were found to be predictors of long-term mortality&#46; The other variables were the CCI score&#44; male gender&#44; serum albumin <span class="elsevierStyleMonospace">&#60;</span>2&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#44; age&#44; and ISI score&#46; The latter was the main predictor &#40;HR&#58; 9&#46;6&#41;&#44; insofar as each 0&#46;1 increment in the ISI score increased the likelihood of death during follow-up by 26&#37;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0245" class="elsevierStylePara elsevierViewall">In our study&#44; patients who developed AKI in the CCU were men with an average age of 75 years and a high CCI score &#40;6&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9&#41;&#46; These results coincide with those of other authors&#44; such as Zhang and Wang&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">The number of surgical patients developing AKI was 5&#46;06&#37; higher than those admitted for medical reasons&#46; In general&#44; these patients require a longer stay&#44; more invasive techniques&#44; and presented more infectious complications&#46; In these terms&#44; our results coincide with those Mas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a> in their study of ICUs in Spain &#40;138&#44;000 patients&#41;&#44; in which emergency and surgical patients predominated&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">In this study&#44; although episodes of AKI were more frequent in postoperative patients&#44; this did not affect the higher mortality rates in this subgroup&#46; However&#44; incidence of AKI in a particular sub-population is not necessarily linked to mortality in the same group&#44; given that &#8220;surgical cause&#8221; encompasses different aetiologies of varying severity in each particular case&#46; The FRAMI study&#44; in contrast&#44; showed that incidence of AKI in the ICU was higher among patients admitted for medical reasons&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">Continuous monitoring and observation will allow clinicians to promptly diagnose AKI and start treatment&#44; sometimes even before admission to the CCU&#46; Once in the unit&#44; the ISI can be used to determine AKI prognosis and to dynamically monitor the severity of the disease and response to treatment&#46; Therefore&#44; the possibility of using AKI prognosis scales to prevent onset of the disease warrants further investigation&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">We observed good correlation between the RIFLE&#44; AKIN and KDIGO scales&#46; We diagnosed 23 more AKI patients using the KDIGO scale than with RIFLE or AKIN&#44; which increased the number of patients diagnosed with mild renal insufficiency&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Incidence of AKI in our series was 43&#46;6&#37;&#44; a finding that coincides with other studies<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">14&#44;15</span></a>&#59; we were unable to compare our results with other studies performed in CCUs similar to ours&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">In patients with insufficient renal blood flow&#44; kidney damage may be minimised by promptly restored perfusion&#46; In critical care&#44; small increments in serum creatinine could increase the sensitivity of a diagnosis of abrupt &#40;within 48<span class="elsevierStyleHsp" style=""></span>h&#41; AKI&#46; Whether or not improving the early diagnosis of stage <span class="elsevierStyleSmallCaps">I</span> AKI will improve the quality of care by optimising fluid and haemodynamic management and avoiding nephrotoxins is a topic that merits further research&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">We also observed a higher incidence of patients with severe AKI than other studies&#46; This may be due to the characteristics of our patients&#44; since critical patients that need advanced life support measures are admitted to the CCU&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a> Thirty-five of our patients &#40;7&#46;2&#37; of cases with AKI&#41; required haemodialysis&#46; Patients with CKD stages G4 and G3B presented a higher incidence of severe and moderate AKI&#46; This echoes the results of other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0285" class="elsevierStylePara elsevierViewall">We agree with the recommendation of other authors<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a> to provide extra monitoring for AKI in the CCU in patients admitted for surgical reasons&#44; with advanced age&#44; high comorbidity&#44; particularly systemic vascular involvement and previous pharmacological treatment &#40;mainly RAAS blockers and diuretics&#41;&#44; reduced functional reserve and renal compliance in the context of CKD&#44; and with processes that involve low cardiac output &#40;fluid depletion&#44; hypoalbuminaemia or other situations that involve renal hypoperfusion&#41;&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">In our series&#44; patients who developed AKI required longer CCU stays&#44; with the greater consumption of resources that this entails&#46; Most authors agree that patients with AKI require longer hospital stays&#46; This is due to the seriousness of the disease and the associated complications that delay the recovery of renal function&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a></p><p id="par0295" class="elsevierStylePara elsevierViewall">As in other studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">21&#44;22</span></a> overall survival in our sample was 6&#46;4 months lower among patients admitted to the CCU with AKI&#46; Increase in the severity of AKI was linked to an increase in the in-CCU mortality rate&#59; comorbidity &#40;CCI&#41;&#44; which is a prognosis factor for mortality&#44; is significantly higher in elderly patients&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">In the multivariate analysis of survival during the CCU stay&#44; the probability of decreased survival in patients with AKI is 5&#46;5 higher and the risk is 10 times higher for every ISI score increment&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">The end-of-study multivariate analysis showed that the risk of mortality increased by 3&#37; per year <span class="elsevierStyleMonospace">&#62;</span>70 years&#44; while male gender increased the risk by 38&#37;&#46; Some authors have not found advanced age to be an independent risk factor for death&#44; although it is a risk factor when associated with the underlying disease&#46; Comorbidity&#44; measured using the CCI&#44; is significantly higher in this group of patients&#59; the probability of survival decreases by 9&#37; for each increment in CCI score&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a></p><p id="par0310" class="elsevierStylePara elsevierViewall">We agree with other studies reporting that patients with serum albumin &#60;2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl are less likely to survive&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a> ICU patients frequently present cardiovascular collapse and inflammation&#46; The baseline clinical complexity of these patients&#44; oliguria and malnutrition-inflammation&#44; are the main prognostic and mortality factors in AKI&#46; In our study&#44; the risk of death during follow-up increased by 56&#37; in patients with CKD&#46; Similar results were reported by Ortiz Librero et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">2</span></a></p><p id="par0315" class="elsevierStylePara elsevierViewall">AKI-related mortality in the ICU has remained at the same high level reported 20 years ago &#40;50&#8211;60&#37;&#41;&#44; although the causes of death are different&#46; In recent years&#44; medical and nephrotoxic causes have increased considerably&#44; while obstetric causes have almost disappeared&#46; The incidence of postoperative AKI&#44; meanwhile&#44; particularly when associated with sepsis&#44; hypotension and&#47;or ischaemic factors&#44; continues to be very high&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a></p><p id="par0320" class="elsevierStylePara elsevierViewall">We agree with Lins et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a> that prognostic models for AKI must be used&#46; ISI score is higher among patients with all 3 stages of AKI&#46; Lia&#241;o explains that AKI usually occurs in the context of diseases that in themselves can be fatal&#59; in this regard&#44; the ISI is a good predictive tool&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a></p><p id="par0325" class="elsevierStylePara elsevierViewall">Most studies of AKI in the ICU focus on mortality and renal recovery during ICU stay and at the time of discharge home&#59; in other words&#44; in the context of an acute&#44; short-term disease&#46; Chertow et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">27</span></a> developed predictive 60-day mortality models in patients with AKI for use at 3 different times&#58; day of diagnosis of AKI&#44; day of consultation with a nephrologist&#44; and day of onset of renal replacement therapy &#40;RRT&#41;&#46; However&#44; this method is for use in patients with more severe AKI&#44; and is hard to use in those with less severe disease&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">In our study&#44; patients were followed up for an average of 18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;24 months&#44; which gave us a broad perspective of the evolution of various disease-related aspects&#46; Regarding long-term mortality&#44; 262 patients &#40;23&#46;5&#37;&#41; had died by15 July 2015&#44; of whom 194 had developed AKI during their CCU stay&#46; These results are consistent with other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a></p><p id="par0335" class="elsevierStylePara elsevierViewall">The results of our multivariate analysis of mortality-related variables are largely similar to those reported in the FRAMI study&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a> The authors of FRAMI&#44; however&#44; observed a relationship with diabetes&#46; This could due to the characteristics of our respective samples&#44; which may differ in terms of some factors that were not controlled by the study design&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">It is striking that some variables&#44; such as diabetes&#44; together with heart failure&#44; COPD or haemoglobin&#44; did not significantly influence survival in the CCU or subsequent follow-up&#46; Although we recruited a large sample&#44; which gives our study adequate statistical power&#44; its retrospective nature may conceal biases that have an impact on this result&#46; More studies are needed to obtain evidence in this regard&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">It is also important to bear in mind that the factors influencing the evolution of patients with AKI are not necessarily the same in the early and late stages of the disease&#44; as these constitute different clinical scenarios&#46; Therefore&#44; although in our study only 2 variables were independently related to in-CCU mortality &#40;onset of AKI and ISI score&#41;&#44; the multivariate model selected 7 significant follow-up variables&#58; AKI and ISI&#44; in addition to CCI score&#44; serum albumin &#60;2&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#44; previous history of CKD&#44; male gender&#44; and age&#46; The presence of AKI in both models highlights the prognostic importance of this complication both in the short and long term&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">In our series&#44; mortality was 32&#46;3&#37; among patients with AKI&#46; These patients also have a higher probability &#40;72&#37;&#41; of shorter survival&#46; Our results are similar to those of other studies reporting high mortality rates in surgical patients and AKI&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a></p><p id="par0355" class="elsevierStylePara elsevierViewall">Given the high mortality rate and the lack of specific and effective treatment for these patients&#44; every effort must be made to identify risk factors for AKI as soon as possible&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a></p><p id="par0360" class="elsevierStylePara elsevierViewall">The limitations of this study stem from its observational nature&#46; First&#44; due to its retrospective design&#44; we cannot rule out possible selection bias and errors in the collection and interpretation of the clinical history data&#46; Although the cohort studied was representative of the local population&#44; all study patients were recruited at a single hospital&#46; Another problem involves the difference between the characteristics of CCUs and other ICUs&#46;</p><p id="par0365" class="elsevierStylePara elsevierViewall">The absence of validated severity scales&#44; such as APACHE II&#44; SAPS or SOFA for critical AKI patients is another limitation&#46; However&#44; this was compensated by the ISI&#44; which is a specific scale validated for AKI&#46; Unlike the APACHE II&#44; which cannot be used to evaluate patients over time&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a> the study of dynamic changes in ISI score has a prognostic value&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0370" class="elsevierStylePara elsevierViewall">Finally&#44; our study is not free from lead-time bias&#44; in other words&#44; the incorrect estimation of risk at the time of admission to the ICU due to the results of previous therapeutic measures&#46;</p><p id="par0375" class="elsevierStylePara elsevierViewall">In conclusion&#44; our study shows the prognostic value of detecting AKI in patients admitted to a CCU&#46; This complication is extremely common&#44; increases the average length of stay and associated medical costs&#44; and is detrimental to survival both in the CCU and during post-discharge follow-up&#46; Therefore&#44; once the risk factors of AKI have been described&#44; measures should be taken to enable the prevention and early diagnosis of this disease&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0380" class="elsevierStylePara elsevierViewall">The study received a scholarship from the <span class="elsevierStyleGrantSponsor" id="gs1">Official College of Physicians of Zaragoza</span>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0385" class="elsevierStylePara elsevierViewall">The authors have no potential conflicts of interest related to the contents of this article&#46;</p></span></span>"
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    "fechaRecibido" => "2017-08-23"
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            0 => "Acute kidney injury"
            1 => "Reanimation and special care unit"
            2 => "Chronic kidney disease"
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          "palabras" => array:3 [
            0 => "Fracaso renal agudo"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The main objective of the study is to perform an analysis on the incidence&#44; predictive variables&#44; and severity of acute kidney injury &#40;AKI&#41; and its impact on the morbidity and mortality of patients in the Resuscitation and Special Care Unit &#40;RSCU&#41; of a regional hospital&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective observational study was conducted that included all patients admitted from 1 January 2012 to 1 January 2015 &#40;1115 patients&#41;&#46; The follow-up was until 15 July 2015&#46; A descriptive statistical analysis of clinical&#8211;epidemiological and analytical variables was carried out&#46; An analysis was then performed AKI in RSCU and mortality&#44; as well as the agreement between the Risk&#44; Injury&#44; Failure&#44; Loss of Kidney Function&#44; and End-stage Kidney Disease &#40;RIFLE&#41;&#47;Acute Kidney Injury Network &#40;AKIN&#41;&#47;Kidney Disease&#58; Improving Global Outcomes &#40;KDIGO&#41; criteria &#40;kappa index&#41;&#46; A multivariate logistic regression analysis was performed to select the variables associated with the presentation of AKI in RSCU and a univariate &#40;Kaplan&#8211;Meier&#41; and multivariate survival analysis &#40;Cox regression&#41;&#46; The statistical analysis was carried out using the statistical package SPSS 21&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">During admission to RSCU&#44; 486 patients presented with AKI &#40;43&#46;6&#37;&#41;&#44; of which 21&#37; were in stage I&#44; 13&#46;8&#37; in stage II&#44; and in stage III 8&#46;7&#37;&#46; A high level of agreement was observed between the RIFLE&#47;AKIN&#47;KDIGO criteria&#46; The variables that were related to the presence of AKI&#44; are male &#40;OR&#58; 1&#46;37&#59; 95&#37; CI&#58; 1&#46;02&#8211;2&#46;30&#41;&#44; to high Charlson Comorbidity Index &#40;OR&#58; 1&#46;17&#59; 95&#37; CI&#58; 1&#46;09&#8211;1&#46;26&#41;&#44; carriers of chronic kidney disease &#40;OR&#58; 5&#46;99&#59; 95&#37; CI&#58; 4&#46;58&#8211;8&#46;18&#41;&#44; admission due to surgery &#40;OR&#58; 1&#46;69&#59; 95&#37; CI&#58; 1&#46;24&#8211;2&#46;30&#41;&#44; and shock &#40;OR&#58; 4&#46;70&#59; 95&#37; CI&#58; 3&#46;34&#8211;6&#46;61&#41;&#46; The probability of survival during admission in RSCU decreases in patients with AKI &#40;HR&#58; 5&#46;44&#59; 95&#37; CI&#58; 1&#46;70&#8211;17&#46;39&#41;&#44; and as the individual severity index of Lia&#241;o increases &#40;HR&#58; 10&#46;29&#59; 95&#37; CI&#58; 3&#46;34&#8211;31&#46;76&#41;&#46; The probability of survival at the end of follow-up after hospital discharge decreases in patients with AKI &#40;HR&#58; 1&#46;72&#59; 95&#37; CI&#58; 1&#46;14&#8211;2&#46;61&#41;&#44; as the individual severity index of Lia&#241;o increases &#40;HR&#58; 9&#46;6&#59; 95&#37; CI&#58; 5&#46;07&#8211;18&#46;20&#41;&#44; the Charlson Comorbidity Index &#62;6 &#40;HR&#58; 1&#46;09&#59; 95&#37; CI&#58; 1&#46;03&#8211;1&#46;15&#41;&#44; low serum albumin &#60;2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;HR&#58; 1&#46;69&#59; 95&#37; CI&#58; 1&#46;13&#8211;2&#46;53&#41;&#44; age by year &#62;70 years &#40;HR&#58; 1&#46;03&#59; 95&#37; CI&#58; 1&#46;01&#8211;1&#46;04&#41;&#44; males &#40;HR&#58; 1&#46;38&#59; 95&#37; CI&#58; 1&#46;06&#8211;1&#46;79&#41; and carriers of previous chronic kidney disease &#40;HR&#58; 1&#46;56&#59; 95&#37; CI&#58; 1&#46;02&#8211;2&#46;38&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This study shows the presentation of an episode of AKI was an independent factor associated both with mortality during admission to RSCU&#44; and later after hospital discharge&#46; It is necessary to know the risk factors of this complication in order to adopt preventive measures&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0005"
            "titulo" => "Objectives"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo principal del estudio es analizar la incidencia&#44; las variables predictoras y gravedad del fracaso renal agudo &#40;FRA&#41; y su repercusi&#243;n en la morbimortalidad de los pacientes de la Unidad de Reanimaci&#243;n y Cuidados Especiales &#40;URCE&#41; de un hospital comarcal&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo que incluye a todos los pacientes ingresados del 1&#47;1&#47;2012 al 1&#47;1&#47;2015 &#40;1&#46;115 pacientes&#41;&#46; El seguimiento fue hasta el 15&#47;07&#47;2015&#46; Se llev&#243; a cabo una estad&#237;stica descriptiva de variables clinicoepidemiol&#243;gicas y anal&#237;ticas&#46; Se realiz&#243; el an&#225;lisis de FRA en URCE y la concordancia entre los sistemas RIFLE&#47;AKIN&#47;KDIGO &#40;&#237;ndice kappa&#41;&#46; Para seleccionar las variables asociadas a la presentaci&#243;n de FRA en URCE&#44; se realiz&#243; un an&#225;lisis de regresi&#243;n log&#237;stica multivariante y para el an&#225;lisis de la repercusi&#243;n del FRA en la mortalidad&#44; tanto en URCE como al final del seguimiento&#59; se llev&#243; a cabo un an&#225;lisis de supervivencia univariante &#40;Kaplan&#8211;Meier&#41; y multivariante &#40;regresi&#243;n de Cox&#41;&#46; El an&#225;lisis estad&#237;stico se realiz&#243; con el paquete estad&#237;stico SPSS 21&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Durante el ingreso en URCE&#44; 486 pacientes presentaron FRA &#40;43&#44;6&#37;&#41;&#44; de los cuales&#44; el 21&#37; se encontraban en estadio <span class="elsevierStyleSmallCaps">i</span>&#44; el 13&#44;8&#37; en estadio <span class="elsevierStyleSmallCaps">ii</span> y el 8&#44;7&#37; en estadio <span class="elsevierStyleSmallCaps">iii</span>&#46; Observamos una elevada concordancia entre los sistemas RIFLE &#40;Risk&#44; Injury&#44; Failure&#44; Loss of Kidney Function&#44; and End-stage Kidney Disease&#41;&#47;AKIN &#40;Acute Kidney Injury Network&#41;&#47;KDIGO &#40;Kidney Disease&#58; Improving Global Outcomes&#41;&#46; Las variables que se relacionan con presencia de FRA son varones &#40;OR&#58; 1&#44;37&#59; IC95&#37;&#58; 1&#44;02-2&#44;30&#41;&#44; con el &#237;ndice de comorbilidad de Charlson elevado &#40;OR&#58; 1&#44;17&#59; IC95&#37;&#58; 1&#44;09-1&#44;26&#41;&#44; portadores de enfermedad renal cr&#243;nica &#40;OR&#58; 5&#44;99&#59; IC95&#37;&#58; 4&#44;58-8&#44;18&#41;&#44; ingreso por causa quir&#250;rgica &#40;OR&#58; 1&#44;69&#59; IC95&#37;&#58; 1&#44;24-2&#44;30&#41; y shock &#40;OR&#58; 4&#44;70&#59; IC95&#37;&#58; 3&#44;34-6&#44;61&#41;&#46; La probabilidad de supervivencia&#44; durante el ingreso en URCE&#44; disminuye en pacientes con FRA &#40;HR&#58; 5&#44;44&#59; IC95&#37;&#58; 1&#44;70-17&#44;39&#41; y seg&#250;n aumenta el &#237;ndice de severidad individual de Lia&#241;o &#40;HR&#58; 10&#44;29&#59; IC95&#37;&#58; 3&#44;34-31&#44;76&#41;&#46; La probabilidad de supervivencia&#44; al final del seguimiento&#44; disminuye en pacientes con FRA &#40;HR&#58; 1&#44;72&#59; IC95&#37;&#58; 1&#44;14-2&#44;61&#41;&#44; seg&#250;n aumenta el &#237;ndice de severidad individual de Lia&#241;o &#40;HR&#58; 9&#44;6&#59; IC95&#37;&#58; 5&#44;07-18&#44;20&#41;&#44; el &#237;ndice de comorbilidad de Charlson<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>6 &#40;HR&#58; 1&#44;09&#59; IC95&#37;&#58; 1&#44;03-1&#44;15&#41;&#44; la albuminemia<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;HR&#58; 1&#44;69&#59;IC95&#37;&#58; 1&#44;13-2&#44;53&#41;&#44; la edad por a&#241;o<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>70 a&#241;os &#40;HR&#58; 1&#44;03&#59; IC95&#37;&#58; 1&#44;01-1&#44;04&#41;&#44; ser varones &#40;HR&#58; 1&#44;38&#59; IC95&#37;&#58; 1&#44;06-1&#44;79&#41; y ser portadores de enfermedad renal cr&#243;nica previa &#40;HR&#58; 1&#44;56&#59; IC95&#37;&#58; 1&#44;02-2&#44;38&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En nuestro estudio&#44; la presentaci&#243;n de un episodio de FRA fue un factor asociado de modo independiente&#44; tanto con la mortalidad durante el ingreso en URCE como durante el seguimiento tras el alta hospitalaria&#46; Es necesario conocer los factores de riesgo de esta complicaci&#243;n para adoptar medidas preventivas&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Esteban Ciriano ME&#44; Pe&#241;a Porta JM&#44; Vicente de Vera Florist&#225;n C&#44; Olagorta Garc&#237;a S&#44; &#193;lvarez Lipe R&#44; Vicente de Vera Florist&#225;n JM&#46; Morbimortalidad del fracaso renal agudo en la Unidad de Cuidados Cr&#237;ticos de un hospital comarcal&#46; Rev Esp Anestesiol Reanim&#46; 2018&#59;65&#58;314&#8211;322&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">KDIGO stages of AKI &#40;creatinine-based CKD-EPI equation&#41;&#46;</p>"
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        "etiqueta" => "Figure 2"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Percentage of deaths according to AKI-KDIGO at end of follow-up &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; no AKI vs AKI&#41;&#46;</p>"
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        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Survival curves at the end of follow-up &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RIFLE criteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AKIN criteria<br>Stage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">KDIGO guidelines<br>Stage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Serum creatinine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Urine output&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">R risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;5&#8211;1&#46;9-fold increase in baseline creatinine or &#8805;0&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;&#8805;26<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h<br>for 6&#8211;12<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#8211;2&#46;9-fold increase in baseline creatinine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h<br>for &#8805;12<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3-fold increase in baseline creatinine or &#8805;4<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;&#8805;353&#46;6<span class="elsevierStyleHsp" style=""></span>&#956;mol&#41; or start of renal replacement therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;3<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h<br>for &#8805;24<span class="elsevierStyleHsp" style=""></span>h or anuria <span class="elsevierStyleMonospace">&#62;</span>12<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L loss&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Persistent kidney failure <span class="elsevierStyleMonospace">&#62;</span>4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E end-stage kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Persistent kidney failure <span class="elsevierStyleMonospace">&#62;</span>3 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Classification of acute kidney injury according to RIFLE&#44; AKIN and KDIGO guidelines&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">AKI&#58; acute kidney injury&#59; CCI&#58; Charlson Comorbidity Index&#59; CCU&#58; Critical Care Unit&#59; GFR&#58; glomerular filtration&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AKI &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>486&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No AKI &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>629&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;11 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;299 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline creatinine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;88<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;88<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine at admission to CCU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;327<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;65<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;23<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peak creatinine in CCU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;24<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine at CCU discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;26<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;23<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine at discharge home&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;99<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;23<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline GFR CKD-EPI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;76<span class="elsevierStyleHsp" style=""></span>ml&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;61<span class="elsevierStyleHsp" style=""></span>ml&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Albumin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7<span class="elsevierStyleHsp" style=""></span>g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;679<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;74<span class="elsevierStyleHsp" style=""></span>g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haemoglobin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;14<span class="elsevierStyleHsp" style=""></span>g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;13<span class="elsevierStyleHsp" style=""></span>g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leukocytes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;707<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6643&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#44;806<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6290&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Platelets&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">208&#44;902<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>97&#44;493&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">203&#44;316<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>94&#44;461&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sodium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138&#46;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mmol&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">137&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;4<span class="elsevierStyleHsp" style=""></span>mmol&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Potassium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;522<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>mmol&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;596<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>mmol&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;047&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chlorine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mmol&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mmol&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">pH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bicarbonate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mmol&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;8<span class="elsevierStyleHsp" style=""></span>mmol&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lactate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5<span class="elsevierStyleHsp" style=""></span>mmol&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3<span class="elsevierStyleHsp" style=""></span>mmol&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;43<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stay in CCU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;97 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;27 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean survival&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;5 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;29 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Clinical and analytical variables of study patients according to whether or not they presented AKI during their CCU stay&#46;</p>"
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">CCI&#58; Charlson Comorbidity Index&#59; CKD&#58; chronic kidney disease&#59; COPD&#58; chronic obstructive pulmonary disease&#59; HF&#58; heart failure&#59; OR&#58; odds ratio&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Statistically significant values shown in bold&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Men vs women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;038</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;267&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CCI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;000</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">CKD</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CKD vs no CKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;000</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Reason admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Surgical vs medical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Diabetes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes vs no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;259&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 23411929
Original language: English
DOI:10.1016/j.redare.2018.02.012
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