Effects of 24-hour urine-output trajectories on the risk of acute kidney injury in critically ill patients with cirrhosis: a retrospective cohort analysis
Background Acute kidney injury (AKI) is one of the most common complications for critically ill patients with cirrhosis, but it has remained unclear whether urine output fluctuations are associated with the risk of AKI in such patients. Thus, we explored the influence of 24-h urine-output trajectory...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2024-12-01
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| Series: | Renal Failure |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/0886022X.2023.2298900 |
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| author | Jia Wang Dongdong Niu Xiaolin Li Yumei Zhao Enlin Ye Jiasheng Huang Suru Yue Xuefei Hou Jiayuan Wu |
| author_facet | Jia Wang Dongdong Niu Xiaolin Li Yumei Zhao Enlin Ye Jiasheng Huang Suru Yue Xuefei Hou Jiayuan Wu |
| author_sort | Jia Wang |
| collection | DOAJ |
| description | Background Acute kidney injury (AKI) is one of the most common complications for critically ill patients with cirrhosis, but it has remained unclear whether urine output fluctuations are associated with the risk of AKI in such patients. Thus, we explored the influence of 24-h urine-output trajectory on AKI in patients with cirrhosis through latent category trajectory modeling.Materials and Methods This retrospective cohort study examined patients with cirrhosis using the MIMIC-IV database. Changes in the trajectories of urine output within 24 h after admission to the intensive care unit (ICU) were categorized using latent category trajectory modeling. The outcome examined was the occurrence of AKI during ICU hospitalization. The risk of AKI in patients with different trajectory classes was explored using the cumulative incidence function (CIF) and the Fine-Gray model with the sub-distribution hazard ratio (SHR) and the 95% confidence interval (CI) as size effects.Results The study included 3,562 critically ill patients with cirrhosis, of which 2,467 (69.26%) developed AKI during ICU hospitalization. The 24-h urine-output trajectories were split into five classes (Classes 1–5). The CIF curves demonstrated that patients with continuously low urine output (Class 2), a rapid decline in urine output after initially high levels (Class 3), and urine output that decreased slowly and then stabilized at a lower level (Class 4) were at higher risk for AKI than those with consistently moderate urine output (Class 1). After fully adjusting for various confounders, Classes 2, 3, and 4 were associated with a higher risk of AKI compared with Class 1, and the respective SHRs (95% CIs) were 2.56 (1.87–3.51), 1.86 (1.34–2.59), and 1.83 1.29–2.59).Conclusions The 24-h urine-output trajectory is significantly associated with the risk of AKI in critically ill patients with cirrhosis. More attention should be paid to the dynamic nature of urine-output changes over time, which may help guide early intervention and improve patients’ prognoses. |
| format | Article |
| id | doaj-art-8d42ed6ab9b842a59cbb1cc718ded512 |
| institution | Kabale University |
| issn | 0886-022X 1525-6049 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj-art-8d42ed6ab9b842a59cbb1cc718ded5122025-01-23T04:17:47ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492024-12-0146110.1080/0886022X.2023.2298900Effects of 24-hour urine-output trajectories on the risk of acute kidney injury in critically ill patients with cirrhosis: a retrospective cohort analysisJia Wang0Dongdong Niu1Xiaolin Li2Yumei Zhao3Enlin Ye4Jiasheng Huang5Suru Yue6Xuefei Hou7Jiayuan Wu8Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, ChinaClinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, ChinaClinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, ChinaClinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, ChinaClinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, ChinaClinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, ChinaClinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, ChinaClinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, ChinaClinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, ChinaBackground Acute kidney injury (AKI) is one of the most common complications for critically ill patients with cirrhosis, but it has remained unclear whether urine output fluctuations are associated with the risk of AKI in such patients. Thus, we explored the influence of 24-h urine-output trajectory on AKI in patients with cirrhosis through latent category trajectory modeling.Materials and Methods This retrospective cohort study examined patients with cirrhosis using the MIMIC-IV database. Changes in the trajectories of urine output within 24 h after admission to the intensive care unit (ICU) were categorized using latent category trajectory modeling. The outcome examined was the occurrence of AKI during ICU hospitalization. The risk of AKI in patients with different trajectory classes was explored using the cumulative incidence function (CIF) and the Fine-Gray model with the sub-distribution hazard ratio (SHR) and the 95% confidence interval (CI) as size effects.Results The study included 3,562 critically ill patients with cirrhosis, of which 2,467 (69.26%) developed AKI during ICU hospitalization. The 24-h urine-output trajectories were split into five classes (Classes 1–5). The CIF curves demonstrated that patients with continuously low urine output (Class 2), a rapid decline in urine output after initially high levels (Class 3), and urine output that decreased slowly and then stabilized at a lower level (Class 4) were at higher risk for AKI than those with consistently moderate urine output (Class 1). After fully adjusting for various confounders, Classes 2, 3, and 4 were associated with a higher risk of AKI compared with Class 1, and the respective SHRs (95% CIs) were 2.56 (1.87–3.51), 1.86 (1.34–2.59), and 1.83 1.29–2.59).Conclusions The 24-h urine-output trajectory is significantly associated with the risk of AKI in critically ill patients with cirrhosis. More attention should be paid to the dynamic nature of urine-output changes over time, which may help guide early intervention and improve patients’ prognoses.https://www.tandfonline.com/doi/10.1080/0886022X.2023.2298900Acute kidney injuryurine outputcirrhosislatent category trajectory modeling |
| spellingShingle | Jia Wang Dongdong Niu Xiaolin Li Yumei Zhao Enlin Ye Jiasheng Huang Suru Yue Xuefei Hou Jiayuan Wu Effects of 24-hour urine-output trajectories on the risk of acute kidney injury in critically ill patients with cirrhosis: a retrospective cohort analysis Renal Failure Acute kidney injury urine output cirrhosis latent category trajectory modeling |
| title | Effects of 24-hour urine-output trajectories on the risk of acute kidney injury in critically ill patients with cirrhosis: a retrospective cohort analysis |
| title_full | Effects of 24-hour urine-output trajectories on the risk of acute kidney injury in critically ill patients with cirrhosis: a retrospective cohort analysis |
| title_fullStr | Effects of 24-hour urine-output trajectories on the risk of acute kidney injury in critically ill patients with cirrhosis: a retrospective cohort analysis |
| title_full_unstemmed | Effects of 24-hour urine-output trajectories on the risk of acute kidney injury in critically ill patients with cirrhosis: a retrospective cohort analysis |
| title_short | Effects of 24-hour urine-output trajectories on the risk of acute kidney injury in critically ill patients with cirrhosis: a retrospective cohort analysis |
| title_sort | effects of 24 hour urine output trajectories on the risk of acute kidney injury in critically ill patients with cirrhosis a retrospective cohort analysis |
| topic | Acute kidney injury urine output cirrhosis latent category trajectory modeling |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2023.2298900 |
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