Abstract: FR-PO057
Analysis of Morbidity and Mortality in Patients with Biliary Obstruction and AKI
Session Information
- AKI Clinical: Predictors
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Acute Kidney Injury
- 003 AKI: Clinical and Translational
Authors
- Pan, Di, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York, United States
- Wen, Yumeng, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York, United States
- Mariuma, David, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York, United States
- Gramuglia, Michael, Montefiore Health System, New York , New York, United States
- Meisels, Ira S., Mount Sinai St. Lukes and Mount Sinai West Hospitals, New York, New York, United States
Background
Acute kidney injury has been shown to be a negative prognostic factor for a variety of diseases. Patients with biliary obstruction are unique in the fact that they may develop acute kidney injury through the nephrotoxic effects of hyperbilirubinemia in addition to the conventional mechanisms of renal failure. The goal of this study is to analyze the impact and burden of acute kidney injury on patients with biliary obstruction.
Methods
This is a retrospective cohort study using the 2014 National Inpatient Sample (NIS), which is the largest inpatient database in the United States. A total cohort of 59,500 patients over the age of 18 admitted with either a primary or secondary diagnosis of biliary obstruction were identified using ICD-9 codes. 8,760 (17%) individuals had a concurrent diagnosis of acute kidney injury. The primary outcome was overall in-hospital mortality. Secondary outcomes included length of stay (LOS), total hospital charge, and incidence of receiving renal replacement therapy. Multivariate regression analyses were performed to test for independent associations between AKI and outcomes of interest adjusting for age, gender, race and comorbidities. Independent t-tests were performed for continuous variables, and chi-squared and fisher’s exact tests were performed for categorical variables. Analysis was performed using Stata 14.2.
Results
The presence of acute kidney injury was independently associated with increased overall in-hospital mortality in patients with biliary obstruction (adjusted OR 2.93 p<0.0001, 95% CI 2.34-3.65). LOS was 2.08 days longer ( P<0.0001, 95% CI 1.43 -2.73) in patients with acute kidney injury, and total hospital charges were $24832.04 more than in patients without acute kidney injury (p<0.0001 95% CI 14673.35 - 34990.74). 3.2% of patients received renal-replacement therapy.
Conclusion
The presence of acute kidney injury poses significant burden on patients with biliary obstruction. It is associated with increased mortality, with increased length of stay and hospital charge. We should pay close attention and be aggressive in the monitoring and treatment of AKI in this population.