Abstract: FR-PO058

Definition of Baseline Serum Creatinine Levels Which Are the Best to Predict Clinical Prognosis in Acute Kidney Injury Patients

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

  • Lee, Jeonghwan, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea (the Republic of)
  • Shin, Dong Ho, College of Medicine, Hallym University, Seoul, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University Bundang Hospital, Seong nam, Korea (the Republic of)
  • Na, Ki Young, Seoul National University Bundang Hospital, Seong nam, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seong nam, Korea (the Republic of)
Background

The classification of acute kidney injury (AKI) may be different depending on how the baseline serum creatinine is defined. The authors aimed to determine the best way to define the baseline serum creatinine according to the patients’ kidney function.

Methods

A total of 19656 adult patients were enrolled at one university hospital during the year 2013. The baseline serum creatinine levels were defined by 4 different methods (the lowest value of serum creatinine levels during 14 days, 92 days, or 184 days before admission; and the serum creatinine levels inversely calculated from the MDRD GFR 75 ml/min/1.73m2 values). Using the Receiver Operating Characteristic curve analysis, the area under the curve (AUC) was measured to compare the diagnostic performance of AKI for clinical outcomes according to the definition of baseline serum creatinine levels.

Results

In patients with a baseline GFR above 60 ml/min/1.73m2, the AUCs for in-hospital mortality were similar for the four definitions of baseline creatinine levels. The AUC for ESRD was significantly superior when the baseline serum creatinine values were calculated from the GFR 75 value. In patients with a baseline GFR below 60 ml/min/1.73m2, when the baseline serum creatinine values calculated from the GFR 75 value, the AUC for in-hospital mortality was poor and the AUC for ESRD was significantly lower.

Conclusion

In patients with normal GFR, serum creatinine levels, which were back-calculated from the GFR 75 values, can be used as the baseline creatinine levels to define AKI. However, in patients with impaired kidney function, baseline serum creatinine levels obtained directly from the 6-month serum creatinine levels before admission can predict the prognosis of AKI more accurately.

C-statistics for ROC curve for in-hospital mortality and end-stage renal disease according to the AKI with 4 different baseline creatinine definitions
  In-hospital mortalityESRD
Basal GFRBaseline Creatinine (Cr) DefinitionAUC95% confidence intervalAUC95% confidence interval
GFR ≧ 60 ml/min/1.73m2Cr from GFR 750.5690.556-0.5820.9200.877-0.962
Lowest Cr 14 days before admission0.5580.545-0.5710.7750.702-0.848
Lowest Cr 92 days before admission0.5700.557-0.5830.7780.707-0.849
Lowest Cr 184 days before admission0.5740.561-0.5870.7750.704-0.846
GFR < 60 ml/min/1.73m2Cr from GFR 750.6390.579-0.6990.6380.593-0.684
Lowest Cr 14 days before admission0.7410.672-0.8100.7300.677-0.783
Lowest Cr 92 days before admission0.7350.669-0.8000.7700.725-0.814
Lowest Cr 184 days before admission0.7350.673-0.7970.7820.744-0.821