Can Serum Nutritional Related Biomarkers Predict Mortality Of Critically Ill Older Patients With Acute Kidney Injury?

Abstract

Background

Critically ill older patients with acute kidney injury (AKI), also referred to as acute renal failure, are associated with high in-hospital mortalities. Preexisting malnutrition is highly prevalent among AKI patients and increases in-hospital mortality rate. This study is to evaluate the predictive power of some serum nutritional related biomarkers predicting the 90 days in-hospital mortality of critically ill older patients with AKI.

Methods

A prospective, observational study was conducted in a university teaching hospital. One hundred and five critically ill older patients with AKI aged 60–95 were enrolled and were divided into survival group (n=44) and non-survival group (n=61) in the light of their final outcomes. Receiver operating characteristic analyses (ROC) were performed to calculate the area under ROC curve (AUC). Sensitivity and specificity of in-hospital mortality prediction were calculated.

Results

Significant differences were found between the survival group and non-survival group of critically ill older patients with AKI. AUC of low density lipoprotein (LDL) and albumin were 0.686 and 0.595, respectively. The asymptotic 95% confidence intervals of LDL and albumin were 0.524–0.820 and 0.488–0.696, respectively. Sensitivity of the 90 days in-hospital mortality prediction of LDL and albumin were 68.71% and 69.09%, respectively. Specificity of 90 days in-hospital mortality prediction of LDL and albumin were 69.23% and 50.0%, respectively.

Conclusion

LDL and albumin did not have sufficient power to predict the 90 days in-hospital mortality of critically ill older patients with AKI. Further research on the association between malnutrition and poor prognosis of critically ill older patients with AKI is needed in the future.

Trial registration: ClinicalTrials.gov identifier: NCT0953992.

Keywords:

• critically ill older patients
• acute kidney injury
• mortality
• nutritional related biomarker

Acknowledgment

The authors gratefully acknowledge Mrs Fen Zhang for the assistance with medical statistics.

Abbreviations

AKI, acute kidney injury; ROC, receiver operating characteristic analyses; AUC, area under receiver operating characteristic analyses curve; LDL, low density lipoprotein; RIFLE, risk, injury, failure, loss, or end-stage kidney disease criteria; Cho, serum total cholesterol; HDL, high density lipoprotein; BMI, body mass index; RRT, renal replacement therapy; SOFA, sepsis-related organ failure assessment; APACHE II, version II of Acute physiology and chronic health evaluation II; SAPS II, Simplified acute physiology score; MODS, multiple organ dysfunction syndrome; ICU, intensive care unit.

Ethics Approval And Informed Consent

The protocol for this research project has been approved by the Ethics Committee of Huashan Hospital, Fudan University, and the reference number is 2009-206.

Data Availability

All data generated or analysed during this study are included in this published article.

Author Contributions

Yu Gong, Feng Ding, and Yong Gu contributed substantially to the conception and design, acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure

The authors report no conflicts of interest in this work.