5) Acute Kidney Injury Predicts Outcomes of Non-Critically-Ill Patients
Clinical question: Does acute kidney injury affect in-hospital mortality, need for renal replacement therapy, and length of stay in patients who are not critically ill?
Background: Using the Acute Kidney Injury Network’s definition of acute kidney injury (AKI), including an abrupt increase in creatinine of 0.3 mg/dL, the authors previously showed an association with poor outcomes in critically ill patients. There is less evidence as to whether it predicts outcomes in non-critically-ill patients.
Study design: Retrospective cohort and a case-control study.
Setting: Bridgeport (Conn.) Hospital, a 350-bed community teaching hospital affiliated with Yale New Haven Health System.
Synopsis: Seven hundred thirty-five patients admitted to a medical unit who developed AKI, defined as a serum creatinine increase of 0.3 mg/dL or more within a 48-hour period, were compared to 5,089 controls. Patients who were admitted to critical care or who received RRT within the first 48 hours were excluded. AKI patients had higher in-hospital mortality of 14.8%, compared with 1.5% of controls, longer hospital stays of 7.9 versus 3.7 days, higher rates of transfer to the ICU of 28.6% versus 4.3%, and 73 versus zero patients who required renal replacement therapy. All findings were statistically significant (P<0.001). Some patients were omitted because of inadequate data collection.
Two hundred eighty-two patients were randomly selected from each group and matched based on age and demographic characteristics to perform a case-control study. AKI patients were eight times more likely to die in the hospital and five times more likely to have prolonged lengths of stay and transfer to the ICU.
This study does not differentiate between types of AKI and does not show a causal relationship.
Bottom line: AKI, defined as a serum creatinine increase of 0.3 mg/dL or more within a 48-hour period, predicts worse outcomes in non-critically-ill patients.
Citation: Barrantes F, Feng Y, Ivanov O, et al. Acute kidney injury predicts outcomes of non-critically ill patients. Mayo Clin Proc. 2009;84(5):410-416.
6) Statin Therapy after First Stroke Reduces Recurrence and Improves Survival
Clinical question: Does statin therapy after first ischemic stroke reduce recurrence and long-term mortality?
Background: Statin treatment has been shown to reduce primary stroke incidence, but there is less evidence on secondary prevention.
Study design: Retrospective observational study.
Setting: Acute stroke, general medicine, and neurology units at the hospitals affiliated with the University of Ioannina School of Medicine in Athens, Greece.
Synopsis: Seven hundred ninety-four primary ischemic stroke patients were admitted and followed for a 10-year period. Of those, 596 patients were discharged without a statin; 198 patients were discharged on statin therapy. One hundred twelve, or 14.1%, of the 794 patients had a recurrent event. The recurrence rate was 16.3% among those who did not receive a statin versus 7.6% among those who did receive a statin post-discharge (P=0.002).
Bottom line: Post-discharge statin therapy after an initial stroke appears to reduce the risk of recurrence.
Citation: Milionis HJ, Giannopoulos S, Kosmidou M, et al. Statin therapy after first stroke reduces 10-year stroke recurrence and improves survival. Neurology. 2009;72(21):1816-1822.
7) Low-Dose Corticosteroids Provide Modest Benefit to Patients with Vasopressor-Dependent Sepsis and Septic Shock
Clinical question: What are the risks and benefits of corticosteroid treatment in severe sepsis and septic shock?
Background: For more than 50 years, corticosteroids have been used as an adjuvant treatment for sepsis with conflicting benefits on mortality.
Study design: Meta-analysis. Literature Search of Cochrane Library, MEDLINE, EMBASE, and LILACS.