Incident infection following acute kidney injury with recovery to baseline creatinine: A propensity score matched analysis

Severe acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with incident infection is unknown. We hypothesized that risk of both short and long term infection would be higher among patients with AKI and return to ba...

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Vydané v:	PloS one Ročník 14; číslo 6; s. e0217935
Hlavní autori:	Griffin, Benjamin R., You, Zhiying, Holmen, John, SooHoo, Megan, Gist, Katja M., Colbert, James F., Chonchol, Michel, Faubel, Sarah, Jovanovich, Anna
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States Public Library of Science 24.06.2019 Public Library of Science (PLoS)
Predmet:	Acute kidney failure Acute Kidney Injury - blood Acute Kidney Injury - complications Biology and Life Sciences Care and treatment Case-Control Studies Chronic illnesses Creatinine Creatinine - blood Critical care Economic aspects Epidemiology Female Health care Health care costs Health care policy Hemodialysis Hospital admission and discharge Hospital patients Hospitalization Hospitals Humans Hypertension Infection Infections Infections - blood Infections - complications Infectious diseases Injury analysis Kidney diseases Kidneys Male Matched-Pair Analysis Medicine and Health Sciences Middle Aged Morbidity Mortality Nephrology Patient outcomes Patients Pediatrics Propensity Score Recovery (Medical) Renal replacement therapy Sepsis Studies Surgery Survival Analysis England United Kingdom > UK United States > US Colorado
ISSN:	1932-6203, 1932-6203
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Abstract	Severe acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with incident infection is unknown. We hypothesized that risk of both short and long term infection would be higher among patients with AKI and return to baseline creatinine than in propensity score matched peers without AKI in the year following a non-infectious hospital admission. Retrospective, propensity score matched cohort study. We identified 494 patients who were hospitalized between January 1, 1999 and December 31, 2009 and had AKI followed by return to baseline creatinine. These were propensity score matched to controls without AKI. The predictor variable was AKI defined by International Classification of Diseases, Ninth Revision (ICD-9) codes and by the Kidney Disease Improving Global Outcomes definition, with return to baseline creatinine defined as a decrease in serum creatinine level to within 10% of the baseline value within 7 days of hospital discharge. The outcome variable was incident infection defined by ICD-9 code within 1 year of hospital discharge. AKI followed by return to baseline creatinine was associated with a 4.5-fold increased odds ratio for infection (odds ratio 4.53 [95% CI, 2.43-8.45]; p<0.0001) within 30 days following discharge. The association between AKI and subsequent infection remained significant at 31-60 days and 91 to 365 days but not during 61-90 days following discharge. Among patients from an integrated health care delivery system, non-infectious AKI followed by return to baseline creatinine was associated with an increased odds ratio for infection in the year following discharge.
AbstractList	Background Severe acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with incident infection is unknown. Objective We hypothesized that risk of both short and long term infection would be higher among patients with AKI and return to baseline creatinine than in propensity score matched peers without AKI in the year following a non-infectious hospital admission. Design Retrospective, propensity score matched cohort study. Participants We identified 494 patients who were hospitalized between January 1, 1999 and December 31, 2009 and had AKI followed by return to baseline creatinine. These were propensity score matched to controls without AKI. Main Measures The predictor variable was AKI defined by International Classification of Diseases, Ninth Revision (ICD-9) codes and by the Kidney Disease Improving Global Outcomes definition, with return to baseline creatinine defined as a decrease in serum creatinine level to within 10% of the baseline value within 7 days of hospital discharge. The outcome variable was incident infection defined by ICD-9 code within 1 year of hospital discharge. Results AKI followed by return to baseline creatinine was associated with a 4.5-fold increased odds ratio for infection (odds ratio 4.53 [95% CI, 2.43-8.45]; p<0.0001) within 30 days following discharge. The association between AKI and subsequent infection remained significant at 31-60 days and 91 to 365 days but not during 61-90 days following discharge. Conclusion Among patients from an integrated health care delivery system, non-infectious AKI followed by return to baseline creatinine was associated with an increased odds ratio for infection in the year following discharge. Background Severe acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with incident infection is unknown. Objective We hypothesized that risk of both short and long term infection would be higher among patients with AKI and return to baseline creatinine than in propensity score matched peers without AKI in the year following a non-infectious hospital admission. Design Retrospective, propensity score matched cohort study. Participants We identified 494 patients who were hospitalized between January 1, 1999 and December 31, 2009 and had AKI followed by return to baseline creatinine. These were propensity score matched to controls without AKI. Main Measures The predictor variable was AKI defined by International Classification of Diseases, Ninth Revision (ICD-9) codes and by the Kidney Disease Improving Global Outcomes definition, with return to baseline creatinine defined as a decrease in serum creatinine level to within 10% of the baseline value within 7 days of hospital discharge. The outcome variable was incident infection defined by ICD-9 code within 1 year of hospital discharge. Results AKI followed by return to baseline creatinine was associated with a 4.5-fold increased odds ratio for infection (odds ratio 4.53 [95% CI, 2.43–8.45]; p<0.0001) within 30 days following discharge. The association between AKI and subsequent infection remained significant at 31–60 days and 91 to 365 days but not during 61–90 days following discharge. Conclusion Among patients from an integrated health care delivery system, non-infectious AKI followed by return to baseline creatinine was associated with an increased odds ratio for infection in the year following discharge. Severe acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with incident infection is unknown.BACKGROUNDSevere acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with incident infection is unknown.We hypothesized that risk of both short and long term infection would be higher among patients with AKI and return to baseline creatinine than in propensity score matched peers without AKI in the year following a non-infectious hospital admission.OBJECTIVEWe hypothesized that risk of both short and long term infection would be higher among patients with AKI and return to baseline creatinine than in propensity score matched peers without AKI in the year following a non-infectious hospital admission.Retrospective, propensity score matched cohort study.DESIGNRetrospective, propensity score matched cohort study.We identified 494 patients who were hospitalized between January 1, 1999 and December 31, 2009 and had AKI followed by return to baseline creatinine. These were propensity score matched to controls without AKI.PARTICIPANTSWe identified 494 patients who were hospitalized between January 1, 1999 and December 31, 2009 and had AKI followed by return to baseline creatinine. These were propensity score matched to controls without AKI.The predictor variable was AKI defined by International Classification of Diseases, Ninth Revision (ICD-9) codes and by the Kidney Disease Improving Global Outcomes definition, with return to baseline creatinine defined as a decrease in serum creatinine level to within 10% of the baseline value within 7 days of hospital discharge. The outcome variable was incident infection defined by ICD-9 code within 1 year of hospital discharge.MAIN MEASURESThe predictor variable was AKI defined by International Classification of Diseases, Ninth Revision (ICD-9) codes and by the Kidney Disease Improving Global Outcomes definition, with return to baseline creatinine defined as a decrease in serum creatinine level to within 10% of the baseline value within 7 days of hospital discharge. The outcome variable was incident infection defined by ICD-9 code within 1 year of hospital discharge.AKI followed by return to baseline creatinine was associated with a 4.5-fold increased odds ratio for infection (odds ratio 4.53 [95% CI, 2.43-8.45]; p<0.0001) within 30 days following discharge. The association between AKI and subsequent infection remained significant at 31-60 days and 91 to 365 days but not during 61-90 days following discharge.RESULTSAKI followed by return to baseline creatinine was associated with a 4.5-fold increased odds ratio for infection (odds ratio 4.53 [95% CI, 2.43-8.45]; p<0.0001) within 30 days following discharge. The association between AKI and subsequent infection remained significant at 31-60 days and 91 to 365 days but not during 61-90 days following discharge.Among patients from an integrated health care delivery system, non-infectious AKI followed by return to baseline creatinine was associated with an increased odds ratio for infection in the year following discharge.CONCLUSIONAmong patients from an integrated health care delivery system, non-infectious AKI followed by return to baseline creatinine was associated with an increased odds ratio for infection in the year following discharge. Severe acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with incident infection is unknown. We hypothesized that risk of both short and long term infection would be higher among patients with AKI and return to baseline creatinine than in propensity score matched peers without AKI in the year following a non-infectious hospital admission. Retrospective, propensity score matched cohort study. We identified 494 patients who were hospitalized between January 1, 1999 and December 31, 2009 and had AKI followed by return to baseline creatinine. These were propensity score matched to controls without AKI. AKI followed by return to baseline creatinine was associated with a 4.5-fold increased odds ratio for infection (odds ratio 4.53 [95% CI, 2.43-8.45]; p<0.0001) within 30 days following discharge. The association between AKI and subsequent infection remained significant at 31-60 days and 91 to 365 days but not during 61-90 days following discharge. Among patients from an integrated health care delivery system, non-infectious AKI followed by return to baseline creatinine was associated with an increased odds ratio for infection in the year following discharge. BackgroundSevere acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with incident infection is unknown.ObjectiveWe hypothesized that risk of both short and long term infection would be higher among patients with AKI and return to baseline creatinine than in propensity score matched peers without AKI in the year following a non-infectious hospital admission.DesignRetrospective, propensity score matched cohort study.ParticipantsWe identified 494 patients who were hospitalized between January 1, 1999 and December 31, 2009 and had AKI followed by return to baseline creatinine. These were propensity score matched to controls without AKI.Main measuresThe predictor variable was AKI defined by International Classification of Diseases, Ninth Revision (ICD-9) codes and by the Kidney Disease Improving Global Outcomes definition, with return to baseline creatinine defined as a decrease in serum creatinine level to within 10% of the baseline value within 7 days of hospital discharge. The outcome variable was incident infection defined by ICD-9 code within 1 year of hospital discharge.ResultsAKI followed by return to baseline creatinine was associated with a 4.5-fold increased odds ratio for infection (odds ratio 4.53 [95% CI, 2.43-8.45]; p<0.0001) within 30 days following discharge. The association between AKI and subsequent infection remained significant at 31-60 days and 91 to 365 days but not during 61-90 days following discharge.ConclusionAmong patients from an integrated health care delivery system, non-infectious AKI followed by return to baseline creatinine was associated with an increased odds ratio for infection in the year following discharge. Severe acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with incident infection is unknown. We hypothesized that risk of both short and long term infection would be higher among patients with AKI and return to baseline creatinine than in propensity score matched peers without AKI in the year following a non-infectious hospital admission. Retrospective, propensity score matched cohort study. We identified 494 patients who were hospitalized between January 1, 1999 and December 31, 2009 and had AKI followed by return to baseline creatinine. These were propensity score matched to controls without AKI. The predictor variable was AKI defined by International Classification of Diseases, Ninth Revision (ICD-9) codes and by the Kidney Disease Improving Global Outcomes definition, with return to baseline creatinine defined as a decrease in serum creatinine level to within 10% of the baseline value within 7 days of hospital discharge. The outcome variable was incident infection defined by ICD-9 code within 1 year of hospital discharge. AKI followed by return to baseline creatinine was associated with a 4.5-fold increased odds ratio for infection (odds ratio 4.53 [95% CI, 2.43-8.45]; p<0.0001) within 30 days following discharge. The association between AKI and subsequent infection remained significant at 31-60 days and 91 to 365 days but not during 61-90 days following discharge. Among patients from an integrated health care delivery system, non-infectious AKI followed by return to baseline creatinine was associated with an increased odds ratio for infection in the year following discharge.
Audience	Academic
Author	Griffin, Benjamin R. Colbert, James F. Chonchol, Michel Gist, Katja M. Jovanovich, Anna SooHoo, Megan Faubel, Sarah Holmen, John You, Zhiying
AuthorAffiliation	4 Division of Infectious Diseases, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States of America University of Wisconsin, UNITED STATES 1 Division of Renal Diseases and Hypertension, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States of America 2 Intermountain Healthcare System, Salt Lake City, UT, United States of America 3 Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO, United States of America 5 Renal Section, VA Eastern Colorado Health Care System, Denver, CO, United States of America
AuthorAffiliation_xml	– name: 3 Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO, United States of America – name: 2 Intermountain Healthcare System, Salt Lake City, UT, United States of America – name: 4 Division of Infectious Diseases, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States of America – name: University of Wisconsin, UNITED STATES – name: 1 Division of Renal Diseases and Hypertension, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States of America – name: 5 Renal Section, VA Eastern Colorado Health Care System, Denver, CO, United States of America
Author_xml	– sequence: 1 givenname: Benjamin R. surname: Griffin fullname: Griffin, Benjamin R. – sequence: 2 givenname: Zhiying surname: You fullname: You, Zhiying – sequence: 3 givenname: John orcidid: 0000-0003-1852-5174 surname: Holmen fullname: Holmen, John – sequence: 4 givenname: Megan surname: SooHoo fullname: SooHoo, Megan – sequence: 5 givenname: Katja M. surname: Gist fullname: Gist, Katja M. – sequence: 6 givenname: James F. surname: Colbert fullname: Colbert, James F. – sequence: 7 givenname: Michel surname: Chonchol fullname: Chonchol, Michel – sequence: 8 givenname: Sarah surname: Faubel fullname: Faubel, Sarah – sequence: 9 givenname: Anna orcidid: 0000-0001-9416-453X surname: Jovanovich fullname: Jovanovich, Anna
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Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Competing Interests: The author, John Holmen, is employed by Intermountain Healthcare System. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
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Snippet	Severe acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with incident... Background Severe acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with... BackgroundSevere acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with... Background Severe acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with...
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SubjectTerms	Acute kidney failure Acute Kidney Injury - blood Acute Kidney Injury - complications Biology and Life Sciences Care and treatment Case-Control Studies Chronic illnesses Creatinine Creatinine - blood Critical care Economic aspects Epidemiology Female Health care Health care costs Health care policy Hemodialysis Hospital admission and discharge Hospital patients Hospitalization Hospitals Humans Hypertension Infection Infections Infections - blood Infections - complications Infectious diseases Injury analysis Kidney diseases Kidneys Male Matched-Pair Analysis Medicine and Health Sciences Middle Aged Morbidity Mortality Nephrology Patient outcomes Patients Pediatrics Propensity Score Recovery (Medical) Renal replacement therapy Sepsis Studies Surgery Survival Analysis
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Title	Incident infection following acute kidney injury with recovery to baseline creatinine: A propensity score matched analysis
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