Association Between Serum Osmolality and Acute Kidney Injury in Critically Ill Patients: A Retrospective Cohort Study.

Jie Yang,Bo Wang,Ruoran Wang,Yisong Cheng

doi:10.3389/fmed.2021.745803

Jie Yang, Bo Wang + Show 2 more

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https://doi.org/10.3389/fmed.2021.745803

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Abstract

Purposes: Acute kidney injury (AKI) is a common complication in critically ill patients and is usually associated with poor outcomes. Serum osmolality has been validated in predicting critically ill patient mortality. However, data about the association between serum osmolality and AKI is still lacking in ICU. Therefore, the purpose of the present study was to investigate the association between early serum osmolality and the development of AKI in critically ill patients.Methods: The present study was a retrospective cohort analysis based on the medical information mart for intensive care III (MIMIC-III) database. 20,160 patients were involved in this study and divided into six subgroups according to causes for ICU admission. The primary outcome was the incidence of AKI after ICU admission. The association between early serum osmolality and AKI was explored using univariate and multivariate logistic regression analyses.Results: The normal range of serum osmolality was 285–300 mmol/L. High serum osmolality was defined as serum osmolality >300 mmol/L and low serum osmolality was defined as serum osmolality <285 mmol/L. Multivariate logistic regression indicated that high serum osmolality was independently associated with increased development of AKI with OR = 1.198 (95% CL = 1.199–1.479, P < 0.001) and low serum osmolality was also independently associated with increased development of AKI with OR = 1.332 (95% CL = 1.199–1.479, P < 0.001), compared with normal serum osmolality, respectively.Conclusions: In critically ill patients, early high serum osmolality and low serum osmolality were both independently associated with an increased risk of development of AKI.

Highlights

Acute kidney injury (AKI) is a common clinical syndrome characterized by a quick decrease in renal function within a short time, with an obvious accumulation of creatinine and urea or a decrease in urinary output [1, 2]
Multivariate logistic regression indicated that high serum osmolality was independently associated with increased development of AKI with OR = 1.198 (95% CL = 1.199–1.479, P < 0.001) and low serum osmolality was independently associated with increased development of AKI with OR = 1.332 (95% CL = 1.199–1.479, P < 0.001), compared with normal serum osmolality, respectively
In critically ill patients, early high serum osmolality and low serum osmolality were both independently associated with an increased risk of development of AKI

Summary

Introduction

Acute kidney injury (AKI) is a common clinical syndrome characterized by a quick decrease in renal function within a short time, with an obvious accumulation of creatinine and urea or a decrease in urinary output [1, 2]. The primary potential pathogenesis of AKI may be renal cell injury due to unstable hemodynamics, systemic inflammation, or sepsis [3]. Previous studies reported that the development of AKI was commonly associated with patient poor outcomes including prolonged length of hospital stay and increased mortality [7, 8]. The number of investigations and researches on AKI in critically ill patients was continuously increasing and relevant results were discovered. Such as trauma, increased blood lactate, shock, old age, red blood cell distribution width (RDW), and increased procalcitonin were investigated to be independent risk factors for the development of AKI [9,10,11,12]

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