• Jill Vanmassenhove, Norbert Lameire, Annemieke Dhondt, Raymond Vanholder, and Wim Van Biesen.
• Renal Division, Ghent University Hospital, Nephrology section, 0 K12, University Hospital, De Pintelaan 185, B9000, Ghent, Belgium. Jill.Vanmassenhove@ugent.be.
• Bmc Nephrol. 2015 Jul 22; 16: 112.

BackgroundIt is unclear how modifications in the way to calculate serum creatinine (sCr) increase and in the cut-off value applied, influences the prognostic value of Acute Kidney Injury (AKI). We wanted to evaluate whether these modifications alter the prognostic value of AKI for prediction of mortality at 3 months, 1 and 2 years.MethodsWe prospectively included 195 septic patients and evaluated the prognostic value of AKI by using three different algorithms to calculate sCr increase: either as the difference between the highest value in the first 24 h after ICU admission and a pre-admission historical (ΔHIS) or an estimated (ΔEST) baseline value, or by subtracting the ICU admission value from the sCr value 24 h after ICU admission (ΔADM). Different cut-off levels of sCr increase (0.1, 0.2, 0.3, 0.4 and 0.5 mg/dl) were evaluated.ResultsMortality at 3 months, 1 and 2 years in AKI defined as ΔADM > 0.3 mg/dl was 48.1 %, 63.0 % and 63.0 % vs 27.7 %, 39.8 % and 47.6 % in no AKI respectively (OR(95%CI): 2.42(1.06-5.54), 2.58(1.11-5.97) and 1.87(0.81-4.33); 0.3 mg/dl was the lowest cut-off value that was discriminatory. When AKI was defined as ΔHIS > 0.3 mg/dl or ΔEST > 0.3 mg/dl, there was no significant difference in mortality between AKI and no AKI.ConclusionsThe prognostic value of a 0.3 mg/dl increase in sCr, on mortality in sepsis, depends on how this sCr increase is calculated. Only if the evolution of serum creatinine over the first 24 h after ICU admission is taken into account, an association with mortality is found.

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