Costs and outcomes of acute kidney injury in critically ill patients with cancer

J Support Oncol. Jul-Aug 2011;9(4):149-55. doi: 10.1016/j.suponc.2011.03.008.

Abstract

Background: Acute kidney injury (AKI) is a common complication in critically ill patients with cancer. The RIFLE criteria define three levels of AKI based on the percent increase in serum creatinine (Scr) from baseline: risk (> or = 50%), injury (> or = 100%), and failure (> or = 200% or requiring dialysis). The utility of the RIFLE criteria in critically ill patients with cancer is not known.

Objective: To examine the incidence, outcomes, and costs associated with AKI in critically ill patients with cancer.

Methods: We retrospectively analyzed all patients admitted to a single-center ICU over a 13-month period with a baseline Scr < or = 1.5 mg/dL (n = 2,398). Kaplan-Meier estimates for survival by RIFLE category were calculated. Logistic regression was used to determine the association of AKI on 60-day mortality. A log-linear regression model was used for economic analysis. Costs were assessed by hospital charges from the provider's perspective.

Results: For the risk, injury, and failure categories of AKI, incidence rates were 6%, 2.8%, and 3.7%; 60-day survival estimates were 62%, 45%, and 14%; and adjusted odds ratios for 60-day mortality were 2.3, 3, and 14.3, respectively (P < or = 0.001 compared to patients without AKI). Hematologic malignancy and hematopoietic cell transplant were not associated with mortality in the adjusted analysis. Hospital cost increased by 0.16% per 1% increase in creatinine and by 21% for patients requiring dialysis.

Limitations: Retrospective analysis. Single-center study. No adjustment by cost-to-charge ratios.

Conclusions: AKI is associated with higher mortality and costs in critically ill patients with cancer.

MeSH terms

  • Acute Kidney Injury / economics*
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / mortality
  • Aged
  • Creatinine / blood
  • Critical Illness / economics*
  • Female
  • Hospital Costs*
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Neoplasms / complications*
  • Retrospective Studies

Substances

  • Creatinine