#5418 ASSOCIATION BETWEEN TRANSIENT AKI AND ALL-CAUSE MORTALITY IN PATIENTS WITH CRITICAL ILLNESS: AN INTERNATIONAL MULTICENTRE RETROSPECTIVE COHORT STUDY

Abstract Background and Aims Transient acute kidney injury (AKI) is common in critically ill patients. However, the effect of transient AKI on prognosis of patients remains controversial. We aimed to investigate the association of transit AKI with all-cause mortality and kidney outcomes in critically ill patients. Method We conducted a multicentre retrospective cohort study involving 40168 critically ill patients from CRDS and 8657 patients from MIMIC-IV databases. Among them, 10147 patients were diagnosed as AKI according to KDIGO criteria and classified into transient (duration ≤48 h) and persistent (duration >48 h). The study outcomes included mortality in hospital, by day 30 and up to 1 year, and risk of progress to CKD. We determined the effect of transit AKI on mortality by Cox regression model adjusting for confounding variables and analyzed CKD incidence by Fine-Gray model adjusted for difference in biologically plausible confounders. Results AKI occurred in 20.8% of 48825 critically ill patients, of which 36.4% was classified into transient and 63.6% persistent. Compared with those without AKI, Patients with transit AKI were older, more often received diuretic therapy and sedative therapy, and higher Charlson comorbidity index. After adjusting confounders including AKI severity, transient AKI was independently associated with increased risk of in hospital death (HR 1.97, 95% CI 1.68 to 2.31), 30-day mortality (HR 1.73, 95% CI 1.51 to 1.98) and 1- year mortality (HR 1.31, 95% CI 1.19 to 1.44). Meanwhile, the risk of all-cause mortality increased with the duration of AKI in those with persistent patients (P<0.05). Among survivors without history of CKD, compared with patients without AKI, transient AKI was also associated with increased risk of incident CKD after discharge (HR 1.61, 95% CI 1.33 to 1.96). Conclusion Transient AKI was associated with increased risk of all-cause mortality and incident CKD in critically ill patients. Raising of awareness about transient AKI was required to urge clinician monitor such patients closer.