SOFA coagulation score and changes in platelet counts in severe acute kidney injury: analysis from the randomized evaluation of normal versus augmented level (RENAL) study

Jin Lin, Martin Gallagher, Rinaldo Bellomo, Meili Duan, Konlawi Trongtrakul, Amanda Ying Wang, The RENAL Study Investigators, ANZICS Clinical Trials Group

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Aim: To evaluate the prognostic value of baseline SOFA coagulation score (SOFA-CS) and change in platelet counts in patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Methods: We performed a secondary analysis from the Randomized Evaluation of Normal versus Augmented Level of RRT (RENAL) study. The primary endpoint was all-cause mortality at 90 days after randomization. The association between baseline SOFA-CS, changes in platelet counts, process of care, and clinical outcomes were analyzed using multivariate Cox model adjusted for baseline variables. Results: The complete SOFA-CS data were available in 1454 out of 1508 patients from the RENAL study. Among them, 708 patients had an abnormal SOFA-CS (defined as SOFA-CS ≥ 1), while 746 patients had normal SOFA-CS at baseline (SOFA-CS = 0). An abnormal SOFA-CS was independently associated with an increased risk of death at 90 days (HR = 1.27, 95% CI = 1.05-1.53, P = 0.015). An abnormal SOFA-CS was associated with prolonged length of ICU stay and duration of mechanical ventilation as well. Furthermore, there was no significant association between changes in platelet counts in patients who survived beyond 4 days and 90 day mortality (HR = 1.26, 95% CI = 0.29-5.56, P = 0.76). However, on multivariable analysis a decline of ≥60% (HR = 1.93, 95% CI = 1.23-3.05, P = 0.004) was associated with 90 day mortality in patients who survived beyond the first 4 days. Conclusions: In the RENAL study, thrombocytopaenia is a common phenomenon in patients with severe AKI receiving CRRT. An abnormal baseline SOFA-CS and reductions in platelet counts were associated with increased mortality at 90 days.

LanguageEnglish
Pages518-525
Number of pages8
JournalNephrology (Carlton, Vic.)
Volume24
Issue number5
DOIs
Publication statusPublished - 1 May 2019

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Platelet Count
Acute Kidney Injury
Renal Replacement Therapy
Mortality
Random Allocation
Artificial Respiration
Proportional Hazards Models
Length of Stay

Keywords

  • acute kidney injury
  • mortality
  • renal replacement therapy
  • SOFA coagulation score

Cite this

Lin, Jin ; Gallagher, Martin ; Bellomo, Rinaldo ; Duan, Meili ; Trongtrakul, Konlawi ; Wang, Amanda Ying ; The RENAL Study Investigators ; ANZICS Clinical Trials Group. / SOFA coagulation score and changes in platelet counts in severe acute kidney injury : analysis from the randomized evaluation of normal versus augmented level (RENAL) study. In: Nephrology (Carlton, Vic.). 2019 ; Vol. 24, No. 5. pp. 518-525.
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title = "SOFA coagulation score and changes in platelet counts in severe acute kidney injury: analysis from the randomized evaluation of normal versus augmented level (RENAL) study",
abstract = "Aim: To evaluate the prognostic value of baseline SOFA coagulation score (SOFA-CS) and change in platelet counts in patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Methods: We performed a secondary analysis from the Randomized Evaluation of Normal versus Augmented Level of RRT (RENAL) study. The primary endpoint was all-cause mortality at 90 days after randomization. The association between baseline SOFA-CS, changes in platelet counts, process of care, and clinical outcomes were analyzed using multivariate Cox model adjusted for baseline variables. Results: The complete SOFA-CS data were available in 1454 out of 1508 patients from the RENAL study. Among them, 708 patients had an abnormal SOFA-CS (defined as SOFA-CS ≥ 1), while 746 patients had normal SOFA-CS at baseline (SOFA-CS = 0). An abnormal SOFA-CS was independently associated with an increased risk of death at 90 days (HR = 1.27, 95{\%} CI = 1.05-1.53, P = 0.015). An abnormal SOFA-CS was associated with prolonged length of ICU stay and duration of mechanical ventilation as well. Furthermore, there was no significant association between changes in platelet counts in patients who survived beyond 4 days and 90 day mortality (HR = 1.26, 95{\%} CI = 0.29-5.56, P = 0.76). However, on multivariable analysis a decline of ≥60{\%} (HR = 1.93, 95{\%} CI = 1.23-3.05, P = 0.004) was associated with 90 day mortality in patients who survived beyond the first 4 days. Conclusions: In the RENAL study, thrombocytopaenia is a common phenomenon in patients with severe AKI receiving CRRT. An abnormal baseline SOFA-CS and reductions in platelet counts were associated with increased mortality at 90 days.",
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Lin, J, Gallagher, M, Bellomo, R, Duan, M, Trongtrakul, K, Wang, AY, The RENAL Study Investigators & ANZICS Clinical Trials Group 2019, 'SOFA coagulation score and changes in platelet counts in severe acute kidney injury: analysis from the randomized evaluation of normal versus augmented level (RENAL) study', Nephrology (Carlton, Vic.), vol. 24, no. 5, pp. 518-525. https://doi.org/10.1111/nep.13387

SOFA coagulation score and changes in platelet counts in severe acute kidney injury : analysis from the randomized evaluation of normal versus augmented level (RENAL) study. / Lin, Jin; Gallagher, Martin; Bellomo, Rinaldo; Duan, Meili; Trongtrakul, Konlawi; Wang, Amanda Ying; The RENAL Study Investigators; ANZICS Clinical Trials Group.

In: Nephrology (Carlton, Vic.), Vol. 24, No. 5, 01.05.2019, p. 518-525.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - SOFA coagulation score and changes in platelet counts in severe acute kidney injury

T2 - Nephrology

AU - Lin, Jin

AU - Gallagher, Martin

AU - Bellomo, Rinaldo

AU - Duan, Meili

AU - Trongtrakul, Konlawi

AU - Wang, Amanda Ying

AU - The RENAL Study Investigators

AU - ANZICS Clinical Trials Group

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Aim: To evaluate the prognostic value of baseline SOFA coagulation score (SOFA-CS) and change in platelet counts in patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Methods: We performed a secondary analysis from the Randomized Evaluation of Normal versus Augmented Level of RRT (RENAL) study. The primary endpoint was all-cause mortality at 90 days after randomization. The association between baseline SOFA-CS, changes in platelet counts, process of care, and clinical outcomes were analyzed using multivariate Cox model adjusted for baseline variables. Results: The complete SOFA-CS data were available in 1454 out of 1508 patients from the RENAL study. Among them, 708 patients had an abnormal SOFA-CS (defined as SOFA-CS ≥ 1), while 746 patients had normal SOFA-CS at baseline (SOFA-CS = 0). An abnormal SOFA-CS was independently associated with an increased risk of death at 90 days (HR = 1.27, 95% CI = 1.05-1.53, P = 0.015). An abnormal SOFA-CS was associated with prolonged length of ICU stay and duration of mechanical ventilation as well. Furthermore, there was no significant association between changes in platelet counts in patients who survived beyond 4 days and 90 day mortality (HR = 1.26, 95% CI = 0.29-5.56, P = 0.76). However, on multivariable analysis a decline of ≥60% (HR = 1.93, 95% CI = 1.23-3.05, P = 0.004) was associated with 90 day mortality in patients who survived beyond the first 4 days. Conclusions: In the RENAL study, thrombocytopaenia is a common phenomenon in patients with severe AKI receiving CRRT. An abnormal baseline SOFA-CS and reductions in platelet counts were associated with increased mortality at 90 days.

AB - Aim: To evaluate the prognostic value of baseline SOFA coagulation score (SOFA-CS) and change in platelet counts in patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Methods: We performed a secondary analysis from the Randomized Evaluation of Normal versus Augmented Level of RRT (RENAL) study. The primary endpoint was all-cause mortality at 90 days after randomization. The association between baseline SOFA-CS, changes in platelet counts, process of care, and clinical outcomes were analyzed using multivariate Cox model adjusted for baseline variables. Results: The complete SOFA-CS data were available in 1454 out of 1508 patients from the RENAL study. Among them, 708 patients had an abnormal SOFA-CS (defined as SOFA-CS ≥ 1), while 746 patients had normal SOFA-CS at baseline (SOFA-CS = 0). An abnormal SOFA-CS was independently associated with an increased risk of death at 90 days (HR = 1.27, 95% CI = 1.05-1.53, P = 0.015). An abnormal SOFA-CS was associated with prolonged length of ICU stay and duration of mechanical ventilation as well. Furthermore, there was no significant association between changes in platelet counts in patients who survived beyond 4 days and 90 day mortality (HR = 1.26, 95% CI = 0.29-5.56, P = 0.76). However, on multivariable analysis a decline of ≥60% (HR = 1.93, 95% CI = 1.23-3.05, P = 0.004) was associated with 90 day mortality in patients who survived beyond the first 4 days. Conclusions: In the RENAL study, thrombocytopaenia is a common phenomenon in patients with severe AKI receiving CRRT. An abnormal baseline SOFA-CS and reductions in platelet counts were associated with increased mortality at 90 days.

KW - acute kidney injury

KW - mortality

KW - renal replacement therapy

KW - SOFA coagulation score

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U2 - 10.1111/nep.13387

DO - 10.1111/nep.13387

M3 - Article

VL - 24

SP - 518

EP - 525

JO - Nephrology

JF - Nephrology

SN - 1320-5358

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ER -