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Title: SOFA coagulation score and changes in platelet counts in severe acute kidney injury: analysis from the Randomised Evaluation of Normal versus Augmented Level(RENAL)study.
Austin Authors: Lin, Jin;Gallagher, Martin;Bellomo, Rinaldo ;Duan, Meili;Trongtrakul, Konlawi;Wang, Amanda Ying
Affiliation: The George Institute for Global Health, UNSW, Sydney, Australia
Beijing Friendship Hospital, Capital Medical University, China
Concord Repatriation General Hospital, Concord, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Faculty of Medicine & Health Sciences. Macquarie University, NSW, Australia
Issue Date: May-2019 2018-04-24
Publication information: Nephrology 2019; 24(5): 518-525
Abstract: 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). We performed a secondary analysis from the Randomised Evaluation of Normal versus Augmented Level of RRT (RENAL) study. The primary endpoint was all-cause mortality at 90 days after randomisation. The association between baseline SOFA-CS, changes in platelet counts, process of care, and clinical outcomes were analysed using multivariate Cox model adjusted for baseline variables. 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. In the RENAL study, thrombocytopenia 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.
DOI: 10.1111/nep.13387
ORCID: 0000-0002-1650-8939
PubMed URL: 29693303
Type: Journal Article
Subjects: Acute kidney injury
SOFA coagulation score
renal replacement therapy
Appears in Collections:Journal articles

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