Current classification for acute kidney injury (AKI) in critically ill patients with sepsis relies only on its severity-measured by maximum creatinine which overlooks inherent complexities and longitudinal evaluation of this heterogenous syndrome. The role of classification of AKI based on early creatinine trajectories is unclear. This retrospective study identified patients with Sepsis-3 who developed AKI within 48-h of intensive care unit admission using Medical Information Mart for Intensive Care-IV database. We used latent class mixed modelling to identify early creatinine trajectory-based classes of AKI in critically ill patients with sepsis. Our primary outcome was development of acute kidney disease (AKD). Secondary outcomes were composite of AKD or all-cause in-hospital mortality by day 7, and AKD or all-cause in-hospital mortality by hospital discharge. We used multivariable regression to assess impact of creatinine trajectory-based classification on outcomes, and eICU database for external validation. Among 4197 patients with AKI in critically ill patients with sepsis, we identified eight creatinine trajectory-based classes with distinct characteristics. Compared to the class with transient AKI, the class that showed severe AKI with mild improvement but persistence had highest adjusted risks for developing AKD (OR 5.16; 95% CI 2.87–9.24) and composite 7-day outcome (HR 4.51; 95% CI 2.69–7.56). The class that demonstrated late mild AKI with persistence and worsening had highest risks for developing composite hospital discharge outcome (HR 2.04; 95% CI 1.41–2.94). These associations were similar on external validation. These 8 classes of AKI in critically ill patients with sepsis, stratified by early creatinine trajectories, were good predictors for key outcomes in patients with AKI in critically ill patients with sepsis independent of their AKI staging.

中文翻译：

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机器学习得出的脓毒症危重患者急性肾损伤的血清肌酐轨迹

目前脓毒症危重患者急性肾损伤（AKI）的分类仅依赖于通过最大肌酐测量的严重程度，而忽略了这种异质综合征的固有复杂性和纵向评估。基于早期肌酐轨迹的 AKI 分类的作用尚不清楚。这项回顾性研究使用重症监护 IV 医疗信息集市数据库，确定了进入重症监护病房 48 小时内发生 AKI 的脓毒症 3 型患者。我们使用潜在类别混合模型来识别脓毒症危重患者中基于肌酐轨迹的早期 AKI 类别。我们的主要结局是急性肾病（AKD）的发展。次要结局是第 7 天时的 AKD 或全因院内死亡率，以及出院时的 AKD 或全因院内死亡率。我们使用多变量回归来评估基于肌酐轨迹的分类对结果的影响，并使用 eICU 数据库进行外部验证。在 4197 名脓毒症危重 AKI 患者中，我们确定了八种基于肌酐轨迹的具有独特特征的类别。与短暂性 AKI 类别相比，显示严重 AKI 且轻度改善但持续存在的类别发生 AKD 的调整后风险最高（OR 5.16；95% CI 2.87–9.24）和综合 7 天结果（HR 4.51；95% CI） 2.69–7.56）。表现出晚期轻度 AKI 且持续且恶化的类别出现复合出院结果的风险最高（HR 2.04；95% CI 1.41–2.94）。这些关联在外部验证上是相似的。这 8 类脓毒症危重患者 AKI 按早期肌酐轨迹分层，是脓毒症危重患者 AKI 关键结局的良好预测因子，与 AKI 分期无关。