Abstract: FR-PO108
Real-World Evidence on the Impact of Incident AKI on Mortality, Healthcare Resource Utilization, and Costs Among Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass (CPB) from US Hospitals
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Declue, Richard W., Janssen Research and Development LLC, Raritan, New Jersey, United States
- Park, Jonghanne, Janssen Research and Development LLC, Raritan, New Jersey, United States
- Emont, Seth, Premier Inc, Charlotte, North Carolina, United States
- Cao, Zhun, Premier Inc, Charlotte, North Carolina, United States
- Tyagi, Manu, Premier Inc, Charlotte, North Carolina, United States
- Lipkin, Craig Bennett, Premier Inc, Charlotte, North Carolina, United States
- Ajmani, Vivek B., Premier Inc, Charlotte, North Carolina, United States
- Wong, Peggy H., Janssen Research and Development LLC, Raritan, New Jersey, United States
- Breyer, Matthew Douglas, Janssen Research and Development LLC, Raritan, New Jersey, United States
- Dishy, Victor, Janssen Research and Development LLC, Raritan, New Jersey, United States
- Makimura, Hideo, Janssen Research and Development LLC, Raritan, New Jersey, United States
Background
AKI is among the most common complications in hospitalized patients, including 100,000 US cases per year in patients undergoing CPB. AKI is underdiagnosed and its severity is not routinely captured by ICD-10 codes. Therefore, we used serum creatinine (SCr) values (i.e., KDIGO criteria) to evaluate the true impact of AKI on mortality, healthcare resource utilization (HCRU), and costs among inpatients undergoing CPB.
Methods
Using an all-payer US hospital-based database, this retrospective cohort study included adult patients undergoing CPB with an index visit between January 2018 and December 2020. All-cause death, HCRU, and index hospitalization costs were described by AKI stage. Incident AKI and staging were defined by KDIGO criteria and/or an ICD-10 (or dialysis procedure) code at index. Propensity score matching was used to create matched cohorts to address differences in demographic and clinical characteristics between patients with severe AKI (stage 2/3) and no or mild AKI (stage 1). A comparison by presence vs absence of AKI by ICD-10 code was done as a reference.
Results
More severe AKI was associated with higher risk of death and greater HCRU (Table). Adjusted analysis indicated independent associations of severe AKI with 34.1x and 2.5x higher odds of death and 30-day readmission, mean LOS increase of 9.8 days, and mean increased costs of $58.4k compared to confirmed non-AKI or AKI stage 1. The impact of severe AKI was underestimated for ICD-10 AKI diagnosis vs. absent: 9.3x and 1.9x higher odds of death and 30-day readmission, mean LOS increase of 5.4 days, and mean increased costs of $25.5k.
Conclusion
Severe AKI in patients undergoing CPB is associated with significantly high mortality, HCRU, and cost compared to no or mild AKI. ICD-code based definition can underestimate the impact of AKI.
Mortality, HCRU, and Costs by AKI stage
| AKI Stage | Mortality at Index (%) | 30-Day Readmission (%) | Index LOS (Mean Days) | Index Hospitalization Costs (Mean) |
| Confirmed non-AKI | 0.4 | 8.9 | 8.9 | $43,960 |
| Stage 1 | 2.6 | 15.0 | 13.1 | $63,486 |
| Stage 2 | 13.3 | 22.0 | 20.8 | $101,569 |
| Stage 3 w/o dialysis | 17.8 | 22.2 | 21.9 | $104,465 |
| Stage 3 w/ new dialysis | 39.2 | 26.2 | 26.1 | $166,222 |
Funding
- Commercial Support – Janssen Research & Development