CHEST Guidelines-Response_chest

Response_chest_13 (5)

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The correspondence between Drs. Nikita Desai and Imran Iftikhar and the authors of a study examines the effects of intensive monitoring on patients with and without acute kidney injury (AKI). The initial query from Desai and Iftikhar highlights discrepancies between unadjusted and adjusted hazard ratios (HR) for mortality in patients with AKI undergoing intensive urine output (UO) monitoring. They observed that while unadjusted results often indicated statistically significant outcomes, adjusted results for age and APS-III scores showed opposite trends and were often not significant. Specifically, the unadjusted HR for AKI patients with intensive monitoring was significant (HR: 1.47), but the adjusted HR was not (HR: 1.10). Similarly, for non-AKI patients monitored intensively for serum creatinine, unadjusted HR was lower (HR: 0.70) versus adjusted HRs which were higher and significant.<br /><br />The response from John A. Kellum and colleagues clarifies that the reference condition in their study was nonintensive monitoring in AKI-positive patients. They point out that in both intensive and nonintensive monitoring groups, AKI-negative patients had better outcomes compared to the reference group, confirming that not having AKI correlates with better survival. They address possible misunderstandings in their presentation and confirm that older age and higher APACHE scores are associated with worse outcomes.<br /><br />Moreover, the authors verify that extended modeling to one year did not change the outcome, countering the hypothesis that differences might become significant if monitoring extended beyond 30 days. This reaffirms their stance that the intensity of monitoring may primarily influence short-term survival.

Keywords

acute kidney injury

intensive monitoring

hazard ratios

mortality

urine output

serum creatinine

unadjusted vs adjusted

APACHE scores

short-term survival

study correspondence