Do acute elevations of serum XXXX in primary care engender an increased mortality risk?

@entity1 @entity810 @entity1011
BACKGROUND: The significant impact @entity810 ( @entity810 ) has on @entity1 morbidity and mortality emphasizes the need for early recognition and effective treatment. @entity810 presenting to or occurring during hospitalisation has been widely studied but little is known about the incidence and outcomes of @entity1 experiencing acute elevations in serum @entity1011 in the primary care setting where @entity1 are not subsequently admitted to hospital. The aim of this study was to define this incidence and explore its impact on mortality. METHODS: The study cohort was identified by using hospital data bases over a six month period.Inclusion criteria: @entity1 with a serum @entity1011 request during the study period, 18 or over and not on renal replacement therapy.The @entity1 were stratified by a rise in serum @entity1011 corresponding to the @entity810 Network (AKIN) criteria for comparison purposes. Descriptive and survival data were then analysed.Ethical approval was granted from National Research Ethics Service (NRES) Committee South East Coast and from the National Information Governance Board. RESULTS: The total study population was 61,432. 57,300 subjects with 'no @entity810 ', mean age 64.The number (mean age) of acute serum @entity1011 rises overall were, ' @entity810 1' 3,798 (72), ' @entity810 2' 232 (73), and ' @entity810 3' 102 (68) which equates to an overall incidence of 14,192 pmp/year (adult). Unadjusted 30 day survival was 99.9% in subjects with 'no @entity810 ', compared to 98.6%, 90.1% and 82.3% in those with ' @entity810 1', ' @entity810 2' and ' @entity810 3' respectively. After multivariable analysis adjusting for age, gender, baseline kidney function and co-morbidity the odds ratio of 30 day mortality was 5.3 (95% CI 3.6, 7.7), 36.8 (95% CI 21.6, 62.7) and 123 (95% CI 64.8, 235) respectively, compared to those without acute serum @entity1011 rises as defined. CONCLUSIONS: @entity1 who develop acute elevations of serum @entity1011 in primary care without being admitted to hospital have significantly worse outcomes than those with stable kidney function.
