Baseline predictors of in-hospital mortality among patients with chronic kidney disease admitted to the emergency department

Abstract

BACKGROUND

Chronic kidney disease (CKD) contributes significantly to emergency department (ED) presentations in low- and middle-income countries. These patients frequently have multiple comorbidities and face high in-hospital mortality. However, limited data exist on early predictors of mortality at ED admission. Identifying key clinical and laboratory features associated with adverse outcomes may support timely risk stratification and targeted interventions for acutely ill CKD patients.

AIM

To identify baseline predictors of in-hospital mortality in adult Indian patients with CKD admitted to the ED.

METHODS

This retrospective study was conducted from January 2021 to December 2022 at the Acute Care and Emergency Medicine Unit of the Postgraduate Institute of Medical Education and Research, Chandigarh, India. CKD was diagnosed and staged following the Kidney Disease: Improving Global Outcomes guidelines. Data were extracted from medical records using a structured form. All consecutive patients aged ≥ 18 years were included. Independent mortality predictors were identified using multivariate Cox regression analysis.

RESULTS

Among 354 patients (mean age 49 years; 58% males), 60.5% had CKD stage 5, and 41.2% were on maintenance dialysis. Hypertension (74.9%) and diabetes (46.0%) were common comorbidities. Diabetic kidney disease was the primary etiology in 35.6%, while 43.2% had unknown causes. Infection (63.0%) was the most frequent cause for ED admission. In-hospital mortality was 29.1% (n = 103). Independent mortality predictors were Glasgow coma scale (GCS) < 15 [hazard ratio (HR): 1.822, P = 0.017], hyperglycemia (HR: 1.641, P = 0.020), and low albumin (HR: 1.270, P = 0.028). Advanced age, Charlson comorbidity Index, quick Sequential Organ Failure Assessment, and neutrophilia were significant in univariate but not multivariate analysis. CKD stage, dialysis dependency, cardiovascular disease, and neutrophil-lymphocyte ratio were not predictive.

CONCLUSION

A low GCS, hyperglycemia, and low albumin levels at admission independently predict in-hospital mortality in CKD patients presenting to the ED, warranting early recognition and targeted interventions.

Keywords: Chronic kidney disease; Emergency department; Mortality; Predictor; Prognosis

Core Tip: Despite the high burden of chronic kidney disease (CKD) in Indian emergency departments, baseline prognostic markers remain underexplored. This study found a high in-hospital mortality rate among adult patients with CKD. Independent predictors of mortality included a low Glasgow coma scale, hyperglycemia, and low serum albumin at admission. These findings highlight the importance of early risk stratification and targeted interventions to improve short-term survival in acutely ill patients with CKD.