Hierarchical endpoints in critical care: A post-hoc exploratory analysis of the standard versus accelerated initiation of renal-replacement therapy in acute kidney injury and the intensity of continuous renal-replacement therapy in critically ill patients trials
Authors' conclusion
The primary re-analyses of the STARRT-AKI and RENAL trials both yielded neutral results; however, there was suggestion of heterogeneity in treatment effect in stratified analyses of the STARRT-AKI trial by surgical status and sepsis.
Study context
- Population
- Critically ill patients with AKI with complete information in the STARRT-AKI and RENAL trials
- Comparison
- STARRT-AKI: accelerated vs standard RRT initiation; RENAL: two different RRT doses
- Primary endpoint
- Win ratio (WR) of a hierarchical composite endpoint:
- 90-day mortality
- RRT dependency at 90-days
- Intensive care unit (ICU) LOS
- Hospital LOS (values above the unit represent benefit of the intervention)
- Follow-up
- 90 days
Methodological detailshierarchical composite endpoint, win ratio, stratified analyses
- Hierarchical composite endpoint
- Win ratio
- Stratified analyses
Primary result
As reported in the abstract
Hierarchical composite endpoint (primary analysis)
Win ratio (95% CI)P value
STARRT-AKIaccelerated vs standard
1.04(0.96–1.13)
P = 0.33RENAL vs standardtwo RRT doses compared
1.02(0.90–1.15)
P = 0.75Further findings
Hierarchical composite endpoint with length-of-stay (LOS) replaced by days alive and free of RRT (secondary analysis)
| WR (95% CI) | P value | ||
|---|---|---|---|
| STARRT-AKIAccelerated vs standard | 0.88 (0.79–0.99) | P = 0.03 | |
| 0.512Win ratio (log scale) |
| Outcome | WR (95% CI) | P value | |
|---|---|---|---|
| Hierarchical composite endpoint with LOS replaced by days alive and free of RRT (secondary analysis)RENAL vs standard · two RRT doses compared | 1.02 (0.87–1.21) | P = 0.77 | |
| 0.512Win ratio (log scale) |
Stratified analyses (subgroup)
- STARRT-AKI primary: possible benefit of the accelerated-strategy for non-surgical patients with sepsis
- STARRT-AKI secondary: possible harm of the accelerated-strategy for surgical patients without sepsis
- RENAL: no evidence of heterogeneity in treatment effects
Original publication
Hierarchical endpoints in critical care: A post-hoc exploratory analysis of the standard versus accelerated initiation of renal-replacement therapy in acute kidney injury and the intensity of continuous renal-replacement therapy in critically ill patients trials. J Crit Care. Published 11 March 2024. doi:10.
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