tetano
Editor, Senior Moderator
Acute kidney injury in critical ill patients affected by influenza A (H1N1) v infection
Ignacio Martin-Loeches email, Elisabeth Papiol email, Alejandro Rodriguez email, Emili Diaz email, Rafel Zaragoza email, Rosa Maria Granada email, Lorenzo Socias email, Juan Bonastre email, Montserrat Valverdu email, Juan Carlos Pozo email, Pilar Luque email, Jose Antonio Julia-Narvaez email, Lourdes Cordero email, Antonio Albaya email, Daniel Seron email, Jordi Rello email and H1n1 semicyuc Working Group email
Critical Care 2011, 15:R66doi:10.1186/cc10046
Published: 22 February 2011
Introduction
Little information exists about the impact of acute kidney injury (AKI) in critically ill patient affected by pandemic 2009 influenza A (H1N1) v infection.
Methods
This was a prospective, observational, multi-center study conducted in 148 Spanish intensive care units (ICU). Patients with chronic renal failure were excluded. AKI was defined according to AKIN criteria.
Results
A total of 661 patients were analyzed. One hundred and eighteen (17.7%) patients developed AKI; 37 (31.4%) of the patients with AKI were classified as AKI I, 15 (12.7%) as AKI II and finally 66 (55.9%) as AKI III, of which 50 (75.7%) required continuous renal replacement therapy (CRRT). Patients with AKI had a higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score (19.2+8.3 versus 12.6+5.9, P<0.001), Sequential Organ Failure Assessment (SOFA) score (8.7+4.2 versus 4.8+2.9 P<0.001), more need of mechanical ventilation (MV) (87.3% versus 56.2% P<0.01 OR 5.3 CI 3.0-9.4), shock (75.4% versus 38.3% P<0.01 OR 4.9 CI 3.1-7.7), multi-organ dysfunction syndrome (MODS) (92.4% versus 54.7% P<0.01 OR 10.0 CI 4.9-20.21) and co-infection (23.7% versus 14.4% P<0.01 OR 1.8 CI 1.1-3.0). In survivors, patients with AKI remained longer on MV, ICU and hospital (length of stay) LOS were longer than patients without AKI. The overall mortality was 18.8% and was significantly higher for AKI patients (44.1% versus 13.3% P<0.01 OR 5.1 CI 3.3-7.9). A logistic regression analysis was performed with AKIN categories and demonstrated that among patients with AKI only AKIN3 was independently associated with higher ICU mortality (OR=4.81; 95% CI 2.17 - 10.62; P<0.001)
Conclusions
In our cohort of patients with pandemic 2009 influenza A (H1N1) v infection only AKI III was independently associated with mortality.
http://ccforum.com/content/pdf/cc10046.pdf
Ignacio Martin-Loeches email, Elisabeth Papiol email, Alejandro Rodriguez email, Emili Diaz email, Rafel Zaragoza email, Rosa Maria Granada email, Lorenzo Socias email, Juan Bonastre email, Montserrat Valverdu email, Juan Carlos Pozo email, Pilar Luque email, Jose Antonio Julia-Narvaez email, Lourdes Cordero email, Antonio Albaya email, Daniel Seron email, Jordi Rello email and H1n1 semicyuc Working Group email
Critical Care 2011, 15:R66doi:10.1186/cc10046
Published: 22 February 2011
Introduction
Little information exists about the impact of acute kidney injury (AKI) in critically ill patient affected by pandemic 2009 influenza A (H1N1) v infection.
Methods
This was a prospective, observational, multi-center study conducted in 148 Spanish intensive care units (ICU). Patients with chronic renal failure were excluded. AKI was defined according to AKIN criteria.
Results
A total of 661 patients were analyzed. One hundred and eighteen (17.7%) patients developed AKI; 37 (31.4%) of the patients with AKI were classified as AKI I, 15 (12.7%) as AKI II and finally 66 (55.9%) as AKI III, of which 50 (75.7%) required continuous renal replacement therapy (CRRT). Patients with AKI had a higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score (19.2+8.3 versus 12.6+5.9, P<0.001), Sequential Organ Failure Assessment (SOFA) score (8.7+4.2 versus 4.8+2.9 P<0.001), more need of mechanical ventilation (MV) (87.3% versus 56.2% P<0.01 OR 5.3 CI 3.0-9.4), shock (75.4% versus 38.3% P<0.01 OR 4.9 CI 3.1-7.7), multi-organ dysfunction syndrome (MODS) (92.4% versus 54.7% P<0.01 OR 10.0 CI 4.9-20.21) and co-infection (23.7% versus 14.4% P<0.01 OR 1.8 CI 1.1-3.0). In survivors, patients with AKI remained longer on MV, ICU and hospital (length of stay) LOS were longer than patients without AKI. The overall mortality was 18.8% and was significantly higher for AKI patients (44.1% versus 13.3% P<0.01 OR 5.1 CI 3.3-7.9). A logistic regression analysis was performed with AKIN categories and demonstrated that among patients with AKI only AKIN3 was independently associated with higher ICU mortality (OR=4.81; 95% CI 2.17 - 10.62; P<0.001)
Conclusions
In our cohort of patients with pandemic 2009 influenza A (H1N1) v infection only AKI III was independently associated with mortality.
http://ccforum.com/content/pdf/cc10046.pdf