Predictors of Acute Kidney Injury in Critically Ill Patient at Intensive Cardiac Care Unit
Background: Acute kidney injury (AKI) occurs frequently in the intensive cardiac care unit and recognized as a heterogeneous syndrome with variable etiology and clinical presentation that affects acute morbidity and mortality. AKI needs to be identified early and underlying causes must be treated
Aim: The aim of this study is to identify the risk factors of AKI in critically ill patients at ICCU Sardjito General Hospital.
Method: We performed a retrospective analysis of patient registry from Sardjito Cardiovascular Intensive Care (SCIENCE) between January 2021 and December 2021. This registry provided demographic data, risk factors, comorbidities, laboratory findings and survival outcomes. The KDIGO criteria were used to define AKI characterized by an increase in serum creatinine more or equal to 0.3 mg/dL in 48 hours, or an increase in serum creatinine more or equal to 1.5 times than previous value, or urine volume less than 0.5 mL/kg BW/hour for 6 hours. Univariate and multivariate data analyses were carried out.
Results: This study included 428 patients with an incidence of AKI was 14,3 %. Univariate analysis showed that AKI was related to diabetes, acute heart failure, sepsis, APACHE score, SAPS, Sardjito score, MCARS, hemoglobin, leukocyte, and plasma albumin concentration. Furthermore, we did multivariate analysis and showed the independent predictor of AKI at ICCU admission is acute heart failure (OR 3.90; 95% CI 1.95–7.77; p <0.001), sepsis (OR 3.02; 95% CI 1.03-8.90; p 0.045) and high APACHE II score (OR 0.33; 95% CI 0.13-0.80; p 0.015).
Conclusions: Acute heart failure, sepsis and high APACHE score at admission is independent predictors of AKI among critically ill in ICCU Sardjito General Hospital. The results of this study may contribute to the implementation of targeted therapies.
2. Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney International Supplements. 2012;2(1):1-138. doi:10.1038/kisup.2012.1
3. Chen JJ, Kuo G, Hung CC, et al. Risk factors and prognosis assessment for acute kidney injury: The 2020 consensus of the Taiwan AKI Task Force. Journal of the Formosan Medical Association. 2021;120(7):1424-1433. doi:10.1016/j.jfma.2021.02.013
4. Abd Elhafeez S, Tripepi G, Quinn R, et al. Risk, predictors, and outcomes of acute kidney injury in patients admitted to intensive care Units in Egypt. Scientific Reports. 2017;7(1). doi:10.1038/s41598-017-17264-7
5. Oweis AO, Alshelleh SA, Momany SM, Samrah SM, Khassawneh BY, al Ali MAK. Incidence, Risk Factors, and Outcome of Acute Kidney Injury in the Intensive Care Unit: A Single-Center Study from Jordan. Critical Care Research and Practice. 2020;2020. doi:10.1155/2020/8753764
6. Malhotra R, Kashani KB, Macedo E, et al. A risk prediction score for acute kidney injury in the intensive care unit. Nephrology Dialysis Transplantation. 2017;32(5):814-822. doi:10.1093/ndt/gfx026
7. Holgado JL, Lopez C, Fernandez A, et al. Acute kidney injury in heart failure: a population study. ESC Heart Failure. 2020;7(2):415-422. doi:10.1002/ehf2.12595
8. Ahmad T, Jackson K, Rao VS, et al. Worsening renal function in patients with acute heart failure undergoing aggressive diuresis is not associated with tubular injury. Circulation. 2018;137(19):2016-2028. doi:10.1161/CIRCULATIONAHA.117.030112
9. Kumar U, Wettersten N, Garimella PS. Cardiorenal Syndrome: Pathophysiology. Cardiology Clinics. 2019;37(3):251-265. doi:10.1016/j.ccl.2019.04.001
10. Chahal RS, Chukwu CA, Kalra PR, Kalra PA. Heart failure and acute renal dysfunction in the cardiorenal syndrome. Clinical Medicine, Journal of the Royal College of Physicians of London. 2020;20(2):146-150. doi:10.7861/clinmed.2019-0422
11. Ronco C, Cicoira M, McCullough PA. Cardiorenal syndrome type 1: Pathophysiological crosstalk leading to combined heart and kidney dysfunction in the setting of acutely decompensated heart failure. Journal of the American College of Cardiology. 2012;60(12):1031-1042. doi:10.1016/j.jacc.2012.01.077
12. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Medicine. 2017;43(3):304-377. doi:10.1007/s00134-017-4683-6
13. Doi K. Role of kidney injury in sepsis. Journal of Intensive Care. 2016;4(1). doi:10.1186/s40560-016-0146-3
14. Panitchote A, Mehkri O, Hasting A, et al. Factors associated with acute kidney injury in acute respiratory distress syndrome. Annals of Intensive Care. 2019;9(1). doi:10.1186/s13613-019-0552-5
15. Fuhrman DY, Kane-Gill S, Goldstein SL, Priyanka P, Kellum JA. Acute kidney injury epidemiology, risk factors, and outcomes in critically ill patients 16–25 years of age treated in an adult intensive care unit. Annals of Intensive Care. 2018;8(1). doi:10.1186/s13613-018-0373-y
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