Acute kidney injury in critical ill patients affected by influenza A (H1N1) v infection.
Crit Care. 2011 Feb 22;15(1):R66
Authors: Martin-Loeches I, Papiol E, Rodriguez A, Diaz E, Zaragoza R, Granada RM, Socias L, Bonastre J, Valverdu M, Pozo JC, Luque P, Julia-Narvaez JA, Cordero L, Albaya A, Seron D, Rello J, Working Group HN
ABSTRACT: 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.
PMID: 21342489 [PubMed - as supplied by publisher]