Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection

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• 作者：Ignacio Martin-Loeches (1)
  Elisabeth Papiol (1)
  Alejandro Rodríguez (1)
  Emili Diaz (1)
  Rafael Zaragoza (2)
  Rosa María Granada (3)
  Lorenzo Socias (4)
  Juan Bonastre (5)
  Montserrat Valverdú (6)
  Juan Carlos Pozo (7)
  Pilar Luque (8)
  Jose Antonio Juliá-Narvaéz (9)
  Lourdes Cordero (10)
  Antonio Albaya (11)
  Daniel Serón (12)
  Jordi Rello (13)
  
• 刊名：Critical Care
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：15
• 期：1
• 全文大小：
• 作者单位：Ignacio Martin-Loeches (1)
  Elisabeth Papiol (1)
  Alejandro Rodríguez (1)
  Emili Diaz (1)
  Rafael Zaragoza (2)
  Rosa María Granada (3)
  Lorenzo Socias (4)
  Juan Bonastre (5)
  Montserrat Valverdú (6)
  Juan Carlos Pozo (7)
  Pilar Luque (8)
  Jose Antonio Juliá-Narvaéz (9)
  Lourdes Cordero (10)
  Antonio Albaya (11)
  Daniel Serón (12)
  Jordi Rello (13)
  
  1. Critical Care Department, Joan XXIII University Hospital-CIBER Enfermedades Respiratorias, URV, and IISPV, Mallafre i Guasch, ES-43007, Tarragona, Spain
  2. Critical Care Department, Hospital Dr. Peset, Gaspar Aguilar, ES-46017, Valencia, Spain
  3. Critical Care Department, Hospital de Bellvitge, Feixa Llarga, ES-08907, Barcelona, Spain
  4. Critical Care Department, Hospital Son Llatzer, Carretera Manacor, ES-07198, Mallorca, Spain
  5. Critical Care Department, Hospital La Fe, Avenida Campanar, ES-46009, Valencia, Spain
  6. Critical Care Department, Hospital Arnau, Av. Alcalde Rovira Roure, ES-25198, Lleida, Spain
  7. Critical Care Department, Hospital Reina Sofía, Avenida Menéndez Pidal, ES-14004, Córdoba, Spain
  8. Critical Care Department, Hospital Lozano Blesa, Avenida San Juan Bosco, ES-50009, Zaragoza, Spain
  9. Critical Care Department, Hospital Infanta Cristína, Avenida Huelva, 06005, ES-Badajoz, Spain
  10. Critical Care Department, CHUAC, Xubias de Arriba, ES-15006, A’Coru?a, Spain
  11. Critical Care Department, Hospital de Guadalajara, C/Donante de Sangre, ES-19002, Guadalajara, Spain
  12. Nephrology Department Vall d’Hebron University Hospital, Passeig Vall d’Hebron, ES-08035, Barcelona, Spain
  13. Critical Care Department, Vall d’Hebron University Hospital, IRVH, CIBERes, Passeig Vall d’Hebron, ES-08035, Barcelona, Spain
  
• ISSN：1364-8535

文摘

Introduction Little information exists about the impact of acute kidney injury (AKI) in critically ill patients with the pandemic 2009 influenza A (H1N1) virus infection. Methods We conducted a prospective, observational, multicenter study in 148 Spanish intensive care units (ICUs). Patients with chronic renal failure were excluded. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria. Results A total of 661 patients were analyzed. One hundred eighteen (17.7%) patients developed AKI; of these, 37 (31.4%) of the patients with AKI were classified as AKI I, 15 (12.7%) were classified as AKI II and 66 (55.9%) were classified as AKI III, among the latter of whom 50 (75.7%) required continuous renal replacement therapy. Patients with AKI had a higher Acute Physiology and Chronic Health Evaluation II score (19.2 ± 8.3 versus 12.6 ± 5.9; P < 0.001), a higher Sequential Organ Failure Assessment score (8.7 ± 4.2 versus 4.8 ± 2.9; P < 0.001), more need for mechanical ventilation (MV) (87.3% versus 56.2%; P < 0.01, odds ratio (OR) 5.3, 95% confidence interval (CI) 3.0 to 9.4), a greater incidence of shock (75.4% versus 38.3%; P < 0.01, OR 4.9, 95% CI, 3.1 to 7.7), a greater incidence of multiorgan dysfunction syndrome (92.4% versus 54.7%; P < 0.01, OR 10.0, 95% CI, 4.9 to 20.21) and a greater incidence of coinfection (23.7% versus 14.4%; P < 0.01, OR 1.8, 95% CI, 1.1 to 3.0). In survivors, patients with AKI remained on MV longer and ICU and hospital length of stay were longer than in 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, 95% CI, 3.3 to 7.9). Logistic regression analysis was performed with AKIN criteria, and it demonstrated that among patients with AKI, only AKI III was independently associated with higher ICU mortality (P < 0.001, OR 4.81, 95% CI 2.17 to 10.62). Conclusions In our cohort of patients with H1N1 virus infection, only those cases in the AKI III category were independently associated with mortality.