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Acute kidney injury outcome in critically ill patients

Author: 
Hassan Abdel-Hady, Ibrahim M. Baghdadi, Mahmoud A. Kora, Yassin S. Yassin, Safwa O. Toulan and Hany S. Elbarbary
Subject Area: 
Health Sciences
Abstract: 

Background :The incidence of ICU related AKI has increased over the last few decades This is probably related to the rising incidence of sepsis related hospital admissions, increased prevalence of risk factors for AKI, including chronic kidney disease (CKD), diabetes mellitus, and congestive heart failure, and expanded use of intravenous radio-contrast agents. ICU patients with AKI have higher morbidity, mortality, and health care costs compared to ICU patients without AKI. Objective: To study indicators of acute kidney injury that might affect the outcome of critically ill patients. Design: Prospective study. Setting: ICU units of Menoufiya University Hospitals- Egypt. Patients: All patients with acute kidney injury (AKI) were prospectively enrolled in the study from their admission in ICU till discharge. AKI was defined by RIFLE and AKIN classification systems. All patients are critically ill assessed by APACHE III score, excluding those patients with CKD stage IV and ESRD patients. Measurements : Age, sex, cause of admission to ICU ,preexisting organ dysfunction ,DM ,HTN , type and mechanism of acute kidney injury were recorded. The Acute Physiology and Chronic Health Evaluation (APACHE III) score, was recorded at admission. The most severe RIFLE class and AKIN stage that the patient reached were recorded. Investigations including Complete blood count, Liver functions {Serum albumin, Prothrombin time, Total and direct bilirubin} Liver enzymes (AST – ALT) Renal functions (Blood urea and Serum creatinine), Serum electrolytes (Serum sodium, Serum potassium, Serum calcium, Serum phosphorus), Lipid profile (Serum Cholesterol and Triglycerides) were done to the patients and recorded. Resting electrocardiogram was done and its results were recorded. There were 51 patients in the study; all patients were enrolled in the study at the time of ICU admission. Results: 55.9% of patients were in good health 3 months before ICU entry. The reason for admission was medical in 86, 3 % of cases. The type of acute kidney injury was prerenal (45.1%), renal (52.9%), or postrenal (2%). Renal replacement therapy was used in 23.5 % of patients. Twenty six (51.0%) patients died during the hospital stay. Six variables were predictive of death. These variables were male gender, severity of RIFLE class, AKIN stage, hypocalcaemia, hypertriglyceridemia and severity of illness as assessed at the time of ICU admission by APACHE III score. Conclusions: In our study the indicators of AKI that are associated with worse outcome of critically ill patients with AKI in ICU included: male gender, Cardiac cause at admission to ICU, abnormal ECG changes, severe class/stage of AKI according to RIFLE and AKIN classifications and high APACHE III score at ICU admission. On the other hand, a cutoff value of APACHE III score < 73 is a good predictor of recovery of critically ill patients with AKI at time of admission.

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