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. 2015 Apr 17;19(1):169.
doi: 10.1186/s13054-015-0900-2.

Acute kidney injury after cardiac arrest

Omar Tujjar  1 , Giulia Mineo  2 , Antonio Dell'Anna  3 , Belen Poyatos-Robles  4 , Katia Donadello  5 , Sabino Scolletta  6 , Jean-Louis Vincent  7 , Fabio Silvio Taccone  8
Affiliations

Acute kidney injury after cardiac arrest

Omar Tujjar et al. Crit Care. .

Abstract

Introduction: The aim of this study was to evaluate the incidence and determinants of AKI in a large cohort of cardiac arrest patients.

Methods: We reviewed all patients admitted, for at least 48 hours, to our Dept. of Intensive Care after CA between January 2008 and October 2012. AKI was defined as oligo-anuria (daily urine output <0.5 ml/kg/h) and/or an increase in serum creatinine (≥0.3 mg/dl from admission value within 48 hours or a 1.5 time from baseline level). Demographics, comorbidities, CA details, and ICU interventions were recorded. Neurological outcome was assessed at 3 months using the Cerebral Performance Category scale (CPC 1-2 = favorable outcome; 3-5 = poor outcome).

Results: A total of 199 patients were included, 85 (43%) of whom developed AKI during the ICU stay. Independent predictors of AKI development were older age, chronic renal disease, higher dose of epinephrine, in-hospital CA, presence of shock during the ICU stay, a low creatinine clearance (CrCl) on admission and a high cumulative fluid balance at 48 hours. Patients with AKI had higher hospital mortality (55/85 vs. 57/114, p = 0.04), but AKI was not an independent predictor of poor 3-month neurological outcome.

Conclusions: AKI occurred in more than 40% of patients after CA. These patients had more severe hemodynamic impairment and needed more aggressive ICU therapy; however the development of AKI did not influence neurological recovery.

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Figures

Figure 1
Figure 1
Flow-chart of the study. sCr, serum creatinine; CA, cardiac arrest; UO, urine output.
Figure 2
Figure 2
Diagnosis of acute kidney injury (AKI) in patients suffering from out-of-hospital cardiac arrest (OHCA) or in-hospital (IHCA) cardiac arrest. Among patients with previous chronic renal disease (CKD), diagnosis of AKI was initially based on the increase of serum creatinine (sCr) of at least 1.5 times the baseline values or the reduction in daily urine output (UO) or both. Among patients without previous chronic renal disease (No CKD), diagnosis of AKI was initially based on the increase of serum creatinine (sCr) ≥0.3 mg/dL from the baseline value or the reduction of daily urine or both. For each group, the number of patients eventually treated with continuous renal replacement therapy (CRRT) was reported.
Figure 3
Figure 3
Proportion of patients developing acute kidney injury (AKI) stage 1, 2 or 3 according to the diagnosis of AKI based on the serum creatinine (sCr) criterion, the urine output (UO) criterion or both.
Figure 4
Figure 4
Time course of median serum creatinine over the first 3 days following ICU admission in patients with favorable (FNO) and poor (PNO) neurological outcomes.
Figure 5
Figure 5
Proportion of patients with favorable neurological outcome according to the presence of augmented renal clearance (ARC) without acute kidney injury (AKI), normal renal function (no AKI), AKI or AKI requiring continuous renal replacement therapy (CRRT).
See this image and copyright information in PMC

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