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. 2019 Jul 1;9(1):74.
doi: 10.1186/s13613-019-0552-5.

Factors associated with acute kidney injury in acute respiratory distress syndrome

Anupol Panitchote  1   2 , Omar Mehkri  1 , Andrei Hastings  1 , Tarik Hanane  1 , Sevag Demirjian  3 , Heather Torbic  4 , Eduardo Mireles-Cabodevila  1 , Sudhir Krishnan  1 , Abhijit Duggal  5
Affiliations

Factors associated with acute kidney injury in acute respiratory distress syndrome

Anupol Panitchote et al. Ann Intensive Care. .

Erratum in

Abstract

Background: Acute kidney injury (AKI) is the most frequent extra-pulmonary organ failure in acute respiratory distress syndrome (ARDS). The objective of this study was to assess the factors associated with the development and severity of AKI in patients with ARDS.

Methods: This is a retrospective cohort study of ARDS patients without acute or chronic kidney disease prior to the onset of ARDS over a 7-year period (2010-2017). AKI and severity of AKI were defined according to the Kidney Disease Improving Global Outcomes 2012 guidelines.

Results: Of the 634 ARDS patients, 357 patients met study criteria. A total of 244 (68.3%) patients developed AKI after ARDS onset: 60 (24.6%) had stage I AKI, 66 (27%) had stage II AKI, and 118 (48.4%) had stage III AKI. The median time of AKI onset for stage I AKI was 2 days (interquartile range, 1.5-5.5) while stage II and III AKI was 4 days. On multivariable analysis, factors associated with development of AKI were age [subdistribution hazard ratio (SHR) 1.01, 95% confidence interval (CI) 1.00-1.02], SOFA score (SHR 1.16, 95%CI 1.12-1.21), a history of diabetes mellitus (DM) (SHR 1.42, 95%CI 1.07-1.89), and arterial pH on day 1 of ARDS (SHR per 0.1 units decrease was 1.18, 95%CI 1.05-1.32). In severity of AKI, stage I AKI was associated with age (SHR 1.03, 95%CI 1.01-1.05) and serum bicarbonate on day 1 of ARDS (SHR 1.07, 95%CI 1.02-1.13). Stage II AKI was associated with age (SHR 1.03, 95%CI 1.01-1.05), serum bicarbonate on day 1 (SHR 1.12, 95%CI 1.06-1.18), SOFA score (SHR 1.19, 95%CI 1.10-1.30), history of heart failure (SHR 3.71, 95%CI 1.63-8.46), and peak airway pressure (SHR 1.04, 95%CI 1.00-1.07). Stage III AKI was associated with a higher BMI (SHR 1.02, 95%CI 1.00-1.03), a history of DM (SHR 1.79, 95%CI 1.18-2.72), SOFA score (SHR 1.29, 95%CI 1.22-1.36), and arterial pH on day 1 (SHR per 0.1 units decrease was 1.25, 95%CI 1.05-1.49).

Conclusions: Age, a higher severity of illness, a history of diabetes, and acidosis were associated with development of AKI in ARDS patients. Severity of AKI was further associated with BMI, history of heart failure, and peak airway pressure.

Keywords: Acute kidney injury; Acute respiratory distress syndrome; Gas exchange; Lung protective ventilation; Mechanical ventilation; Septic shock.

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Conflict of interest statement

All authors report no competing interests relevant to this article.

Figures

Fig. 1
Fig. 1
Consort flow chart
Fig. 2
Fig. 2
Forest plot showing the results of multivariable competing risk regression analysis for factors associated with development of acute kidney injury and severity of acute kidney injury. The x-axis represents the adjusted subdistribution hazard ratio (SHRadj) on a log scale with the reference line (solid vertical line), adjusted subdistribution hazard ratio (square), and 95% confidence interval (whisker)
Fig. 3
Fig. 3
Adjusted 28-day survival curves stratified by severity of acute kidney injury (adjusted for PaO2:FiO2 on day 1, APACHE III score, and septic shock)
See this image and copyright information in PMC

References

    1. Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788–800. doi: 10.1001/jama.2016.0291. - DOI - PubMed
    1. Bautista E, Arcos M, Jimenez-Alvarez L, et al. Angiogenic and inflammatory markers in acute respiratory distress syndrome and renal injury associated to A/H1N1 virus infection. Exp Mol Pathol. 2013;94(3):486–492. doi: 10.1016/j.yexmp.2013.03.007. - DOI - PubMed
    1. Ranieri VM, Suter PM, Tortorella C, et al. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA. 1999;282(1):54–61. doi: 10.1001/jama.282.1.54. - DOI - PubMed
    1. Ranieri VM, Giunta F, Suter PM, Slutsky AS. Mechanical ventilation as a mediator of multisystem organ failure in acute respiratory distress syndrome. JAMA. 2000;284(1):43–44. doi: 10.1001/jama.284.1.43. - DOI - PubMed
    1. Liu KD, Glidden DV, Eisner MD, et al. Predictive and pathogenetic value of plasma biomarkers for acute kidney injury in patients with acute lung injury. Crit Care Med. 2007;35(12):2755–2761. - PMC - PubMed