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Factors associated with acute kidney injury in acute respiratory distress syndrome

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 co...

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Autores principales: Panitchote, Anupol, Mehkri, Omar, Hastings, Andrei, Hanane, Tarik, Demirjian, Sevag, Torbic, Heather, Mireles-Cabodevila, Eduardo, Krishnan, Sudhir, Duggal, Abhijit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603088/
https://www.ncbi.nlm.nih.gov/pubmed/31264042
http://dx.doi.org/10.1186/s13613-019-0552-5
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author Panitchote, Anupol
Mehkri, Omar
Hastings, Andrei
Hanane, Tarik
Demirjian, Sevag
Torbic, Heather
Mireles-Cabodevila, Eduardo
Krishnan, Sudhir
Duggal, Abhijit
author_facet Panitchote, Anupol
Mehkri, Omar
Hastings, Andrei
Hanane, Tarik
Demirjian, Sevag
Torbic, Heather
Mireles-Cabodevila, Eduardo
Krishnan, Sudhir
Duggal, Abhijit
author_sort Panitchote, Anupol
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-019-0552-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-66030882019-07-18 Factors associated with acute kidney injury in acute respiratory distress syndrome Panitchote, Anupol Mehkri, Omar Hastings, Andrei Hanane, Tarik Demirjian, Sevag Torbic, Heather Mireles-Cabodevila, Eduardo Krishnan, Sudhir Duggal, Abhijit Ann Intensive Care Research 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-019-0552-5) contains supplementary material, which is available to authorized users. Springer International Publishing 2019-07-01 /pmc/articles/PMC6603088/ /pubmed/31264042 http://dx.doi.org/10.1186/s13613-019-0552-5 Text en © The Author(s) 2019, corrected publication 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
Panitchote, Anupol
Mehkri, Omar
Hastings, Andrei
Hanane, Tarik
Demirjian, Sevag
Torbic, Heather
Mireles-Cabodevila, Eduardo
Krishnan, Sudhir
Duggal, Abhijit
Factors associated with acute kidney injury in acute respiratory distress syndrome
title Factors associated with acute kidney injury in acute respiratory distress syndrome
title_full Factors associated with acute kidney injury in acute respiratory distress syndrome
title_fullStr Factors associated with acute kidney injury in acute respiratory distress syndrome
title_full_unstemmed Factors associated with acute kidney injury in acute respiratory distress syndrome
title_short Factors associated with acute kidney injury in acute respiratory distress syndrome
title_sort factors associated with acute kidney injury in acute respiratory distress syndrome
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603088/
https://www.ncbi.nlm.nih.gov/pubmed/31264042
http://dx.doi.org/10.1186/s13613-019-0552-5
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