Abstract: SA-PO026
Risk Factors for Polymyxin-Induced AKI in Critically Ill Patients
Session Information
- AKI Clinical: Epidemiology and Outcomes
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Acute Kidney Injury
- 003 AKI: Clinical and Translational
Authors
- da Fonseca, Cassiane Dezoti, School of Nursing, University of São Paulo, Carapicuíba, Brazil
- Watanabe, Mirian, University of Sao Paulo, Sao Paulo, Brazil
- Vattimo, Maria De Fatima, None, Sao Paulo, SÃO PAULO, Brazil
- Fernandes, Sheila Marques, School of Nursing, University of São Paulo, Carapicuíba, Brazil
- Santos, Luciana soares Costa, Universidade de São Paulo, SÃO PAULO, Brazil
- Coelho, Filipe U, University of São Paulo, São paulo, Brazil
- Oliveira, Natalia Abreu de, Organization University of São Paulo, São Paulo, Brazil
Group or Team Name
- Research Group on Acute Kidney Injury-GERA
Background
Critically ill patients with infections and sepsis frequently need robust antimicrobial agents, such as polymyxins (Pmxs), for efficacy against multi-resistant gram-negative bacteria. However, acute kidney injury (AKI) may be the most important limiting adverse effect of Pmxs. This study evaluated the incidence and identified the risk factors for the development of AKI in critically patients receiving Pmxs.
Methods
A multicenter retrospective cohort study enrolling 1009 intensive care patients Wwas performed. AKI was defined by KDIGO criteria. Primary outcome was patients who received Pmxs and developed AKI. The main secundary outcomes were clinical risk factors for Pmxs-induced AKI. Multivariate analyses with logistic regression were performed.
Results
A total of 936 patients were included. AKI was detected in 404 (43%) patients. Mean age was 59.1 ± 17.0 years, 63% were male. Systemic arterial hypertension (45%), Diabetes Mellitus (26%), sepsis (22%) and shock state (57%) were observed in AKI individuals. The mortality was 37% for AKI patients (P<0.001). Among 75 patients treated with Pmxs, rate of AKI was 88%. The risk factor of AKI associated with Pmxs were prolonged hospital stay, mechanical ventilation and shock state (P<0.001).
Conclusion
This data highligted that the rate of Pmx-induced AKI was greather than other studies. Critically ill patients are at higher risk due to the presence of prolonged hospital stay, mechanical ventilation and shock state.
Risk factor of AKI associated polymyxins use
| Variable | OR (IC 95%) | p value |
| Age | 0.05 (0.9-1.0) | 0.059 |
| Shock | 4.91 (1.6-14.8) | 0.005 |
| Vasoactive drug | 0.59 (0.2-1.3) | 0.212 |
| Mechanical ventilation | 1.07 (1.0-1.1) | <0.001 |
| Clinical hospitalization | 1.39 (0.7-2.7) | 0.337 |
| ICU hospital stay | 1.09 (1.0-1.1) | <0.001 |
Figure 1. Survivel curve of patients in use of polymyxins.
Funding
- Government Support - Non-U.S.