Abstract: TH-PO1136

Fluid Overload Is a Risk Factor for AKI and Mortality in Influenza Patients

Session Information

Category: Fluid, Electrolytes, and Acid-Base

  • 704 Fluid, Electrolyte, Acid-Base Disorders

Authors

  • Bonilla, Luis Ignacio, University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
  • Vera, Raymundo, University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
  • Sánchez, Raymundo A, University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
  • Villegas-Gasson, Israel Alfredo, University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
  • Samoni, Sara, International Renal Research Institute of Vicenza, Vicenza, Italy
  • Ronco, Claudio, International Renal Research Institute of Vicenza, Vicenza, Italy
  • Rizo Topete, Lilia Maria, University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
Background

Influenza virus, especially A(H1N1) has been consistently associated with high mortality in the subset of critically ill patients who develop Acute Distress Respiratory Syndrome (ADRS). Risk factors for this association have not been well described. Fluid overload (FO) is now a recognized condition which increases the incidence of acute kidney injury (AKI) and its association with mortality in critically ill patients has been well documented. Nevertheless the impact of FO in mortality of ARDS influenza patients has not been yet described.

Methods

This is a retrospective analysis of 30 records of patients who were admitted to the ICU with the diagnosis of ARDS and suspicion of influenza infection during the Influenza season 2016-2017. Demographic, laboratory, and clinical data were obtained. We calculated FO as the algebraic sum of the inputs and outputs recorded every day during the whole ICU stay divided by the patient’s weight at admission and expressed as a %. We divided patients into 2 groups: A) < 5% FO and B) > 10% FO and compared mortality among both groups.

Results

Mean age in our cohort was 46.4yrs, 66.6% were male and 46.6% were obese. Influenza was confirmed in 12 patients; 41.6% with A(H1N1). Mortality among A(H1N1) patients was 100%. AKI was diagnosed in 20 patients (66.6%) with 16.6%, 10% and 36.6% of KDIGO stages 1-3 respectively. RRT was initiated in 10 (50%) of AKI patients. Among groups A and B AKI was diagnosed in 50% and 75% of patients respectively p=0.23. ICU mortality was 60% among the whole cohort. Median fluid balance (FB) among survivors was +3,885.8ml (2,108.7-7,525.5) and among non-survivors +8,036.5ml (5,283-18,863) p=0.043. Mortality in group A was 35.7% and in group B 63.3% p=0.22. The OR for mortality and AKI in group A was 0.58 (CI95% 0.22-1.54) and in group B 3.0 (CI 95% 0.49-18.1) p=0.22.

Conclusion

In our cohort of ARDS patients, FO >10% was associated with increasing incidence of AKI and mortality. Also, the presence of a confirmatory diagnosis influenza A(H1N1) conferred a 100% mortality. With these findings, we can strongly recommend a conservative fluid strategy in the treatment of this kind of patients. More studies with bigger cohorts are needed to obtain statistical significance and clearly demonstrate these associations.