Abstract: SA-PO009

AKI and Associated Risk Factors for Mortality in Influenza Patients

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Sánchez, Raymundo A, Hospital Universitario Dr. José Eleuterio González , Monterrey, Nuevo León, Mexico
  • Bonilla, Luis Ignacio, Hospital Universitario Dr. José Eleuterio González , Monterrey, Nuevo León, Mexico
  • Vera, Raymundo, Hospital Universitario Dr. José Eleuterio González , Monterrey, Nuevo León, Mexico
  • Villegas-Gasson, Israel Alfredo, Hospital Universitario Dr. José Eleuterio González , Monterrey, Nuevo León, Mexico
  • Reyes, Alan Ledif, Hospital Universitario Dr. José Eleuterio González , Monterrey, Nuevo León, Mexico
  • Cruz Valdez, Jesus, Hospital Universitario Dr. José Eleuterio González , Monterrey, Nuevo León, Mexico
  • Rizo Topete, Lilia Maria, Hospital Universitario Dr. José Eleuterio González , Monterrey, Nuevo León, Mexico
Background

In 2009,a pandemia of influenza A(H1N1) virus severely affected Mexico.Several reports described the presentation of this disease in critically ill patients. Acute kidney injury (AKI) and mortality showed high prevalence in these studies. AKI incidence has been reported between 33.6%and 51% in A(H1N1) patients, with mortality rates between 36.3 and 51%.

Methods

We conducted a retrospective, observational study in patients admitted to the ICU during the 2016-2017 influenza season. All patients were diagnosed as ARDS and had suspicion of influenza infection. We obtained demographic,clinical and laboratory data. AKI was defined according to Acute Kidney Injury Network criteria.Patients were divided into two groups, survivors and non survivors.

Results

30 patients were included in the study;20(66.6%) were male, median age was 46.4(±11.91).Mortality in the ICU was 60% and AKI was present in 66.6% of the patients.The mean APACHE II score was 24.2 ± 7.97, mean stay in ICU was 10 days(IQR: 6-15). Use of double vasopressor in 14(46.6%). All patients required invasive mechanical ventilation with PEEP 10.13(± 5.68), PaO2/FIO2 126.42(IQR: 75.9-171.25), tidal volume of 185(IQR:150-205).The diagnosis of influenza was confirmed in 12(40%), 3(16.7%) with influenza rapid diagnostic test (RIDTs) and 9(83.3%) with reverse transcriptase PCR(RT-PCR);of these 5(41.6%) confirmed influenza A(H1N1). The main comorbidities recorded were obesity(n=14, 46.7%),smoking(n=12, 40%), and diabetes mellitus type 2(n=11, 36.7%).
The risk factors associated with mortality were obesity OR=2.62(IC=0.881-7.824,p=0.82), A(H1N1)influenza infection confirmed by PCR OR=3.824(IC=1.006-14.536,p=0.016), presence of AKI OR=2.8(IC=1.184-6.622,p=0.18), specially KDIGO 3 OR 10 (p=0.007), and renal replacement therapy(RRT) OR=11 (IC=1.164-103.94,p=0.018).

Conclusion

Influenza A(H1N1) is still a cause of great morbidity and mortality in the young Mexican population. In our cohort we found consistent data that can help the treatment of these patients in the setting of the ICU. The presence of acute kidney injury, obesity, and the need for RRT were strong risk factors for mortality in this study. Modifiable factors should be early identified to improve outcomes in critically ill.