Abstract: SA-PO070

The Incidence and Risk Factors of AKI in Patients with Pulmonary Infection-Associated Acute Respiratory Distress Syndrome

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Wan, Xin, Nanjing Hospital Affiliated to Nanjing Medical University (Nanjing First Hospital), Nanjing, China
  • Cao, Changchun, Sir Run Run Hospital Affiliated to Nanjing Medical University, Nanjing, JIANGSU , China
Background

Acute kidney injury (AKI) is a common complication in critically ill patients and is a major risk factor for death. Among critically ill patients, AKI occurred in 31.3% of patients and was more common in patients with ARDS (44.3% versus 27.4% in patients without ARDS.
Infection (44.1%) was the most common risk factor for the development of ARDS. Lung was the most common infection site in infection-related ARDS, and also the only infection site significantly associated with increased risk of developing ARDS.there is no a study pay a attention to AKI in patients with pulmonary infection -associated ARDS (PI-ARDS).
Therefore, we aimed to explore the incidence and risk factors of acute kidney injury in patients with PI-ARDS.

Methods

This retrospective cohort study included patients aged 18 or more who was admitted to hospital for pulmonary infection combined with or secondary to ARDS at Nanjing First Hospital in Nanjing, China, between January 2014 and March 2017.Univariate and multiple logistic regression models were used for determining the association between the development of AKI and risk factors. Multiple Cox-proportional hazards modeling was performed to evaluate the impact of AKI on the in-hospital mortality and hospital length of stay (LOS).

Results

Of 846 patients with ARDS result from pulmonary infection, the incidence of patients with PI-ARDS developed AKI was 53.1% (449/846).A total of 36(8.0%) PI-ARDS patients required renal replacement therapy.In the multivariate analysis, factors independently associated with AKI were male, age, white blood cell, platelets, several nephrotoxic drugs (diuretic, vancomycin, Aminoglycosides), proteinuria and invasive ventilation. The model was well calibrated and an area under the receiver operator curve (AUC) was 0.766. Furthermore, subjects with proteinuria of trace to 1+, 2+, 3+, had a 1.45(P = 0.037, 1.02 to 2.06), 3.36(P <0.001, 1.78 to 6.35), 11.26(P < 0.001, 3.11 to 40.80) fold increase in adjusted odds ratio of AKI compared with subjects with negative, respectively. AKI was also significantly associated with in-hospital mortality, especially in patients needing RRT, and prolonged hospital length of stay.

Conclusion

Proteinuria is an independent risk factor for AKI in PI-ARDS patients, and patients with PI-ARDS develop AKI would have a grave prognosis.