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Abstract: TH-PO035

Association of AKI on Outcomes in Patients with ARDS - Secondary Analysis of LUNG-SAFE Patient Cohort

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • McNicholas, Bairbre A., National University of Ireland, Galway, Galway, Ireland
  • Rezoagli, Emanuele, National University of Ireland, Galway, Galway, Ireland
  • Guiard, Elsa, Toronto General Hospital UHN, Toronto, Ontario, Canada
  • Bellani, Giacomo, University of Milan-Bicocca, Monza, Italy
  • Griffin, Matthew D., National University of Ireland, Galway, Galway, Ireland
  • Pham, Tài, University of Toronto, Toronto, Ontario, Canada
  • Laffey, John G., National University of Ireland, Galway, Galway, Ireland
Background

The impact of Acute Kidney Injury (AKI) in Adult Respiratory Distress Syndrome (ARDS) is poorly understood. We addressed this in a secondary analysis of the large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) patient cohort. LUNG SAFE was an international, multicentre, prospective cohort study of patients with severe respiratory failure conducted during 4 consecutive weeks in winter 2014, in 459 intensive-care units (ICU) in 50 countries across six continents.

Methods

Patients undergoing invasive mechanical ventilation (IMV) with a diagnosis of ARDS at D1 or D2 post onset of acute hypoxic respiratory failure (AHRF) with no history of chronic kidney disease (eGFR<60ml/min/1.73m2) and not transferred from another ICU were included in the analysis. Patients were categorised based on worst serum creatinine (Scr) or urine output between D1-D7 post diagnosis of ARDS into (1) no AKI Serum creatinine <1.5mg/dl or urine output >0.5mL/kg/h (2) Moderate AKI: Scr 1.5-4mg/dl or min urine output<0.5mL/kg/h or (3) severe AKI: Scr >4mg/dl or Renal Replacement Therapy (RRT) during D1-D7 following onset of ARDS.

Results

2016 patients were included in the analysis; 1193 (59%) with no AKI, 619 (31%) moderate AKI and 204 (10%) with severe AKI. RRT was required in 1.2% of patient with no AKI, 24.6% of moderate AKI and 100% of severe AKI over the 28 day follow-up period. Sequential organ failure assessment score was higher with worsening category of AKI (8.8±3.8, no AKI, 11.5±3.7 moderate AKI, 12.2±3.8 severe AKI, p<0.001). Lower pH, PaO2-FiO2 ratio and higher positive end-expiratory pressure were noted with advancing AKI category. Ventilatory free days was lower and ICU mortality and hospital mortality was higher with advancing AKI category (table 1).

Conclusion

The development of AKI, even in those who do not require RRT is associated with a substantial increase in mortality in patients with ARDS, with over half of these patients dying in hospital.

Association of AKI on outcomes in patients with ARDS
Category of AKINo AKI N=1193Moderate AKI N=619Severe AKI N=204P-value
Ventilator Free days, median (IQR), days 17.0 [0.0;23.0]0.0 [0.0;19.0]0.0 [0.0;12.0]<0.001
ICU Mortality No. (%)306(25.6%)276(44.6%)116(56.9%)<0.001
Hospital Mortality, No. (%)355(29.9%)310(50.2%)125(61.3%)<0.001

Funding

  • Government Support - Non-U.S.