Abstract: FR-PO084
Fluid Overload, AKI, and Mortality in Influenza Patients: Our Two-Year Experience
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid and Electrolytes
- 902 Fluid and Electrolytes: Clinical
Authors
- Bonilla, Luis Ignacio, Renal Research Institute of Vicenza, Vicenza, Italy
- Vera, Raymundo, Hospital Universitario, Monterrey, Mexico
- Ronco, Claudio, University of Padova, IRRIV, San Bortolo Hospital, Vicenza, Italy
- Rizo Topete, Lilia Maria, Hospital Universitario, UANL, Monterrey, Nuevo Leon, Mexico
Background
Influenza virus, especially A(H1N1) has been associated with high mortality in critically ill patients who develop Acute Distress Respiratory Sydrome (ADRS). ARDS is considered as a septic condition and one of the cornerstones for its treatment is an adequate fluid resuscitation. Fluid overload (FO) is now a recognized as a cause of acute kidney injury (AKI), and its association with mortality in critically ill patients has been well documented. The impact of FO in mortality of ARDS influenza patients has not been well described
Methods
This is a retrospective 2-year study of patients admitted to the ICU with ARDS and suspicion of influenza infection during the Influenza seasons 2016-2017 and 2017-2018. Demographic, laboratory, and clinical data were obtained. We calculated FO as the algebraic sum of the inputs and outputs during the ICU stay divided by the patient’s weight at admission and expressed as a %. We divided patients in grouo: A) < 10% FO and B) > 10% FO and compared mortality and AKI incidence among both groups
Results
40 records met the inclusion criteria. Mean age in our cohort was 43.5yrs, 60% were male. Influenza was confirmed in 55% of the patients; 22.7% with A(H1N1). Mortality among A(H1N1) patients was 100%. AKI was diagnosed in 24 patients (60%) with 12.5%, 7.5% and 40% of KDIGO stages 1-3 respectively. RRT was initiated in 13 (32%) of AKI patients. Among groups A and B AKI was diagnosed in 52% and 73% of patients respectively p=0.182. ICU mortality was 55% among the whole cohort. Median fluid balance (FB) among survivors was +3,813ml (2,131-7,284) and among non-survivors +8,370ml (4,477-16,502) p=0.008. Mortality in group A was 40% and in group B 80% p=0.014. The OR for AKI development in group B was 2.53 (CI 95% 0.634-10.166) p=0.182, and for mortality was 6.0, (CI 95% 1.34-26.8), p= 0.014
Conclusion
In our two-year retrospective study of ARDS patients, FO >10% was significantly associated with increasing incidence of AKI and mortality. Ah1N1 diagnosis involved 100% mortality. With these findings, we can strongly recommend a conservative fluid strategy in the treatment of this kind of patients. And we can advise to implement strategies to maintain the fluid gain in less than 10% of the initial patient’s weight. More studies with bigger cohorts are needed to clearly demonstrate these associations