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Abstract: TH-PO077

AKI in Critically Ill Patients Presenting With Gastrointestinal Hemorrhage

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Anil Kumar, Mythri, UConn Health, Farmington, Connecticut, United States
  • Grover, Dheera, UConn Health, Farmington, Connecticut, United States
  • Moallem, Niala, UConn Health, Farmington, Connecticut, United States
  • Mclaughlin, Tara, Hartford Hospital, Hartford, Connecticut, United States
  • Parikh, Raj, Hartford Hospital, Hartford, Connecticut, United States
Background

Acute gastrointestinal bleeding (GIB) is associated with a high mortality and morbidity rate. Acute kidney injury (AKI) in critically ill patients admitted with GIB as their primary diagnosis is scarcely studied. We aimed to determine the incidence, risk factors and significance of acute kidney injury (AKI) in this cohort.

Methods

This was a single center retrospective study of patients admitted to the IU and ICU from the ED with GIB as their primary diagnosis from March 1, 2015 to March 1, 2021. Baseline characteristics, laboratory values and therapeutic interventions performed were extracted. AKI was defined according to the KDIGO criteria. Groups with and without AKI were compared. Chi square test was and Wilcoxon rank sum test were performed for categorical and continuous variables respectively.

Results

Among 300 patients, 46.3% developed an AKI. Diabetes mellitus (DM), heart failure (HF), atrial fibrillation (Afib), chronic kidney disease (CKD) were more frequently present in GIB patients who developed AKI. Mean arterial pressure (MAP) and heart rate (HR) at admission were lower in the AKI group [75 (interquartile range (IQR) 67,88) vs 80 (IQR 71,93) and 82 (IQR 72,100) vs 92 (IQR 76.5,108) respectively]. Vasopressor use and mechanical ventilation rates were higher in the AKI group. 14.7% of the GIB patients who developed AKI were transitioned to comfort care only (CMO) compared to 4.9% patients without AKI. While 90-day readmission rate with GIB and 30-day mortality rate were not significantly different between the groups, both the hospital and ICU/IU LOS were longer in patients with AKI [6 (IQR 4,10.25) vs 5 (IQR 3,7); p value <0.001 and 3.5 (IQR 2,5) vs 3 (IQR 2,4); p value 0.015 respectively].

Conclusion

In critically ill GIB patients, comorbid conditions such as DM, HF, Afib, CKD are risk factors for the development of AKI. They tended to present with a lower MAP, lower HR and higher lactic acid (LA). Risk stratification scores including Glasgow-Blatchford Bleeding Score (GBS) and AIMS 65 were worse. These patients were sicker and had higher vasopressor and mechanical ventilation needs. Consequently, they had longer hospital and ICU/IU LOS and were more likely to be made CMO. The development of AKI in critically ill GIB patients is associated with greater morbidity.