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Acute kidney injury among critically ill patients with pandemic H1N1 influenza A in Canada: cohort study.

Abstract：

BACKGROUND:Canada's pandemic H1N1 influenza A (pH1N1) outbreak led to a high burden of critical illness. Our objective was to describe the incidence of AKI (acute kidney injury) in these patients and risk factors for AKI, renal replacement therapy (RRT), and mortality. METHODS:From a prospective cohort of critically ill adults with confirmed or probable pH1N1 (16 April 2009-12 April 2010), we abstracted data on demographics, co-morbidities, acute physiology, AKI (defined by RIFLE criteria for Injury or Failure), treatments in the intensive care unit, and clinical outcomes. Univariable and multivariable logistic regression analyses were used to evaluate the associations between clinical characteristics and the outcomes of AKI, RRT, and hospital mortality. RESULTS:We included 562 patients with pH1N1-related critical illness (479 [85.2%] confirmed, 83 [14.8%] probable]: mean age 48.0 years, 53.4% female, and 13.3% aboriginal. Common co-morbidities included obesity, diabetes, and chronic obstructive pulmonary disease. AKI occurred in 60.9%, with RIFLE categories of Injury (23.0%) and Failure (37.9%). Independent predictors of AKI included obesity (OR 2.94; 95%CI, 1.75-4.91), chronic kidney disease (OR 4.50; 95%CI, 1.46-13.82), APACHE II score (OR per 1-unit increase 1.06; 95%CI, 1.03-1.09), and P(a)O2/F(i)O2 ratio (OR per 10-unit increase 0.98; 95%CI, 0.95-1.00). Of patients with AKI, 24.9% (85/342) received RRT and 25.8% (85/329) died. Independent predictors of RRT were obesity (OR 2.25; 95% CI, 1.14-4.44), day 1 mechanical ventilation (OR 4.09; 95% CI, 1.21-13.84), APACHE II score (OR per 1-unit increase 1.07; 95% CI, 1.03-1.12), and day 1 creatinine (OR per 10 μmol/L increase, 1.06; 95%CI, 1.03-1.10). Development of AKI was not independently associated with hospital mortality. CONCLUSION:The incidence of AKI and RRT utilization were high among Canadian patients with critical illness due to pH1N1.

journal_name

BMC Nephrol

journal_title

BMC nephrology

authors

Bagshaw SM,Sood MM,Long J,Fowler RA,Adhikari NK,Canadian Critical Care Trials Group H1N1 Collaborative.

doi

10.1186/1471-2369-14-123

subject

Has Abstract

pub_date

2013-06-13 00:00:00

pages

123

issn

1471-2369

pii

1471-2369-14-123

journal_volume

pub_type

杂志文章,多中心研究

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Acute kidney injury among critically ill patients with pandemic H1N1 influenza A in Canada: cohort study.