Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection
Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection
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DOI：
10.1186/cc10046
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发表时间：
2011-01-01
期刊：
影响因子：
15.1
通讯作者：
Rello, Jordi
中科院分区：
文献类型：
--
作者：
Martin-Loeches, Ignacio;Papiol, Elisabeth;Rello, Jordi
简介：关于2009年甲型H1N1流感病毒感染对重症患者急性肾损伤（阿基）影响的信息很少：我们在148个西班牙重症监护病房（ICU）进行了一项前瞻性、观察性、多中心研究。排除慢性肾衰竭患者。阿基的定义参照急性肾损伤网络（AKIN）标准。118例（17.7%）患者发生阿基;其中，37例（31.4%）阿基患者归类为阿基I，15例（12.7%）归类为阿基II，66例（55.9%）归类为阿基III，其中50例（75.7%）患者需要连续肾脏替代治疗。阿基患者的急性生理学和慢性健康评估II评分较高，（19.2 +/- 8.3对比12.6 +/- 5.9; P < 0.001），序贯器官衰竭评估评分较高（8.7 +/- 4.2 vs 4.8 +/- 2.9; P < 0.001），更需要机械通气（MV）（87.3%对56.2%; P < 0.01，比值比（OR）5.3，95%置信区间（CI）3.0 - 9.4），休克发生率更高（75.4%对38.3%; P < 0.01，OR 4.9，95% CI，3.1至7.7），多器官功能障碍综合征的发生率更高（92.4% vs 54.7%; P < 0.01，OR 10.0，95% CI，4.9 - 20.21），合并感染的发生率更高（23.7%对14.4%; P < 0.01，OR 1.8，95% CI，1.1至3.0）。在幸存者中，阿基患者的MV停留时间更长，ICU和住院时间长于无阿基患者。总死亡率为18.8%，阿基患者的总死亡率显著更高（44.1% vs 13.3%; P < 0.01，OR 5.1，95% CI，3.3 - 7.9）。采用AKIN标准进行Logistic回归分析，结果显示阿基患者中只有阿基III与ICU高死亡率独立相关（P < 0.001，OR 4.81，95% CI 2.17 ~ 10.62）。结论：在我们的H1N1病毒感染患者队列中，只有阿基III与死亡率独立相关。
Introduction: Little information exists about the impact of acute kidney injury (AKI) in critically ill patients with the pandemic 2009 influenza A (H1N1) virus infection.Methods: We conducted a prospective, observational, multicenter study in 148 Spanish intensive care units (ICUs). Patients with chronic renal failure were excluded. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria.Results: A total of 661 patients were analyzed. One hundred eighteen (17.7%) patients developed AKI; of these, 37 (31.4%) of the patients with AKI were classified as AKI I, 15 (12.7%) were classified as AKI II and 66 (55.9%) were classified as AKI III, among the latter of whom 50 (75.7%) required continuous renal replacement therapy. Patients with AKI had a higher Acute Physiology and Chronic Health Evaluation II score (19.2 +/- 8.3 versus 12.6 +/- 5.9; P < 0.001), a higher Sequential Organ Failure Assessment score (8.7 +/- 4.2 versus 4.8 +/- 2.9; P < 0.001), more need for mechanical ventilation (MV) (87.3% versus 56.2%; P < 0.01, odds ratio (OR) 5.3, 95% confidence interval (CI) 3.0 to 9.4), a greater incidence of shock (75.4% versus 38.3%; P < 0.01, OR 4.9, 95% CI, 3.1 to 7.7), a greater incidence of multiorgan dysfunction syndrome (92.4% versus 54.7%; P < 0.01, OR 10.0, 95% CI, 4.9 to 20.21) and a greater incidence of coinfection (23.7% versus 14.4%; P < 0.01, OR 1.8, 95% CI, 1.1 to 3.0). In survivors, patients with AKI remained on MV longer and ICU and hospital length of stay were longer than in patients without AKI. The overall mortality was 18.8% and was significantly higher for AKI patients (44.1% versus 13.3%; P < 0.01, OR 5.1, 95% CI, 3.3 to 7.9). Logistic regression analysis was performed with AKIN criteria, and it demonstrated that among patients with AKI, only AKI III was independently associated with higher ICU mortality (P < 0.001, OR 4.81, 95% CI 2.17 to 10.62).Conclusions: In our cohort of patients with H1N1 virus infection, only those cases in the AKI III category were independently associated with mortality.