Acute Kidney Injury in Mechanically Ventilated Patients: The Risk Factor Profile Depends on the Timing of Aki Onset.
Identifieur interne : 000380 ( Main/Exploration ); précédent : 000379; suivant : 000381Acute Kidney Injury in Mechanically Ventilated Patients: The Risk Factor Profile Depends on the Timing of Aki Onset.
Auteurs : Raúl Lombardi [États-Unis] ; Nicolás Nin ; Oscar Pe Uelas ; Alejandro Ferreiro ; Fernando Rios ; Maria Carmen Marin ; Konstantinos Raymondos ; Jose A. Lorente ; Younsuck Koh ; Javier Hurtado ; Marco Gonzalez ; Fekri Abroug ; Manuel Jibaja ; Yaseen Arabi ; Rui Moreno ; Dimitros Matamis ; Antonio Anzueto ; Andres EstebanSource :
- Shock (Augusta, Ga.) [ 1540-0514 ] ; 2017.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Arrêt cardiaque provoqué (effets indésirables), Atteinte rénale aigüe (physiopathologie), Atteinte rénale aigüe (épidémiologie), Atteinte rénale aigüe (étiologie), Bases de données factuelles (MeSH), Facteurs de risque (MeSH), Facteurs temps (MeSH), Facteurs âges (MeSH), Femelle (MeSH), Humains (MeSH), Mâle (MeSH), Pression sanguine (MeSH), Soins de réanimation (MeSH), Sujet âgé (MeSH), Ventilation artificielle (effets indésirables), Études rétrospectives (MeSH).
- MESH :
- effets indésirables : Arrêt cardiaque provoqué, Ventilation artificielle.
- physiopathologie : Atteinte rénale aigüe.
- épidémiologie : Atteinte rénale aigüe.
- étiologie : Atteinte rénale aigüe.
- Adulte, Adulte d'âge moyen, Bases de données factuelles, Facteurs de risque, Facteurs temps, Facteurs âges, Femelle, Humains, Mâle, Pression sanguine, Soins de réanimation, Sujet âgé, Études rétrospectives.
English descriptors
- KwdEn :
- Acute Kidney Injury (epidemiology), Acute Kidney Injury (etiology), Acute Kidney Injury (physiopathology), Adult (MeSH), Age Factors (MeSH), Aged (MeSH), Blood Pressure (MeSH), Critical Care (MeSH), Databases, Factual (MeSH), Female (MeSH), Heart Arrest, Induced (adverse effects), Humans (MeSH), Male (MeSH), Middle Aged (MeSH), Respiration, Artificial (adverse effects), Retrospective Studies (MeSH), Risk Factors (MeSH), Time Factors (MeSH).
- MESH :
- adverse effects : Heart Arrest, Induced, Respiration, Artificial.
- epidemiology : Acute Kidney Injury.
- etiology : Acute Kidney Injury.
- physiopathology : Acute Kidney Injury.
- Adult, Age Factors, Aged, Blood Pressure, Critical Care, Databases, Factual, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Time Factors.
Abstract
BACKGROUND
Acute kidney injury (AKI) is a frequent complication in patients under mechanical ventilation (MV). We aimed to assess the risk factors for AKI with particular emphasis on those potentially preventable.
STUDY DESIGN, SETTING, AND PARTICIPANTS
Retrospective analysis of a large, multinational database of MV patients with >24 h of MV and normal renal function at admission. AKI was defined according to creatinine-based KDIGO criteria. Risk factors were analyzed according to the time point at which AKI occurred: early (≤48 h after ICU admission, AKIE) and late (day 3 to day 7 of ICU stay, AKIL). A conditional logistic regression model was used to identify variables independently associated with AKI.
RESULTS
Three thousand two hundred six patients were included. Seven hundred patients had AKI (22%), the majority of them AKIE (547/704). The risk factor profile was highly dependent upon the timing of AKI onset. In AKIE risk factors were older age; SAPS II score; postoperative and cardiac arrest as the reasons for MV; worse cardiovascular SOFA, pH, serum creatinine, and platelet count; higher level of peak pressure and Vt/kg; and fluid overload at admission. In contrast, AKIL was linked mostly to events that occurred after admission (lower platelet count and pH; ICU-acquired sepsis; and fluid overload). None ventilation-associated parameters were identify as risk factors for AKIL.
CONCLUSIONS
In the first 48 h, risk factors are associated with the primary disease and the patient's condition at admission. Subsequently, emergent events like sepsis and organ dysfunction appear to be predictive factors making prevention a challenge.
DOI: 10.1097/SHK.0000000000000871
PubMed: 28379920
Affiliations:
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Le document en format XML
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1° Octubre, ISSSTE, Ciudad de México, México, Mexico**Medizinische Hochschule Hannover, Hannover, Germany††Asan Medical Center, University of Ulsan, Seoul, Republic of Korea‡‡Clínica Medellín and Universidad Pontificia Bolivariana, Medellín, Colombia§§Hospital Fattouma Bourguina, Monastir, Tunisia||||Hospital Eugenio Espejo, Quito, Ecuador¶¶King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia##UCINC, Hospital de Sao José, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal***Papageorgiou Hospital, Thessaloniki, Greece†††South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>*Servicio Médico Integral, Montevideo, Uruguay†Hospital Español, Montevideo, Uruguay‡Hospital Universitario de Getafe, Madrid, Spain§CIBER Enfermedades Respiratorias, Barcelona, Spain||Hospital de Clínicas, Universidad de la Republica, Montevideo, Uruguay¶Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina#Hospital Regional 1° Octubre, ISSSTE, Ciudad de México, México, Mexico**Medizinische Hochschule Hannover, Hannover, Germany††Asan Medical Center, University of Ulsan, Seoul, Republic of Korea‡‡Clínica Medellín and Universidad Pontificia Bolivariana, Medellín, Colombia§§Hospital Fattouma Bourguina, Monastir, Tunisia||||Hospital Eugenio Espejo, Quito, Ecuador¶¶King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia##UCINC, Hospital de Sao José, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal***Papageorgiou Hospital, Thessaloniki, Greece†††South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio</wicri:cityArea></affiliation></author><author><name sortKey="Nin, Nicolas" sort="Nin, Nicolas" uniqKey="Nin N" first="Nicolás" last="Nin">Nicolás Nin</name></author><author><name sortKey="Pe Uelas, Oscar" sort="Pe Uelas, Oscar" uniqKey="Pe Uelas O" first="Oscar" last="Pe Uelas">Oscar Pe Uelas</name></author><author><name sortKey="Ferreiro, Alejandro" sort="Ferreiro, Alejandro" uniqKey="Ferreiro A" first="Alejandro" last="Ferreiro">Alejandro Ferreiro</name></author><author><name sortKey="Rios, Fernando" sort="Rios, Fernando" uniqKey="Rios F" first="Fernando" last="Rios">Fernando Rios</name></author><author><name sortKey="Marin, Maria Carmen" sort="Marin, Maria Carmen" uniqKey="Marin M" first="Maria Carmen" last="Marin">Maria Carmen Marin</name></author><author><name sortKey="Raymondos, Konstantinos" sort="Raymondos, Konstantinos" uniqKey="Raymondos K" first="Konstantinos" last="Raymondos">Konstantinos Raymondos</name></author><author><name sortKey="Lorente, Jose A" sort="Lorente, Jose A" uniqKey="Lorente J" first="Jose A" last="Lorente">Jose A. Lorente</name></author><author><name sortKey="Koh, Younsuck" sort="Koh, Younsuck" uniqKey="Koh Y" first="Younsuck" last="Koh">Younsuck Koh</name></author><author><name sortKey="Hurtado, Javier" sort="Hurtado, Javier" uniqKey="Hurtado J" first="Javier" last="Hurtado">Javier Hurtado</name></author><author><name sortKey="Gonzalez, Marco" sort="Gonzalez, Marco" uniqKey="Gonzalez M" first="Marco" last="Gonzalez">Marco Gonzalez</name></author><author><name sortKey="Abroug, Fekri" sort="Abroug, Fekri" uniqKey="Abroug F" first="Fekri" last="Abroug">Fekri Abroug</name></author><author><name sortKey="Jibaja, Manuel" sort="Jibaja, Manuel" uniqKey="Jibaja M" first="Manuel" last="Jibaja">Manuel Jibaja</name></author><author><name sortKey="Arabi, Yaseen" sort="Arabi, Yaseen" uniqKey="Arabi Y" first="Yaseen" last="Arabi">Yaseen Arabi</name></author><author><name sortKey="Moreno, Rui" sort="Moreno, Rui" uniqKey="Moreno R" first="Rui" last="Moreno">Rui Moreno</name></author><author><name sortKey="Matamis, Dimitros" sort="Matamis, Dimitros" uniqKey="Matamis D" first="Dimitros" last="Matamis">Dimitros Matamis</name></author><author><name sortKey="Anzueto, Antonio" sort="Anzueto, Antonio" uniqKey="Anzueto A" first="Antonio" last="Anzueto">Antonio Anzueto</name></author><author><name sortKey="Esteban, Andres" sort="Esteban, Andres" uniqKey="Esteban A" first="Andres" last="Esteban">Andres Esteban</name></author></analytic><series><title level="j">Shock (Augusta, Ga.)</title><idno type="eISSN">1540-0514</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute Kidney Injury (epidemiology)</term><term>Acute Kidney Injury (etiology)</term><term>Acute Kidney Injury (physiopathology)</term><term>Adult (MeSH)</term><term>Age Factors (MeSH)</term><term>Aged (MeSH)</term><term>Blood Pressure (MeSH)</term><term>Critical Care (MeSH)</term><term>Databases, Factual (MeSH)</term><term>Female (MeSH)</term><term>Heart Arrest, Induced (adverse effects)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Respiration, Artificial (adverse effects)</term><term>Retrospective Studies (MeSH)</term><term>Risk Factors (MeSH)</term><term>Time Factors (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Arrêt cardiaque provoqué (effets indésirables)</term><term>Atteinte rénale aigüe (physiopathologie)</term><term>Atteinte rénale aigüe (épidémiologie)</term><term>Atteinte rénale aigüe (étiologie)</term><term>Bases de données factuelles (MeSH)</term><term>Facteurs de risque (MeSH)</term><term>Facteurs temps (MeSH)</term><term>Facteurs âges (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Mâle (MeSH)</term><term>Pression sanguine (MeSH)</term><term>Soins de réanimation (MeSH)</term><term>Sujet âgé (MeSH)</term><term>Ventilation artificielle (effets indésirables)</term><term>Études rétrospectives (MeSH)</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Heart Arrest, Induced</term><term>Respiration, Artificial</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Arrêt cardiaque provoqué</term><term>Ventilation artificielle</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Acute Kidney Injury</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Acute Kidney Injury</term></keywords><keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Atteinte rénale aigüe</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Acute Kidney Injury</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Atteinte rénale aigüe</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Atteinte rénale aigüe</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Age Factors</term><term>Aged</term><term>Blood Pressure</term><term>Critical Care</term><term>Databases, Factual</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Retrospective Studies</term><term>Risk Factors</term><term>Time Factors</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Bases de données factuelles</term><term>Facteurs de risque</term><term>Facteurs temps</term><term>Facteurs âges</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Pression sanguine</term><term>Soins de réanimation</term><term>Sujet âgé</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Acute kidney injury (AKI) is a frequent complication in patients under mechanical ventilation (MV). We aimed to assess the risk factors for AKI with particular emphasis on those potentially preventable.</p></div><div type="abstract" xml:lang="en"><p><b>STUDY DESIGN, SETTING, AND PARTICIPANTS</b></p><p>Retrospective analysis of a large, multinational database of MV patients with >24 h of MV and normal renal function at admission. AKI was defined according to creatinine-based KDIGO criteria. Risk factors were analyzed according to the time point at which AKI occurred: early (≤48 h after ICU admission, AKIE) and late (day 3 to day 7 of ICU stay, AKIL). A conditional logistic regression model was used to identify variables independently associated with AKI.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Three thousand two hundred six patients were included. Seven hundred patients had AKI (22%), the majority of them AKIE (547/704). The risk factor profile was highly dependent upon the timing of AKI onset. In AKIE risk factors were older age; SAPS II score; postoperative and cardiac arrest as the reasons for MV; worse cardiovascular SOFA, pH, serum creatinine, and platelet count; higher level of peak pressure and Vt/kg; and fluid overload at admission. In contrast, AKIL was linked mostly to events that occurred after admission (lower platelet count and pH; ICU-acquired sepsis; and fluid overload). None ventilation-associated parameters were identify as risk factors for AKIL.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>In the first 48 h, risk factors are associated with the primary disease and the patient's condition at admission. Subsequently, emergent events like sepsis and organ dysfunction appear to be predictive factors making prevention a challenge.</p></div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Texas</li></region></list><tree><noCountry><name sortKey="Abroug, Fekri" sort="Abroug, Fekri" uniqKey="Abroug F" first="Fekri" last="Abroug">Fekri Abroug</name><name sortKey="Anzueto, Antonio" sort="Anzueto, Antonio" uniqKey="Anzueto A" first="Antonio" last="Anzueto">Antonio Anzueto</name><name sortKey="Arabi, Yaseen" sort="Arabi, Yaseen" uniqKey="Arabi Y" first="Yaseen" last="Arabi">Yaseen Arabi</name><name sortKey="Esteban, Andres" sort="Esteban, Andres" uniqKey="Esteban A" first="Andres" last="Esteban">Andres Esteban</name><name sortKey="Ferreiro, Alejandro" sort="Ferreiro, Alejandro" uniqKey="Ferreiro A" first="Alejandro" last="Ferreiro">Alejandro Ferreiro</name><name sortKey="Gonzalez, Marco" sort="Gonzalez, Marco" uniqKey="Gonzalez M" first="Marco" last="Gonzalez">Marco Gonzalez</name><name sortKey="Hurtado, Javier" sort="Hurtado, Javier" uniqKey="Hurtado J" first="Javier" last="Hurtado">Javier Hurtado</name><name sortKey="Jibaja, Manuel" sort="Jibaja, Manuel" uniqKey="Jibaja M" first="Manuel" last="Jibaja">Manuel Jibaja</name><name sortKey="Koh, Younsuck" sort="Koh, Younsuck" uniqKey="Koh Y" first="Younsuck" last="Koh">Younsuck Koh</name><name sortKey="Lorente, Jose A" sort="Lorente, Jose A" uniqKey="Lorente J" first="Jose A" last="Lorente">Jose A. Lorente</name><name sortKey="Marin, Maria Carmen" sort="Marin, Maria Carmen" uniqKey="Marin M" first="Maria Carmen" last="Marin">Maria Carmen Marin</name><name sortKey="Matamis, Dimitros" sort="Matamis, Dimitros" uniqKey="Matamis D" first="Dimitros" last="Matamis">Dimitros Matamis</name><name sortKey="Moreno, Rui" sort="Moreno, Rui" uniqKey="Moreno R" first="Rui" last="Moreno">Rui Moreno</name><name sortKey="Nin, Nicolas" sort="Nin, Nicolas" uniqKey="Nin N" first="Nicolás" last="Nin">Nicolás Nin</name><name sortKey="Pe Uelas, Oscar" sort="Pe Uelas, Oscar" uniqKey="Pe Uelas O" first="Oscar" last="Pe Uelas">Oscar Pe Uelas</name><name sortKey="Raymondos, Konstantinos" sort="Raymondos, Konstantinos" uniqKey="Raymondos K" first="Konstantinos" last="Raymondos">Konstantinos Raymondos</name><name sortKey="Rios, Fernando" sort="Rios, Fernando" uniqKey="Rios F" first="Fernando" last="Rios">Fernando Rios</name></noCountry><country name="États-Unis"><region name="Texas"><name sortKey="Lombardi, Raul" sort="Lombardi, Raul" uniqKey="Lombardi R" first="Raúl" last="Lombardi">Raúl Lombardi</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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