Epidemiology of acute kidney injury in critically ill patients

Cilj istraživanja: Utvrditi učestalost akutne ozljede bubrega (AOB) u bolesnika hospitaliziranih u jedinici intenzivnog liječenja (JIL), utvrditi čimbenike rizika odgovorne za nastanak poremećaja bubrežne funkcije te utvrditi stupanj AOB i u kojoj mjeri oštećenje bubrežne funkcije utječe na ishod liječenja. Nacrt studije: Retrospektivna studija. Ispitanici i metode: Ispitanici su bolesnici hospitalizirani na JIL-u Klinike za anesteziologiju i intenzivnu medicinu KBC-a Osijek od 1. 1. 2015. do 31. 12. 2016. godine u kojih se tijek komplicirao razvojem AOB. Izuzeti su kardiokirurški, bolesnici na kroničnoj dijalizi i oni koji su u JIL-u proveli < 3 dana. Relevantni podatci prikupljeni su iz medicinske dokumentacije i obrađeni pomoću statističkog programa R (inačica 3.2.0). Rezultati: AOB utvrđena je kod 131 ispitanika unutar 48 sati od dolaska u JIL. Prema KDIGO klasifikaciji, kod 51,2 % ispitanika utvrđena je bolest 2., a kod 41,2 % bolest 3. stupnja. Dvije trećine ispitanika bili su kirurški bolesnici primljeni u JIL nakon planirane ili hitne operacije. Od pratećih bolesti bile su zastupljene hipertenzija, kongestivno zatajenje srca i šećerna bolest. Konzervativno je liječeno 80,9 %, a hemodijalizom 19,1 % ispitanika. Umrlo je 73,3 % ispitanika, pretežito onih s 2. i 3. KDIGO stupnjem bolesti. Zaključak: Rana pojava sugerira da je AOB nastupila prije dolaska u JIL te da je vjerojatno povezana s osnovnom bolešću. Visoki SAPS II i SOFA skor upućuju na tešku narušenost općeg stanja i pojavu AOB u sklopu MODS-a. Uz kiruršku bolest kao vjerojatan čimbenik rizika, mogući su pridonoseći čimbenici hipertenzija, zatajenje srca i šećerna bolest. Teški oblici AOB pridonose smrtnom ishodu kritično oboljelih.Objectives: The objective of the study was to identify the incidence of acute kidney injury (AKI) in patients in the intensive care unit (ICU), to confirm the risk factors responsible for insufficient kidney function, to evaluate a level of AKI and to which extent it affects the hospital outcome. Study design: A retrospective study. Participants and methods: The participants included in the study were patients (admitted to the ICU for the observed period from January 1. 2015. to December 31. 2016.), whose state deteriorated with AKI. Left out from the study were cardiosurgical patients, those on hemodialysis and also those who spent more than 3 days in the ICU. Data relevant to the study were collected from medical histories and calculations were done using the statistical package R (version 3.2.0). Results: AKI was diagnosed in 131 patients within 48 hours upon their admission to the ICU. According to KDIGO classification, in 51.2 % of the patients the disease developed to level 2, in 42.2 % to level 3. Two thirds of the participants were surgical patients admitted to the ICU after a planned or an emergency operation. Associated diseases included high blood pressure, congestive heart failure and diabetes. Conservative treatment was used in 80.9 % cases, hemodialysis in 19.1 %. 73.3 % of the patients died, mainly those with 2 and 3 KDIGO disease level. Conclusion: AKI early incidence may suggest that AKI developed prior to the admittance to the ICU, and was most probably correlated with the basic disease. High SAPS and SOFA scores indicate severely damaged health and an occurence of AKI within MODS. Besides surgical disease as the most plausible risk factor, other potentially contributing risks are hipertension, congestive heart failure and diabetes. Severe cases of AKI may lead to death in high risk patients