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Critical Care
Published in: Critical Care 1/2011

Open Access 01-02-2011 | Research

Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection

Authors: Ignacio Martin-Loeches, Elisabeth Papiol, Alejandro Rodríguez, Emili Diaz, Rafael Zaragoza, Rosa María Granada, Lorenzo Socias, Juan Bonastre, Montserrat Valverdú, Juan Carlos Pozo, Pilar Luque, Jose Antonio Juliá-Narvaéz, Lourdes Cordero, Antonio Albaya, Daniel Serón, Jordi Rello, the H1N1 SEMICYUC Working Group

Published in: Critical Care | Issue 1/2011

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Abstract

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.
Appendix
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Metadata
Title
Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection
Authors
Ignacio Martin-Loeches
Elisabeth Papiol
Alejandro Rodríguez
Emili Diaz
Rafael Zaragoza
Rosa María Granada
Lorenzo Socias
Juan Bonastre
Montserrat Valverdú
Juan Carlos Pozo
Pilar Luque
Jose Antonio Juliá-Narvaéz
Lourdes Cordero
Antonio Albaya
Daniel Serón
Jordi Rello
the H1N1 SEMICYUC Working Group
Publication date
01-02-2011
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2011
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc10046

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