Pattern and prognostic factors of acute kidney injury in an intensive care unit in Nigeria
Abstract
Introduction: Acute kidney injury (AKI) is a clinical entity with significantly high morbidity and mortality rates especially in the intensive care setting. Few previous studies in this area have employed less sensitive criteria with limited results. Thus, application of newer criteria and prognostic scores will give a true picture of the magnitude of the problem in this particular setting.
Methodology: This study was carried out among 100 consecutive patients admitted to the intensive care unit (ICU) over an eighteen-month period to determine the occurrence, frequency, and outcomes, and to also seek a relationship between the diagnostic criteria of AKI such as the Risk, Injury, Failure, Loss and End stage (RIFLE) and the Acute Kidney Injury Network (AKIN) criteria respectively and the Acute
Physiological and Chronic Health Evaluation, (APACHE) IV. The outcome measures in these patients were as follows; need for haemodialysis, survival without haemodialysis or death.
Results: The patients studied were aged between 18 and 70 years (Mean± SD ; 41.5±16.3 ) and the male to female ratio of 1.4:1. The incidence of AKI in patients admitted into the ICU was 54 (54%) . Using the RIFLE criteria, 37% were in the Injury stage while 46.3% were in stage 2 using the AKIN criteria. Surgical cases such as head injuries and advanced carcinomas constituted the major primary aetiology (72.2%). The presence of other organ system failure (apart from the kidney) was largely predictive of outcome among ICU patients (p<0.001). 47 patients had other organ system failure. Out of these, only 7 (14.9%) of them survived. There was a higher APACHE IV scores(61.1± 24.3) in patients that developed AKI compared to those that did not develop AKI (55.2 ± 19.9).
Conclusion: Acute kidney injury is a huge burden in the intensive care setting, early identification using newer diagnostic parameters and risk stratification with more sensitive diagnostic scores could help inidentifying patients at risk
Keywords: Acute, kidney, injury, intensive, care
Résumé
Introduction: L’injurie rénale aiguë (IRA) est une entité clinique présentant des taux de morbidité et de mortalité significativement élevés, en particulier dans le contexte des soins intensifs. Peu d’études antérieures dans ce domaine ont utilisé des critères moins sensibles avec des résultats limités. Ainsi, l’application de critères et de scores pronostiques plus récents donnera une image fidèle de l’ampleur du problème dans ce contexte particulier.
Méthodologie: Cette étude a été réalisée sur 100 patients consécutifs admis en unité de soins intensifs (USI) sur une période de dix-huit mois afin de déterminer l’occurrence, la fréquence et les résultats ainsi que de rechercher une relation entre les critères de diagnostic de l’IRA tels que les critères de risque , blessures, échec, perte et étape ultime (RIFLE) et critères du réseau de lésions rénales aiguës (RIRA) respectivement et évaluation de l’état de santé aiguë physiologique et chronique (APACHE) IV. Les mesures de résultats chez ces patients étaient les suivantes : besoin d’hémodialyse, de survie sans hémodialyse ou mort. Les résultats ; Les patients étudiés étaient âgés de 18 à 70 ans (moyenne ± ET ; 41,5 ± 16,3) et le ratio
hommes / femmes de 1,4 : 1. L’incidence d’IRA chez les patients admis en USI était de 54 (54%). En utilisant les critères RIFLE, 37% se trouvaient à l’étape lésion alors que 46,3% étaient à l’étape 2 en
utilisant les critères RIRA. Les cas chirurgicaux tels que les blessures à la tête et les carcinomes avancés constituaient la principale étiologie primaire (72,2%). La présence d’autres défaillances du système organique (hormis le rein) était largement prédictive du résultat chez les patients en USI (p <0,001). 47 patients ont eu une autre défaillance du système d’organe. Parmi eux, seulement 7 (14,9%) ont survécu. Les scores APACHE IV étaient plus élevés (61,1 ± 24,3) chez les patients ayant développé une IRA par rapport à ceux qui ne présentaient pas d’IRA (55,2 ± 19,9).
Conclusion: Les lésions rénales aiguës représentent un fardeau énorme en soins intensifs. Une identification précoce à l’aide de nouveaux paramètres de diagnostic et une stratification du risque avec des scores de diagnostic plus sensibles pourraient aider à identifier les patients à risque.
Mots-clés: Aiguë, rein, blessure, intensive, soins
Correspondence: Dr. Oluyomi Okunola, Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun
State, Nigeria. Email\:yok8@yahoo.com
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