Acute kidney injury in elderly ICU patients- A prospective study from Indian Sub-continent.
Abstract
Background: Acute kidney injury is defined as a significant increase in serum creatinine (SCr) or a decrease in urine output. It is a common and important occurrence in intensive care unit patients with a prevalence ranging from 2 to 25%. It has been seen that patients >65 years of age had a 10-fold increased incidence of AKI, a higher risk of dialysis dependence and significantly lower rates of renal recovery. Many scores for assessing AKI are devised among which SOFA score (Sequential Organ Function Assessment) and APACHE-II (Acute physiology and chronic health evaluation) are commonly used in the majority of ICUs as predictive of mortality.
The aim of the study: The primary aim was to identify risk factors for AKI and in-medical ICU (intensive care unit) mortality.
Material methods: A Two-year observational study done prospectively from January 2016 to January 2018 at a tertiary care center. All patients were admitted to the medical ICU at Gauhati Medical College Hospital and were followed prospectively from the time of admission in ICU through ICU discharge. A total of 200 patients were included in the study.
Results: Two hundred (200) elderly patients (?60 years) were included in the analysis. AKI developed in 58 patients (29%). AKI group had higher baseline creatinine, higher temperature, initial systolic blood pressure (SBP), heart rate, longer ICU stay and higher mortality rate (52.9% vs.47 %, p<0.001) compared to the non-AKI group. Out of 200 patients, most of the patients were classified as KDIGO stage 2 (58.8%), followed by stage 3 (26.5%) in the survivor's group while as the reverse was true for non-survivors. Non-survivors had higher APACHE II and SOFA>11 score [18.25 ± 2.513 x 42 (82.4), p< 0.001] compared to survivor group [10.82 ± 8.472 x 20(13.4) x, p<0.001]. The commonest etiological factor of AKI in elderly ICU patients was found to be sepsis in 38% (76) patients. Logistic regression analysis identified as factors associated with AKI SOFA>11 (odds ratio [OR] = 54.235, p<0.001), sepsis (OR=1.698), and diabetes (OR=27.692). Oliguria baseline creatinine, SOFA>11, APACHE II, need for renal replacement therapy (RRT) duration of stay in ICU, sepsis, and AKI severity (stage 3) were identified as predictors of death in logistic regression analysis.
Conclusion: Risk factors for AKI in elderly patients are SOFA>11 scores, higher APACHE II, the presence of sepsis, higher baseline creatinine and oliguria (<400 mL/day).
Key words: AKI, SOFA, APACHE-II, KDIGO stage. HAAKI.