BackgroundDespite the growing incidence of acute kidney injury (AKI) worldwide, there is little data on the burden and outcomes of AKI in intensive care unit (ICU) in low resource settings. The present study assessed the incidence of AKI and its impact on mortality in ICU in Kinshasa (Democratic Republic of Congo).MethodsIn a prospective cohort study, 476 consecutive critically ill patients (mean age 52 years, 57 % male) were screened for the presence of AKI in seven ICU from January 1st to March 30th, 2015. Serum creatinine was measured by the enzymatic method (Cobas C111 device®). AKI and its stages (no AKI, AKI 1, AKI 2 and AKI 3) were defined according to AKIN recommendations. The primary outcome was 28 days mortality. Survival (time-to death) curves were built using the Kaplan Meier methods. Predictors of mortality were assessed by Cox proportional hazards regression models. p < 0.05 defined the level of statistical significance.ResultsThe cumulative incidence of AKI was 52.7 % with AKI stage 1, 2 and 3 in 23.7 %, 16.2 % and 12.8 % of patients, respectively. Among patients who developed AKI, 146 died (58 %) vs 62 patients (28 %) in the group without AKI. Only 6.5 % of the patients with AKI stage 3 benefited from dialysis. Median survival time was 15.0 days in patients without AKI and 3.0 days, 6.0 days and 8.0 days in patients with AKI stage 3, 2 and 1 (p < 0.001), respectively. In addition to respiratory distress-induced polypnea (HRa 1.60; 95 % CI: 1.08–2.37; p = 0.018), oxygen desaturation (HRa 1.53; 95 % CI: 1.13–2.08; p = 0.006) and multi-organic involvement (HRa 1.63; 95 % CI: 1.15–2.30), AKI emerged as an independent predictor of death (HRa 1.82; 95 % CI: 1.34–2.48; p < 0.001).ConclusionMore than half of critically ill patients in the present cohort developed AKI which contributed substantially to short-term mortality, highlighting the need for its prevention, early detection and management as well as the availability of dialysis in ICU.
BACKGROUND AND AIM: Although admission hyperglycemia has been reported to be associated with unfavorable outcomes in acute stroke, little is known about this association in sub-Saharan Africa. Therefore, the aim of the present study was to assess the prognostic significance of admission hyperglycemia in the acute phase of stroke in Congolese patients. METHODS: In a multicenter prospective cohort study, consecutive patients with acute stroke were examined in 5 Emergency Rooms or Intensive Care Units of Kinshasa between July 15 th , 2017 and March 15 th , 2018. The severity of stroke was assessed at admission using the Glasgow Coma Scale. Stress hyperglycemia was defined as random blood glucose levels at admission > 140 mg/dL in patients without known type 2 diabetes mellitus (T2DM). The endpoint was 10-day all-cause in-hospital mortality. Survival (time-to-death) curves were built using the Kaplan Meier methods. Cox proportional analysis was used to identify predictors of 10-day all-cause in-hospital mortality. The predictive performance of blood glucose level to predict 10-day all-cause in-hospital mortality was assessed using ROC curve analysis. RESULTS: Out of 194 patients (mean age 58.7 ± 13.1 years; 64% males, 74.7% light to moderate stroke severity; 63.4% ischemic stroke) enrolled, 106 (54.
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