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

Abstract

IntroductionLittle information exists about the impact of acute kidney injury (AKI) in critically ill patients with the pandemic 2009 influenza A (H1N1) virus infection.MethodsWe 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.ResultsA 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).ConclusionsIn our cohort of patients with H1N1 virus infection, only those cases in the AKI III category were independently associated with mortality.

Epidemiology of Acute Kidney Injury in the Intensive Care Unit

“…Severe sepsis, often complicated by renal hypoperfusion in septic shock, is characterized by a profound inflammatory milieu and associated dysfunction of multiple organ systems. Rates of AKI reported in septic patients range from 13% up to >64.4% [49–51, 87, 108, 109]. The toxic effects of sepsis on AKI do not appear to be specific to bacterial or fungal pathogens.…”

“…The toxic effects of sepsis on AKI do not appear to be specific to bacterial or fungal pathogens. The 2009 H1N1 influenza pandemic demonstrated that viral infections caused significant rates of AKI (up to 51%) sometimes exceeding those seen in more common infections [49–53]. Of note, delays in the administration of appropriate antibiotics are associated with the highest incidence of sepsis-induced AKI.…”

“…Multiple case reports of rhabodmyolysis exist, but no systematic analyses of incidence have been published [115–119]. Therefore, it is impossible to determine whether the H1N1 strain uniquely caused AKI or whether the many reports of AKI reflect the underlying severity of the patients' illness upon their arrival in the ICU [49–53]. …”

Acute kidney injury among critically ill patients with pandemic H1N1 influenza A in Canada: cohort study

“…Many studies, however, were limited by design (case reports [14,17,20,22,24,28] or small case series [13,15,18,21,27]), small sample size [16,19,25], or single-center enrollment [13,15,16,18,21]. There have been few larger scale prospective multi-center cohorts [19,23,26], none of which described the Canadian pandemic.…”

Elevation of creatine kinase is associated with worse outcomes in 2009 pH1N1 influenza A infection

“…Introduction pH1N1 (2009 pandemic influenza A) presented with substantial pulmonary involvement; however, extrapulmonary complications were not uncommon and represented an additional contribution to mortality [1][2][3]. Risk factors for poor outcome included multiple-organ dysfunction syndrome and requirement of mechanical ventilation or renal replacement therapies [4][5][6]; indeed, stage III acute kidney injury (AKI) has proved to be an independent risk factor for mortality [7].…”