Clinical Characteristics, Outcomes and Risk Factors for Death Among Critically Ill Patients With Hiv-Related Acute Kidney Injury

Abstract

SUMMARYBackground: The aim of this study is to describe clinical characteristics, outcomes and risk factors for death among patients with HIV-related acute kidney injury (AKI) admitted to an intensive care unit (ICU). Methods: A retrospective study was conducted with HIV-infected AKI patients admitted to the ICU of an infectious diseases hospital in Fortaleza, Brazil. All the patients with confirmed diagnosis of HIV and AKI admitted from January 2004 to December 2011 were included. A comparison between survivors and non-survivors was performed. Risk factors for death were investigated. Results: Among 256 AKI patients admitted to the ICU in the study period, 73 were identified as HIV-infected, with a predominance of male patients (83.6%), and the mean age was 41.2 ± 10.4 years. Non-survivor patients presented higher APACHE II scores (61.4 ± 19 vs. 38.6 ± 18, p = 0.004), used more vasoconstrictors (70.9 vs. 37.5%, p = 0.02) and needed more mechanical ventilation - MV (81.1 vs. 35.3%, p = 0.001). There were 55 deaths (75.3%), most of them (53.4%) due to septic shock. Independent risk factors for mortality were septic shock (OR = 14.2, 95% CI = 2.0-96.9, p = 0.007) and respiratory insufficiency with need of MV (OR = 27.6, 95% CI = 5.0-153.0, p < 0.001). Conclusion: Non-survivor HIV-infected patients with AKI admitted to the ICU presented higher severity APACHE II scores, more respiratory damage and hemodynamic impairment than survivors. Septic shock and respiratory insufficiency were independently associated to death.

Risk factors and outcomes of acute kidney injury in South African critically ill adults: a prospective cohort study

“…Length of stay was shorter for those with HIV, but reflects earlier mortality in those with increased severity of illness. As in other studies in the post-HAART era [36, 37, 43–45], it would appear from our data that traditional predictors of mortality such as higher severity of illness are implicated in predicting mortality and not HIV status, CD4 count, viral suppression nor the use of HAART.…”

An epidemiologic overview of acute kidney injury in intensive care units

“…The overall incidence of AKI ranged from 2.5% 6 to 92.2% 7 and mortality from 5% 8,9 to 80%, reaching 100% in patients who undergo renal replacement therapy (RRT). [10][11][12] Among the papers included in this review, 28 reflect data from developing countries, 17 from developed nations, and 2 are multinational, including countries with different income categories. The mean AKI incidence in developed and developing countries was 33.4% and 37.7%, while the mean mortality rate was 40.6% and 43.2%, respectively.…”

“…7,8 Other chronic pathological conditions that are also noted as risk factors for AKI incidence and mortality in critically ill patients include cardiovascular, 9,17,27-30 respiratory, 10,31 cerebrovascular, 16 cirrhosis, 32,33 cancer 15,25 , and human immunodeficiency virus infection. 10,34 Several studies have shown baseline renal function as one of the most important risk factors for AKI. Luo et al 35 performed prospective analysis of a database from Beijing (China), with more than three CONTINUATION thousand adult patients, and observed that AKI patients identified by KDIGO criteria already had worse baseline renal function in comparison with those without AKI.…”

“…In the presence of sepsis, the reported incidence of AKI was greater than 70%, and mortality rate reached 80%, higher in patients undergoing RRT, 1,10,11,14,17,24,34,36,37,[39][40][41][42][43] Sepsis was also an independent factor that increased the length of stay of individuals in ICUs. 11 The pathophysiological dynamics of the interaction between sepsis and AKI are not fully understood, and the association between sepsis and AKI in ICU patients can cause vascular, glomerular, tubular, and interstitial damage in the kidneys.…”

Death-related factors in HIV/AIDS patients undergoing hemodialysis in an intensive care unit

“…Patients infected with HIV are at high risk for developing critical diseases due to their advanced immunosuppression, increased susceptibility to tuberculosis and bacterial sepsis and underlying comorbidities, which are associated with their more frequent admission to intensive care units (ICUs) 3 , 4 . Other leading causes of hospitalization include drug toxicity, hepatitis B or C coinfection, cardiomyopathy, renal injury, chronic pulmonary disease and cirrhosis 3 .…”