Evaluation of mortality and acute kidney injury by KDIGO and RIFLE in patients treated with colistin in the intensive care unit

Abstract

Introduction: Multidrug-resistant bacterial infections such as pseudomonas aeruginosa, Acinetobacter baumannii, klebsiella pneumoniae are common in Intensive Care Units. Colistin is preferred today due to limited treatment options sensitive to these pathogens. However, colistin has a high potential for nephrotoxicity. Some classifications (KDIGO, RIFLE, AKIN) are used for the diagnosis of Acute Kidney Injury (AKI). The incidence of AKI varies according to these classifications. In our study, we aimed to evaluate and compare the development of Acute Kidney Injury according to KDIGO criteria and RIFLE classification in patients followed up in the intensive care unit and started colistin therapy. Materials and Method: The data of 145 patients who started colistin treatment in the Internal Medicine Intensive Care Unit between January 2016 and December 2019 were retrospectively reviewed. Patients were grouped as those with Acute Kidney Injury and those without. Acute Kidney Injury evaluation was made according to RIFLE classification and KDIGO criteria. Results: In patients who received colistin treatment, 75 patients were evaluated as AKI when KDIGO criteria were used for the AKI diagnosis, and 54 patients were evaluated as AKI when the RIFLE classification was used. While the number of KDIGO Stage 1 patients was 44, the number of patients in the RIFLE classification risk group was determined as 23. The mean SOFA score was calculated as 7.91±2.8 and the mean APACHE II score as 22.77±5.3. The duration of stay in the ICU was 22.60±9.04. The duration of stay in the ICU was shorter in the group who developed AKI. 44.8% of the patients included in the study died. 52% of patients who developed AKI and 37.1% of those who did not develop AKI died. 30-day mortality in patients with AKI was significantly higher than both KDIGO staging and RIFLE classification (p=0.03, p=0.005, respectively). Mortality rate increased 1.42 times in KDIGO Stage 1, 2.79 times in KDIGO Stage 2 and 2.10 times in KDIGO Stage 3. When evaluated by the RIFLE classification, the mortality rate increased 2.32 times in the Risk group, 3.12 times in the Injury group, 2.06 times in the Failure group and 2.15 times in the Loss group. Conclusion:We observed an increase in the frequency of AKI in patients using colistin in the ICU, both according to KDIGO criteria and the RIFLE classification. This situation also increases the 30-day mortality. We think that the KDIGO criteria are more sensitive to diagnose AKI in these patients.