Prognostic factors among critically ill patients with community-acquired acute bacterial meningitis and acute kidney injury

Abstract

ObjectiveTo investigate prognostic factors among critically ill patients with community-acquired bacterial meningitis and acute kidney injury.MethodsA retrospective study including patients admitted to a tertiary infectious disease hospital in Fortaleza, Brazil diagnosed with community-acquired bacterial meningitis complicated with acute kidney injury. Factors associated with death, mechanical ventilation and use of vasopressors were investigated.ResultsForty-one patients were included, with a mean age of 41.6 ± 15.5 years; 56% were males. Mean time between intensive care unit admission and acute kidney injury diagnosis was 5.8 ± 10.6 days. Overall mortality was 53.7%. According to KDIGO criteria, 10 patients were classified as stage 1 (24.4%), 18 as stage 2 (43.9%) and 13 as stage 3 (31.7%). KDIGO 3 significantly increased mortality (OR = 6.67; 95%CI = 1.23 - 36.23; p = 0.028). Thrombocytopenia was not associated with higher mortality, but it was a risk factor for KDIGO 3 (OR = 5.67; 95%CI = 1.25 - 25.61; p = 0.024) and for mechanical ventilation (OR = 6.25; 95%CI = 1.33 - 29.37; p = 0.02). Patients who needed mechanical ventilation by 48 hours from acute kidney injury diagnosis had higher urea (44.6 versus 74mg/dL, p = 0.039) and sodium (138.6 versus 144.1mEq/L; p = 0.036).ConclusionMortality among critically ill patients with community-acquired bacterial meningitis and acute kidney injury is high. Acute kidney injury severity was associated with even higher mortality. Thrombocytopenia was associated with severer acute kidney injury. Higher urea was an earlier predictor of severer acute kidney injury than was creatinine.

Platelet Function in Acute Kidney Injury: A Systematic Review and a Cohort Study

“…In total, 58 studies were eligible for inclusion. Of these, nine investigated platelet function in AKI patients, 28 29 30 52 53 54 55 56 57 46 studies examined platelet count only 23 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 and 3 investigated mean platelet volume. 103 104 105 Thirty-two studies were set in an ICU and twenty-six were set in a medical ward.…”

“…Twenty-nine studies (28 including adults and 1 including children) investigated platelet count or thrombocytopenia prevalence in ICU patients, 28 52 53 54 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 and 24 studies included medical ward patients with either lupus nephritis ( n = 1), 93 rifampicin treatment ( n = 1), 94 snake bite ( n = 2), 91 92 decompensated liver cirrhosis ( n = 3), 30 57 95 infectious diseases ( n = 8), 83 84 85 86 87 88 89 90 or AKI of mixed origin ( n = 9). 23 29 96 97 98 99 100 101 102 Further, three studies investigated mean platelet volume in AKI patients, of which two were set in an ICU 103 104 and one was set in a medical ward.…”

“…60 74 82 Mean/median platelet counts below 150 × 10 9 /L were commonly reported 28 54 65 67 68 78 80 82 and low platelet counts were observed both in the absence 28 65 68 74 77 78 81 82 and presence of RRT. 54 64 67 72 73 74 77 Twelve studies examined platelet count as a predictor of mortality in AKI, 58 59 61 62 63 64 65 66 67 68 69 74 of which nine (75%) found low platelet count predictive of mortality. 58 59 62 63 64 65 66 67 74…”