1Medical Intensive Care Unit, University Hospital Center La Rabta, Tunis, Tunisia
2Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia
3Department of Anesthesia, University Hospital Center La Rabta, Tunisia, Tunis, Tunisia
Copyright © 2021 The Korean Society of Critical Care Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTIONS
Conceptualization: AT, SA, AA. Data curation: YM, AM, OB, BJ, CA, FD. Formal analysis: AT, SA, AA, SBL. Methodology: AT, AM, OB, ES, FC. Project administration: AT, YM, AM. Visualization: AT, YM, YT, FD. Writing–original draft: AT, YM, YT, BJ, CA. Writing–review & editing: SA, AA, SBL.
Variable | Total population (n=109) | AKI group (n=48) | No AKI group (n=61) | P-value |
---|---|---|---|---|
Age | 64 (57–71) | 69 (61–77) | 60 (55–66) | <0.001 |
> 60 yr | 67 (61.5) | 37 (77) | 30 (49) | 0.003 |
Sex (male:female) | 75:34 | 33:15 | 42:19 | 0.999 |
BMI | 27 (24–31) | 27.3 (24.5–30.7) | 27 (24–32.5) | 0.620 |
Obesity (BMI >30 kg/m2) | 32 (29.5) | 11 (23) | 21 (34.5) | 0.182 |
Comorbidity | ||||
Hypertension | 56 (51.5) | 30 (62.5) | 26 (42.6) | 0.054 |
Prior use of ACE inhibitor/A2RB | 27 (25) | 16 (33.5) | 11 (18) | 0.071 |
Diabetes | 44 (40) | 23 (48) | 21 (34.4) | 0.175 |
Chronic renal failure | 5 (4.5) | 1 (2) | 4 (6.5) | 0.388 |
Chronic respiratory failure | 20 (18.5) | 8 (16.5) | 12 (20) | 0.804 |
Cardiomyopathy | 18 (16.5) | 9 (19) | 9 (15) | 0.613 |
Immunocompromised | 6 (5.5) | 4 (8.3) | 2 (3.3) | 0.489 |
Severity score | ||||
APACHE II | 10.5 (7–16) | 13 (10–18) | 9 (6–11) | <0.001 |
SAPS II | 30 (22–40) | 38 (31–53) | 24 (16–30.7) | <0.001 |
SOFA | 4 (3–9) | 7 (4–11) | 4 (2–7.5) | 0.001 |
Initial laboratory finding | ||||
Baseline serum urea (g/L) | 0.57 (0.39–1.05) | 1 (0.71–1.3) | 0.45 (0.36–0.56) | <0.001 |
Baseline creatinine (mg/L) | 9 (7–14) | 12.5 (9–18.4) | 8 (7–10) | <0.001 |
Minimum P/F ratio | 66 (48–93) | 60 (46–78) | 73 (55–126) | 0.110 |
WBC count (×109/L) | 12 (8.5–17) | 17 (7–21) | 10 (4–15) | 0.033 |
Minimum lymphocyte (×103/µl) | 520 (312–720) | 510 (320–760) | 550 (302–715) | 0.819 |
Platelet (×109/L) | 141 (48–238) | 134 (33–266) | 145 (58–229) | 0.772 |
CRP (mg/L) | 199 (98–280) | 248 (171–326) | 151 (74–242) | 0.002 |
Prothrombin time (%) | 60 (45–80) | 56 (41–69) | 75 (52–86) | 0.001 |
Fibrinogen (g/L) | 5.1 (1.7–6.4) | 5.5 (4.2–6.9) | 2.5 (1.5–6.2) | 0.179 |
D-dimer (µg/L) | 1,402 (653–3,881) | 2,222 (813–5,109) | 905 (598–1,757) | 0.002 |
Lactate (mmol/L) | 2.1 (1.6–6) | 2.1 (1.7–4) | 1.9 (1.6–3.6) | 0.448 |
CT scan lesion extension at admissiona, >50% | 33/78 (42) | 13/31 (42) | 20/47 (42.5) | 0.999 |
Predisposing condition | ||||
Sepsis | 49 (45) | 35 (73) | 14 (23) | <0.001 |
ARDS | 81 (74) | 38 (81) | 43 (70.5) | 0.953 |
ACPa | 10/66 (15) | 8/29 (27.5) | 2/37 (5.4) | 0.017 |
Rhabdomyolysis | 21 (19) | 14 (29 | 7 (11.5) | 0.086 |
Vasopressor | 60 (55) | 40 (84) | 20 (33) | <0.001 |
Nephrotoxic drug | 29 (27) | 20 (42.5) | 9 (15) | 0.014 |
Respiratory support | ||||
Alternation HFNC/NIV | 61 (56) | 18 (37.5) | 43 (70.5) | - |
MV | 48 (44) | 30 (62.5) | 18 (29.5) | 0.001 |
Values are presented as median (interquartile range) or number (%).
AKI: acute kidney injury; BMI: body mass index; ACE: angiotensin-converting enzyme; A2RB: angiotensin II receptor blockers; APACHE: Acute Physiology and Chronic Health Evaluation; SAPS: Simplified Acute Physiology Score; SOFA: Sequential Organ Failure Assessment; P/F ratio: ratio of the arterial partial pressure of oxygen and the inspiratory concentration of oxygen; WBC: white blood cell; CRP: C-reactive protein; CT: computed tomography; ARDS: acute respiratory distress syndrome; ACP: acute cor pulmonale; HFNC: high-flow nasal cannula; NIV: noninvasive ventilation; MV: mechanical ventilation.
aCT scan performed in 78 patients and echocardiography in 66 patients.
Variable | Odds ratio | P-value |
---|---|---|
Age > 60 yr | 1.35 | 0.320 |
Hypertension | 1.58 | 0.612 |
Prior use of ACE inhibitor/A2RB | 1.25 | 0.124 |
Diabetes | 1.55 | 0.402 |
P/F ratio <70 | 2.54 | 0.154 |
CRP >200 mg/L | 2.21 | 0.140 |
Fibrinogen >5 g/L | 3.03 | 0.115 |
D-dimers >1,400 µg/L | 12.83 (1.9–85)a | 0.008 |
Sepsis | 5.22 (0.94–28)a | 0.058 |
Rhabdomyolysis | 6.53 | 0.072 |
MV | 4.30 | 0.124 |
Vasopressor | 1.82 | 0.466 |
Nephrotoxic drug | 4.26 | 0.080 |
Values are presented as number (%) or median (interquartile range) unless otherwise indicated.
AKI: acute kidney injury; OR: odds ratio; CI: confidence interval; KDIGO: Kidney Disease: Improving Global Outcomes; NS: not significant; SOFA: Sequential Organ Failure Assessment; P/F ratio: the ratio of the arterial partial pressure of oxygen and the inspiratory concentration of oxygen; MV: mechanical ventilation.
Variable | Total population (n=109) | AKI group (n=48) | No AKI group (n=61) | P-value |
---|---|---|---|---|
Age | 64 (57–71) | 69 (61–77) | 60 (55–66) | <0.001 |
> 60 yr | 67 (61.5) | 37 (77) | 30 (49) | 0.003 |
Sex (male:female) | 75:34 | 33:15 | 42:19 | 0.999 |
BMI | 27 (24–31) | 27.3 (24.5–30.7) | 27 (24–32.5) | 0.620 |
Obesity (BMI >30 kg/m2) | 32 (29.5) | 11 (23) | 21 (34.5) | 0.182 |
Comorbidity | ||||
Hypertension | 56 (51.5) | 30 (62.5) | 26 (42.6) | 0.054 |
Prior use of ACE inhibitor/A2RB | 27 (25) | 16 (33.5) | 11 (18) | 0.071 |
Diabetes | 44 (40) | 23 (48) | 21 (34.4) | 0.175 |
Chronic renal failure | 5 (4.5) | 1 (2) | 4 (6.5) | 0.388 |
Chronic respiratory failure | 20 (18.5) | 8 (16.5) | 12 (20) | 0.804 |
Cardiomyopathy | 18 (16.5) | 9 (19) | 9 (15) | 0.613 |
Immunocompromised | 6 (5.5) | 4 (8.3) | 2 (3.3) | 0.489 |
Severity score | ||||
APACHE II | 10.5 (7–16) | 13 (10–18) | 9 (6–11) | <0.001 |
SAPS II | 30 (22–40) | 38 (31–53) | 24 (16–30.7) | <0.001 |
SOFA | 4 (3–9) | 7 (4–11) | 4 (2–7.5) | 0.001 |
Initial laboratory finding | ||||
Baseline serum urea (g/L) | 0.57 (0.39–1.05) | 1 (0.71–1.3) | 0.45 (0.36–0.56) | <0.001 |
Baseline creatinine (mg/L) | 9 (7–14) | 12.5 (9–18.4) | 8 (7–10) | <0.001 |
Minimum P/F ratio | 66 (48–93) | 60 (46–78) | 73 (55–126) | 0.110 |
WBC count (×109/L) | 12 (8.5–17) | 17 (7–21) | 10 (4–15) | 0.033 |
Minimum lymphocyte (×103/µl) | 520 (312–720) | 510 (320–760) | 550 (302–715) | 0.819 |
Platelet (×109/L) | 141 (48–238) | 134 (33–266) | 145 (58–229) | 0.772 |
CRP (mg/L) | 199 (98–280) | 248 (171–326) | 151 (74–242) | 0.002 |
Prothrombin time (%) | 60 (45–80) | 56 (41–69) | 75 (52–86) | 0.001 |
Fibrinogen (g/L) | 5.1 (1.7–6.4) | 5.5 (4.2–6.9) | 2.5 (1.5–6.2) | 0.179 |
D-dimer (µg/L) | 1,402 (653–3,881) | 2,222 (813–5,109) | 905 (598–1,757) | 0.002 |
Lactate (mmol/L) | 2.1 (1.6–6) | 2.1 (1.7–4) | 1.9 (1.6–3.6) | 0.448 |
CT scan lesion extension at admission |
33/78 (42) | 13/31 (42) | 20/47 (42.5) | 0.999 |
Predisposing condition | ||||
Sepsis | 49 (45) | 35 (73) | 14 (23) | <0.001 |
ARDS | 81 (74) | 38 (81) | 43 (70.5) | 0.953 |
ACP |
10/66 (15) | 8/29 (27.5) | 2/37 (5.4) | 0.017 |
Rhabdomyolysis | 21 (19) | 14 (29 | 7 (11.5) | 0.086 |
Vasopressor | 60 (55) | 40 (84) | 20 (33) | <0.001 |
Nephrotoxic drug | 29 (27) | 20 (42.5) | 9 (15) | 0.014 |
Respiratory support | ||||
Alternation HFNC/NIV | 61 (56) | 18 (37.5) | 43 (70.5) | - |
MV | 48 (44) | 30 (62.5) | 18 (29.5) | 0.001 |
Variable | Odds ratio | P-value |
---|---|---|
Age > 60 yr | 1.35 | 0.320 |
Hypertension | 1.58 | 0.612 |
Prior use of ACE inhibitor/A2RB | 1.25 | 0.124 |
Diabetes | 1.55 | 0.402 |
P/F ratio <70 | 2.54 | 0.154 |
CRP >200 mg/L | 2.21 | 0.140 |
Fibrinogen >5 g/L | 3.03 | 0.115 |
D-dimers >1,400 µg/L | 12.83 (1.9–85) |
0.008 |
Sepsis | 5.22 (0.94–28) |
0.058 |
Rhabdomyolysis | 6.53 | 0.072 |
MV | 4.30 | 0.124 |
Vasopressor | 1.82 | 0.466 |
Nephrotoxic drug | 4.26 | 0.080 |
Variable | Survivor (n=44) | Non-survivor (n=65) | Multivariate analysis, OR (95% CI) | P-value |
---|---|---|---|---|
AKI | 7 (16) | 41 (63) | 6.8 (1.49–105) | <0.001 |
KDIGO 1 | 3 (43) | 8 (19.5) | 0.322 | |
KDIGO 2 | 4 (57) | 5 (12) | 0.017 | |
KDIGO 3 | 0 | 28 (68.5) | 0.001 | |
Age (yr) | 60.5 (56–70) | 66 (58–72) | NS | 0.048 |
Obesity | 19 (43) | 13 (20) | NS | 0.007 |
SOFA score | 3 (2–4) | 6 (4–11) | NS | 0.035 |
Minimal P/F ratio | 93 (65–166) | 59 (45–74) | 20 (1.73–236) | <0.001 |
Sepsis | 4 (9) | 45 (69) | NS | <0.001 |
Vasopressor | 4 (9) | 56 (86) | 15.29 (1.23–189) | <0.001 |
MV | 5 (11.3) | 43 (66) | NS | <0.001 |
Values are presented as median (interquartile range) or number (%). AKI: acute kidney injury; BMI: body mass index; ACE: angiotensin-converting enzyme; A2RB: angiotensin II receptor blockers; APACHE: Acute Physiology and Chronic Health Evaluation; SAPS: Simplified Acute Physiology Score; SOFA: Sequential Organ Failure Assessment; P/F ratio: ratio of the arterial partial pressure of oxygen and the inspiratory concentration of oxygen; WBC: white blood cell; CRP: C-reactive protein; CT: computed tomography; ARDS: acute respiratory distress syndrome; ACP: acute cor pulmonale; HFNC: high-flow nasal cannula; NIV: noninvasive ventilation; MV: mechanical ventilation. CT scan performed in 78 patients and echocardiography in 66 patients.
AKI: acute kidney injury; ACE: angiotensin-Converting enzyme; A2RB: angiotensin II receptor blockers; P/F ratio: the ratio of the arterial partial pressure of oxygen and the inspiratory concentration of oxygen; CRP: C-reactive protein; MV: mechanical ventilation. 95% confidence interval.
Values are presented as number (%) or median (interquartile range) unless otherwise indicated. AKI: acute kidney injury; OR: odds ratio; CI: confidence interval; KDIGO: Kidney Disease: Improving Global Outcomes; NS: not significant; SOFA: Sequential Organ Failure Assessment; P/F ratio: the ratio of the arterial partial pressure of oxygen and the inspiratory concentration of oxygen; MV: mechanical ventilation.