Outcome and features of acute kidney injury complicating hypoxic hepatitis at the medical intensive care unit
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Outcome and features of acute kidney injury complicating hypoxic hepatitis at the medical intensive care unit. / Drolz, Andreas; Horvatits, Thomas; Roedl, Kevin; Rutter, Karoline; Staufer, Katharina; Haider, Dominik G; Zauner, Christian; Heinz, Gottfried; Schellongowski, Peter; Kluge, Stefan; Trauner, Michael; Fuhrmann, Valentin.
In: ANN INTENSIVE CARE, Vol. 6, No. 1, 12.2016, p. 61.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Outcome and features of acute kidney injury complicating hypoxic hepatitis at the medical intensive care unit
AU - Drolz, Andreas
AU - Horvatits, Thomas
AU - Roedl, Kevin
AU - Rutter, Karoline
AU - Staufer, Katharina
AU - Haider, Dominik G
AU - Zauner, Christian
AU - Heinz, Gottfried
AU - Schellongowski, Peter
AU - Kluge, Stefan
AU - Trauner, Michael
AU - Fuhrmann, Valentin
PY - 2016/12
Y1 - 2016/12
N2 - BACKGROUND: Hypoxic hepatitis (HH) is a frequent and potentially life-threatening event typically occurring in critically ill patients as a consequence of hemodynamic impairment. While acute kidney injury (AKI) has been well described in patients with acute liver failure, incidence and outcome of AKI accompanying HH are unclear. The aim of this study was to assess incidence, clinical implications and outcome of AKI and renal replacement therapy (RRT) in critically ill patients with HH.METHODS: A total of 1948 consecutive critically ill admissions were studied at the Medical University of Vienna. Laboratory and clinical parameters as well as the presence of HH and AKI were assessed on a daily basis. Outcome, renal recovery and length of stay were assessed and documented, and patients were followed for 1 year.RESULTS: A total of 295 admissions (15 %) developed HH. Main precipitators were cardiogenic (44 %) and septic shock (36 %). Occurrence of HH was significantly associated with AKI [OR 4.50 (95 % CI 3.30-6.12)] and necessity of renal replacement therapy [RRT; OR 3.36 (95 % CI 2.58-4.37)], p < 0.001 for both. Two hundred forty admissions with HH (81 %) developed AKI, 159 of whom (66 %) had AKI stage 3. Both HH and AKI were significantly linked to mortality. AKI stage 3, international normalized ratio (INR, during HH) and the presence of septic shock were identified as independent predictors of 28-day mortality in admissions with HH, whereas RRT was identified as an independent protective factor. There was a synergistic effect of HH and AKI on length of stay at the ICU. Of all HH survivors treated with RRT, 71 % showed renal recovery during follow-up.CONCLUSION: HH is frequently complicated by occurrence of AKI. Severity of HH, AKI stage and the presence of septic shock seem to contribute to poor outcome in these patients. Initiation of RRT in HH with AKI may enable renal recovery and should not be withheld in medical ICU patients.
AB - BACKGROUND: Hypoxic hepatitis (HH) is a frequent and potentially life-threatening event typically occurring in critically ill patients as a consequence of hemodynamic impairment. While acute kidney injury (AKI) has been well described in patients with acute liver failure, incidence and outcome of AKI accompanying HH are unclear. The aim of this study was to assess incidence, clinical implications and outcome of AKI and renal replacement therapy (RRT) in critically ill patients with HH.METHODS: A total of 1948 consecutive critically ill admissions were studied at the Medical University of Vienna. Laboratory and clinical parameters as well as the presence of HH and AKI were assessed on a daily basis. Outcome, renal recovery and length of stay were assessed and documented, and patients were followed for 1 year.RESULTS: A total of 295 admissions (15 %) developed HH. Main precipitators were cardiogenic (44 %) and septic shock (36 %). Occurrence of HH was significantly associated with AKI [OR 4.50 (95 % CI 3.30-6.12)] and necessity of renal replacement therapy [RRT; OR 3.36 (95 % CI 2.58-4.37)], p < 0.001 for both. Two hundred forty admissions with HH (81 %) developed AKI, 159 of whom (66 %) had AKI stage 3. Both HH and AKI were significantly linked to mortality. AKI stage 3, international normalized ratio (INR, during HH) and the presence of septic shock were identified as independent predictors of 28-day mortality in admissions with HH, whereas RRT was identified as an independent protective factor. There was a synergistic effect of HH and AKI on length of stay at the ICU. Of all HH survivors treated with RRT, 71 % showed renal recovery during follow-up.CONCLUSION: HH is frequently complicated by occurrence of AKI. Severity of HH, AKI stage and the presence of septic shock seem to contribute to poor outcome in these patients. Initiation of RRT in HH with AKI may enable renal recovery and should not be withheld in medical ICU patients.
U2 - 10.1186/s13613-016-0162-4
DO - 10.1186/s13613-016-0162-4
M3 - SCORING: Journal article
C2 - 27392655
VL - 6
SP - 61
JO - ANN INTENSIVE CARE
JF - ANN INTENSIVE CARE
SN - 2110-5820
IS - 1
ER -
