par Tujjar, Omar;Mineo, G;Poyatos, B;Donadello, Katia ;Scolletta, Sabino;Vincent, Jean Louis ;Taccone, Fabio
Référence European Society of Intensive Care Medecine Annual Congress(XXVI: 5-9 October 2013: Paris), 26th ESICM Annual Congress
Publication Publié, 2013-10
Abstract de conférence
Résumé : INTRODUCTION. Acute kidney injury (AKI) is a frequent complication in critically ill patients and may result in increased morbidity and poor outcome. Few data exist on the risk factors and time course of AKI development after cardiac arrest (CA).OBJECTIVES. The aim of this study was to evaluate the occurrence and time course of AKI in a single-center cohort of CA patients.METHODS. We reviewed all patients consecutively admitted for CA to our ICU from January 2008 to October 2012 who stayed in our Dept. of Intensive Care for at least 48 hours. Demographics, comorbidities, development of sepsis, type, location and duration of arrest, use of vasopressors, mechanical ventilation, renal replacement therapy (RRT) and of potential nephrotoxic agents were recorded. AKI was defined as a daily UO < 0.5 ml/kg/h and/or an increase in serum creatinine of = 0.3 mg/dL from baseline levels. Creatinine clearance (CrCl) was calculated on urinary excretion over the first day of ICU stay. Neurological outcome was assessed using the Cerebral Performance Category (CPC, 1=good recovery; 5 = dead) scale at hospital discharge.RESULTS. Of a total of 253 patients admitted for CA over the study period, 199 patients met the inclusion criteria (median age 62 years; 134 male gender). A total of 88 (44%) patients developed AKI during the ICU stay, with a median time to AKI of 2 [2-3] days since admission. Patients with AKI had higher proportion of witnessed CA (73/88 vs. 77/114, p =0.01) and in-hospital CA (42/88 vs. 34/114, p< 0.001) than those without AKI. They also had a lower CrCl on day 1 since admission (23 [8-45] vs. 66 [27-120] ml/min, p< 0.001). Patients with AKI were more commonly treated with vasopressors (63/88 vs. 43/114, p< 0.001), dobutamine (73/88 vs. 40/114, p< 0.001) or a mechanical cardiac support device (i.e. IABP or ECMO, 24/88 vs. 15/114, p=0.01) and had a greater fluid balance over the first 48 hours of ICU stay (4.6 [3.1-8.5] L vs. 3.3 [1.9-5.2] L, p< 0.001). These patients had a trend towards a higher ICU mortality (54/88 vs. 55/114, p=0.06) and CPC score (5 [2-5] vs. 4.5 [1-5], p=0.07).CONCLUSIONS. AKI is very common after CA, occurring in more than 40% of patients. These patients had a more severe hemodynamic impairment and needed a more aggressive ICU therapy, which resulted in a poorer brain recovery.