#6070 PREDICTIVE MODEL OF OBSTETRIC ACUTE RENAL FAILURE IN THE INTENSIVE CARE UNIT

Abstract

Abstract Background and Aims Obstetric acute renal failure (OARF) remains a frequent and serious complication that engages the maternal and fetal prognosis. The objective of our work is to develop a predictive model of obstetric acute renal failure in the intensive care setting. Method To meet our objective we conducted a retrospective comparative and analytical study spread over a period of 7 years, from January 2014 to September 2021 within the obstetric resuscitation department of ABDERRAHIM HAROUCHI hospital of CHU Ibn Rochd of Casablanca. We have thus distinguished two groups of parturients: • Group 1 “ OARF + ” : parturients with ARF (n = 863) • Group 2 “ OARF -” : parturients without ARF (n = 1856 Results During this period 2719 obstetric admissions in intensive care were collected including 863 cases of ARF that we classified according to the KDIGO classification with a percentage of stages I, II and III respectively of 45.2%, 28.5% and 25.3% of cases. The average age of our OARF+ sample was 28.6±5.4 years. 40% of the parturients in this group were primiparous and 60% were multiparous, with the majority of cases occurring between 20 and 28 weeks' gestation (32%). OARF was associated with pre-eclampsia in 57% of cases, hemorrhagic shock in 37.19% of cases and severe sepsis in 31.74% of cases. Extra renal purification was necessary in 148 parturients (17.2%) and the mortality rate in the OARF+ group was 26.18%. In univariate analysis, the clinico-biological risk factors for the occurrence of obstetric ARF were haemostasis disorders (p < 0.001), hypertension (p < 0.001), oligo-anuria (p = 0.002), severe anaemia (p < 0.001) and thrombocytopenia (p < 0.001). As for the etiological factors, our analysis allowed us to retain pre-eclampsia (p < 0.001), hemorrhagic shock (p < 0.001), sepsis (p < 0.001), Hellp Syndrome (p = 0.002) and DIC (p = 0.002). Conclusion Pre-eclampsia, pre- and postpartum hemorrhage, and sepsis represent the main etiologies of obstetric ARF, which is a frequent obstetric complication in the ICU setting and responsible for significant maternal morbidity and mortality. The determination of the risk factors for the occurrence of such a complication allowed us to detect and prevent the patients at risk.