Abstract
IntroductionThe aim of this study was to evaluate the incidence and determinants of AKI in a large cohort of cardiac arrest patients.MethodsWe reviewed all patients admitted, for at least 48 hours, to our Dept. of Intensive Care after CA between January 2008 and October 2012. AKI was defined as oligo-anuria (daily urine output <0.5 ml/kg/h) and/or an increase in serum creatinine (≥0.3 mg/dl from admission value within 48 hours or a 1.5 time from baseline level). Demographics, comorbidities, CA details, and ICU interventions were recorded. Neurological outcome was assessed at 3 months using the Cerebral Performance Category scale (CPC 1–2 = favorable outcome; 3–5 = poor outcome).ResultsA total of 199 patients were included, 85 (43%) of whom developed AKI during the ICU stay. Independent predictors of AKI development were older age, chronic renal disease, higher dose of epinephrine, in-hospital CA, presence of shock during the ICU stay, a low creatinine clearance (CrCl) on admission and a high cumulative fluid balance at 48 hours. Patients with AKI had higher hospital mortality (55/85 vs. 57/114, p = 0.04), but AKI was not an independent predictor of poor 3-month neurological outcome.ConclusionsAKI occurred in more than 40% of patients after CA. These patients had more severe hemodynamic impairment and needed more aggressive ICU therapy; however the development of AKI did not influence neurological recovery.
Highlights
The aim of this study was to evaluate the incidence and determinants of acute kidney injury (AKI) in a large cohort of cardiac arrest patients
After return of spontaneous circulation (ROSC), myocardial dysfunction and the systemic ischemia/reperfusion response can lead to the so-called post cardiac arrest syndrome, which is characterized by the activation of immunologic and coagulation pathways and the release of inflammatory mediators, all leading to tissue hypoperfusion and multiple organ dysfunction [3]
Domanovits et al [6] showed that 12% of cardiac arrest (CA) patients developed AKI within 24 h after admission; in particular, congestive heart failure, history of hypertension and the total dose of epinephrine administered during cardiopulmonary resuscitation (CPR) were independent predictors of AKI
Summary
The aim of this study was to evaluate the incidence and determinants of AKI in a large cohort of cardiac arrest patients. Most studies on patients after resuscitated cardiac arrest (CA) have focused on survival or the extent of brain dysfunction [1]; the prevalence of extra-cerebral organ injury and its impact on outcome has been less wellcharacterized [2]. Roberts et al [4] reported that 96% of a cohort of 203 patients resuscitated after CA had some degree of organ dysfunction, in particular cardiovascular and respiratory impairment; two-thirds of these patients had at least two extra-cerebral organ dysfunctions. Other studies report that AKI occurs in 30 to 50% of CA patients and is associated with high levels of biomarkers of brain injury, the presence of cardiogenic shock and inadequate fluid therapy [9,10,11]. The association of AKI with survival remains unclear [9,12]
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