MP226RISK FACTORS AND IMPACT OF ACUTE KIDNEY INJURY IN NEUROCRITICAL CARE

Abstract

Introduction and Aims: Acute kidney injury (AKI) is a common and severe complication in medical and surgical intensive care units (ICU) accounting for their patients' high morbidity and mortality. Incidence, risk factors and prognostic impact of AKI are well established in this setting. Data concerning the neurocritically ill patient are spares. The aim of this study was to determine the incidence of AKI and identify risk factors in this special population. Methods: Patients admitted to a specialized neurocritical care unit (NCCU) at our hospital between 2005 and 2011 with a stay above 48 hours were analyzed retrospectively for incidence, cause, impact and outcome of AKI (AKIN stage ≥2). Results: Within 7 years 681 patients were included (mean age 60.7±15.8 years, 55.4% male). Most frequent diagnosis was intracerebral hemorrhage (48.5%) followed by cerebral neoplasm (14.5%) and ischaemic stroke (14.2%). Except for stroke, none of the underlying diseases were associated with AKI. Chronic renal failure (CKD) was known in 57 patients (8.4%). AKI incidence was 11.6%. Conservative treatment was sufficient in 43 patients (54.4%). 36 patients (45.6%) developed dialysis dependent AKI. Sepsis was the main cause of AKI (>50%). Independent risk factors for AKI were CKD (OR 12.65; 95%CI 6.34-25.24; p<0.0001), infection (OR 2.84; 95%CI 1.12-7.17; p=0.027) and nephrotoxic medication (OR 2.10; 95%CI 1.17-3.76; p=0.013). Surgical intervention or contrast medium were not associated with NCCU AKI. 2 patients (5.6%) did not recover from AKI. Risk of dying correlates with severity of AKI (no AKI 13.3%, conservative treatment 28%, hemodialysis 50%). Dialysis dependent AKI increased the odds for dying (OR 4.51; 95%CI 1.50-13.50; p=0.007). Conclusions: AKI in the setting of neurocritical follows known rules. The main cause for AKI in this setting is sepsis, frequently caused by ventilator associated pneumonia, and is associated with a high mortality. Interestingly exposure to contrast dye is not associated with AKI in this setting.