Acute kidney injury during the perioperative: incidence and impact of extrarenal organ dys-function in the outcomes
DOI:
https://doi.org/10.17696/2318-3691.26.2.2019.1627Keywords:
Acute Kidney Injury; Intensive Care Unit; Epidemiology; Risk Factors; Perioperative PeriodAbstract
Introduction: Intensive Care Unit (ICU) stay is frequently complicated by Acute Kidney Injury (AKI), especially in cases of sepsis, low cardiac output syndrome and after major sur-geries. Objective: Evaluate the incidence, characteristics, development of other organ dys-functions and outcomes on patients undergoing non-cardiac major surgery that developed AKI acquired in the ICU. Methods: We carried out a prospective cohort study. All patients consecutively admitted to ICUs after noncardiac surgeries from April to May 2017 was ana-lyzed for the development of AKI or not and other organ dysfunctions. Results: The inci-dence of AKI was 16.2%. Patients who developed AKI in the postoperative period were more severely ill. Their needs as to mechanical ventilation (60% vs. 11%; p < 0.001), use of vasoactive drugs (82% vs. 44%; p = 0.021), the presence of infection (80% vs. 21%; p < 0.001), sepsis or septic shock (50% vs. 9%; p < 0.001). and other postoperative complications (91% vs. 58%; p = 0.023) were different from other patients. Other organs dysfunctions were more fre-quent in patients with AKI (2 [2-3] vs. 1 [0-1]; p < 0.001), such as gastrointestinal (73% vs. 19%; p < 0.001), and cardiovascular dysfunction (73% vs. 33%; p = 0.015). The number of patients with two or more organ dysfunctions increased from 21% to 82% in patients with AKI (RR 3.89; CI: 2,18 – 6,90; p < 0.001). The length of hospital stay was 13 ± 9 vs. 5 ± 6 days; p < 0.001, and hospital mortality rates (86% vs. 14%; p < 0.001) were also higher in pa-tients with AKI. Conclusion: Among patients who undergoing noncardiac surgery and re-quired ICU hospitalization, the incidence of AKI is high and associated with complications of other systems, including neurological, gastrointestinal, respiratory and cardiovascular systems. In addition to this, positive cumulative fluid balance, sepsis and shock septic, prolonged length of hospital and ICU stay, as well as higher mortality rates were also found in these patients.
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