The epidemiology and characteristics of acute kidney injury in the Southeast Asia intensive care unit: a prospective multicentre study.

BACKGROUND: Etiologies for acute kidney injury (AKI) vary by geographic region and socioeconomic status. While considerable information is now available on AKI in the Americas, Europe and China, large comprehensive epidemiologic studies of AKI from Southeast Asia (SEA) are still lacking. The aim of this study was to investigate the rates and characteristics of AKI among intensive care unit (ICU) patients in Thailand. METHODS: We conducted the largest prospective observational study of AKI in SEA. The data were serially collected on the first 28 days of ICU admission by registration in electronic web-based format. AKI status was defined by full Kidney Disease: Improving Global Outcome criteria. We used AKI occurrence as the clinical outcome and explored the impact of modifiable and non-modifiable risk factors on the development and progression of AKI. RESULTS: We enrolled 5476 patients from 17 ICU centres across Thailand from February 2013 to July 2015. After excluding patients with end-stage renal disease and those with incomplete data, AKI occurred in 2471 of 4668 patients (52.9%). Overall, the maximum AKI stage was Stage 1 in 7.5%, Stage 2 in 16.5% and Stage 3 in 28.9%. In the multivariable adjusted model, we found that older age, female sex, admission to a regional hospital, medical ICU, high body mass index, primary diagnosis of cardiovascular-related disease and infectious disease, higher Acute Physiology and Chronic Health Evaluation II, non-renal Sequential Organ Failure Assessment scores, underlying anemia and use of vasopressors were all independent risk factors for AKI development. CONCLUSIONS: In Thai ICUs, AKI is very common. Identification of risk factors of AKI development will help in the development of a prognostic scoring model for this population and should help in decision making for timely intervention, ultimately leading to better clinical outcomes.

The role of intraoperative parameters on predicting laparoscopic abdominal surgery associated acute kidney injury.

BACKGROUND: Laparoscopic abdominal surgery has been widely used to reduce the length of hospital stay and complications from open abdominal surgery. During the operation, the creation of pneumoperitoneum is used for better visualization of the operating field. However, the effect of pneumoperitoneum on kidney function is unknown. We aimed to identify risk factors and predictors associated with AKI development following laparoscopic abdominal surgery. METHODS: A single-center prospective cohort study of laparoscopic abdominal surgery patients between June 2012 and December 2013. Acute kidney injury (AKI) was identified by Kidney Disease Improving Global Outcome (KDIGO) criteria. Urinary neutrophil gelatinase associated lipocalin (uNGAL) was measured on the first 3 days after surgery as a surrogate marker of AKI. RESULTS: Of the 64 patients, 23 (35%) developed postoperative AKI. The mean age, initial blood pressure, and initial glomerular filtration rate were not different between AKI and non-AKI groups. Inflation time and exposure index were significantly higher in the AKI group compared to non-AKI group (192.0 vs 151.1 min, p = 0.045, and 2325.9 vs 1866.1 mmHg-minutes, p = 0.035). Operation time, mean intra-abdominal pressure, duration of intraoperative hypotension, amount of blood loss and intravenous fluid were not different between groups. In multivariable analysis adjusted for age, diabetes, baseline estimated glomerular filtration rate, and type of operation (urological surgery), exposure index was significantly associated with postoperative AKI, with odds ratio (95% CI) 1.47 (1.05-2.04), p = 0.024. By combining the intraoperative parameters with clinical model the area under the receiver operating characteristic curve was 0.71 (95% CI 0.58-0.84). CONCLUSIONS: AKI was a common condition in laparoscopic abdominal surgery. Exposure index has been proposed as a novel predictor of laparoscopic abdominal surgery associated AKI.

Lactate Non-Clearance versus Lactate Clearance: A Comparison of Hospital Mortality in High-Risk Surgical Patients.

Objective: The optimal endpoints of resuscitation in high-risk surgical patients remain controversial. Specifically, it is difficult to establish the effective predictive markers as the endpoints of resuscitation in this patient group. Therefore, the study was conducted to assess the predictive value of early lactate non-clearance condition on hospital mortality in high-risk surgical patients. Material and Method: The study is a prospective analytic study. The data were collected in one university-based surgical intensive care unit (SICU) over a 5-month period. All consecutive adult high-risk surgical patients admitted to SICU in postoperative period were recruited to the study. Blood lactate levels were measured on SICU admission (0-hour), 12 hours later, and then calculated for 12-hour blood lactate clearance. The authors categorized the patients into two groups: lactate clearance (LC) and lactate non-clearance (LNC). After that, the patients were monitored until hospital discharge or inhospital death. Results: There were 122 high-risk surgical patients recruited to the study. As concerns the factors of interest, higher incidences of suspected or confirmed infection and mechanical ventilation were found among the LNC group. Regarding the main outcomes, hospital mortality was 5.3% among the LNC group and 3.9% among the LC group (p = 0.578), with no statistical significant differences in hospital mortality, hospital length of stay and SICU length of stay. The independent risk factors associated with LNC condition were considered. The factor of interest was suspected or confirmed infection by multiple logistic regression analysis after adjustment for age and sex revealed that the adjusted odds ratio was 2.70 with a 95% confidence interval of 0.85-8.55, p = 0.092. Conclusion: In high-risk surgical patients, 12-hour LNC cannot demonstrate the prognostic value for hospital morbidity and mortality. However, there is a trend for the suspected or confirmed infection group to associate with the LNC condition, but with no statistical significance.