Incidence and mortality risk factors of acute kidney injury in critical ill pregnancies: a single center retrospective analysis / 中华危重病急救医学

ABSTRACT

Objective To evaluate the incidence and mortality risk factors of pregnancy-related acute kidney injury (PR-AKI) in intensive care unit (ICU). Methods A retrospective analysis was conducted. Critically ill pregnancies admitted to ICU of Shandong University Affiliated Provincial Hospital from January 1st, 2012 to December 31st, 2016 were enrolled. Based on the Kidney Disease: Improving Global Outcomes (KDIGO)-acute kidney injury (AKI) criteria, patients were divided into two groups: PR-AKI group and non-PR-AKI group. Clinical characteristics and laboratory data of two groups were compared. Risk factors of incidence and mortality of PR-AKI patients were analyzed, and the receiver operating characteristic (ROC) curve was drawn to evaluate the value of these risk factors in predicting mortality of PR-AKI patients in ICU. Results ①A total of 219 pregnancies in ICU were included in the analysis, 85 cases (38.8％) were diagnosed with PR-AKI, with 29.4％ in AKI stage 1, 27.1％ in AKI stage 2 and 43.5％ in AKI stage 3. ②Nineteen of 219 critically ill pregnancies died in ICU, the total ICU mortality was 8.7％. The mortality of PR-AKI group was higher than non-PR-AKI group (16.5％ vs. 3.7％, P = 0.003). The mortality was worsened with increasing severity of AKI (4.0％ for AKI stage 1, 4.3％ for AKI stage 2, 32.4％ for AKI stage 3). ③Acute fatty liver of pregnancy (AFLP) and lactate (Lac) were the independent risk factors for PR-AKI [AFLP: odds ratio (OR) = 6.081, 95％ confidence interval (95％CI) was 1.587-23.308, P = 0.008; Lac: OR = 1.460, 95％CI was 1.078-1.977, P = 0.014]. ④ Age, Lac, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) and sequential organ failure assessment (SOFA) were the independent risk factors associated with the mortality of PR-AKI patients in ICU (age: OR = 1.130, 95％CI was 1.022-1.249, P = 0.017; Lac: OR = 1.198, 95％CI was 1.009-2.421, P = 0.039; APACHEⅡ: OR = 1.211, 95％CI was 1.102-1.330, P < 0.001; SOFA: OR = 1.411, 95％CI was 1.193-1.669, P < 0.001). ⑤ ROC curve analysis showed that age, Lac, APACHEⅡscore and SOFA score all had good predictive values for in-hospital mortality among PR-AKI patients in ICU, the cut-off value was 29 years old, 3.8 mmol/L, 16 and 8, respectively, and the AUC was 0.751, 0.757, 0.892 and 0.919, respectively (all P < 0.01). Conclusions The incidence and mortality of PR-AKI of critically ill pregnancies in ICU are high. Increased age, Lac, APACHEⅡ score and SOFA score are independent risk factors associated with the mortality of PR-AKI patients in ICU, and have good predictive values for prognosis.