scholarly journals Risk Factors and Outcomes of Acute Kidney Injury in Neonates with Persistent Pulmonary Hypertension of the Newborn

2021 ◽  
Author(s):  
Nuran Üstün ◽  
Fahri Ovalı
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Pulmonary Hypertension ◽  
Neonatal Intensive Care ◽  
Kidney Injury ◽  
University Hospital ◽  
Persistent Pulmonary Hypertension ◽  
Increased Risk ◽  
Stage 1

Objective: To identify the incidence of and risk factors for acute kidney injury (AKI) in neonates with persistent pulmonary hypertension of the newborn (PPHN) and to evaluate its association with neonatal outcomes. Method: A total of 78 newborns with confirmed PPHN admitted to the neonatal intensive care unit of a university hospital between 2016 and 2020 were retrospectively analyzed. AKI was defined according to the modified neonatal Kidney Disease: Improving Global Outcomes criteria. Results: Of 78 PPHN infants, AKI was found in 29.5% (23/78). Multivariate analysis indicated that male sex (OR 3.43 95% CI 1.03-11.48, p=0.04) and severe PPHN (OR 5.67 95% CI 1.55- 20.68, p<0.01) were independently associated with increased risk for AKI. Infants with AKI had significantly higher mortality rate than infants without AKI (43.5% vs. 9.1%, p<0.01). Mortality rates in stage 1, stage 2 and stage 3 AKI were similar (36.4%, 57.1%, and 40%, respectively, p=0.68). Among survivors, AKI infants had significantly longer mechanical ventilation and lenght of stay than infants without AKI. Conclusion: In infants with PPHN, AKI is a common complication and is associated with increased mortality, and longer mechanical ventilation and lenght of stay. Careful monitoring of kidney function in infants with PPHN, especially in males and those who had severe PPHN can help to improve patient outcomes.

Factors and Outcomes of Persistent Pulmonary Hypertension of the Newborn Associated with Acute Kidney Injury in Thai Neonates

2017 ◽  
Vol 35 (03) ◽  
pp. 298-304 ◽  
Author(s):  
Wuttichart Kamolvisit ◽  
Sutthikiat Jaroensri ◽  
Benthira Ratchatapantanakorn ◽  
Narongsak Nakwan
Keyword(s):  
Acute Kidney Injury ◽  
Pulmonary Hypertension ◽  
Urine Output ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Persistent Pulmonary Hypertension ◽  
Factors Associated ◽  
Increased Risk ◽  
Stage 1

Objective This study aims to determine the risk factors and outcome of persistent pulmonary hypertension of the newborn (PPHN)-associated acute kidney injury (AKI). Study Design Infants diagnosed with PPHN at Hat Yai Hospital from January 2012 to December 2016 were retrospectively reviewed. Results Of the 109 included PPHN infants, 28.4% (31/109) died, and AKI was found in 28.4% following neonatal KDIGO classification. Of the 31, 19 who died (61.3%) reached stage 1, 3 (9.7%) reached stage 2, and 9 (29.0%) reached stage 3. AKI (all stages combined) was significantly associated with increased mortality with an odds ratio (OR) of 8.71 (95% confidence interval [CI], 3.37–22.49). Multivariate logistic regression analysis indicated that male gender (adjusted OR = 8.56; 95% CI = 0.84–85.09) and urine output of < 1 mL/kg/h in 12 hours of admission (adjusted OR = 15.57; 95% CI = 2.58–93.98) were the main factors associated with an increased risk for AKI, while birth by cesarean delivery was associated with reduced risk of AKI (adjusted OR = 0.10; 95% CI = 0.16–0.68). Conclusion The incidence of AKI in PPHN was high in this study, and this complication was also significantly associated with higher mortality. In PPHN neonates, AKI should be especially closely monitored in males and infants who have a urine output of < 1 mL/kg/h in the first 12 hours of admission.

scholarly journals Risk Factors and Outcomes of Acute Kidney Injury in Critically Ill Patients with Coronavirus Disease 2019

2020 ◽  
pp. 1-9
Author(s):  
Yichun Cheng ◽  
Nanhui Zhang ◽  
Ran Luo ◽  
Meng Zhang ◽  
Zhixiang Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Stage 1

<b><i>Background:</i></b> Coronavirus disease 2019 (COVID-19) has emerged as a major global health threat with a great number of deaths worldwide. Acute kidney injury (AKI) is a common complication in patients admitted to the intensive care unit. We aimed to assess the incidence, risk factors and in-hospital outcomes of AKI in COVID-19 patients admitted to the intensive care unit. <b><i>Methods:</i></b> We conducted a retrospective observational study in the intensive care unit of Tongji Hospital, which was assigned responsibility for the treatments of severe COVID-19 patients by the Wuhan government. AKI was defined and staged based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Mild AKI was defined as stage 1, and severe AKI was defined as stage 2 or stage 3. Logistic regression analysis was used to evaluate AKI risk factors, and Cox proportional hazards model was used to assess the association between AKI and in-hospital mortality. <b><i>Results:</i></b> A total of 119 patients with COVID-19 were included in our study. The median patient age was 70 years (interquartile range, 59–77) and 61.3% were male. Fifty-one (42.8%) patients developed AKI during hospitalization, corresponding to 14.3% in stage 1, 28.6% in stage 2 and 18.5% in stage 3, respectively. Compared to patients without AKI, patients with AKI had a higher proportion of mechanical ventilation mortality and higher in-hospital mortality. A total of 97.1% of patients with severe AKI received mechanical ventilation and in-hospital mortality was up to 79.4%. Severe AKI was independently associated with high in-hospital mortality (OR: 1.82; 95% CI: 1.06–3.13). Logistic regression analysis demonstrated that high serum interleukin-8 (OR: 4.21; 95% CI: 1.23–14.38), interleukin-10 (OR: 3.32; 95% CI: 1.04–10.59) and interleukin-2 receptor (OR: 4.50; 95% CI: 0.73–6.78) were risk factors for severe AKI development. <b><i>Conclusions:</i></b> Severe AKI was associated with high in-hospital mortality, and inflammatory response may play a role in AKI development in critically ill patients with COVID-19.

scholarly journals Acute Kidney Injury in Term Babies with Persistent Pulmonary Hypertension of the Newborn

2019 ◽  
Vol 11 (11) ◽  
pp. 60
Author(s):  
Mohamed M. Sheta ◽  
Abeer I. Al-Khalafawi ◽  
Syed M. Raza ◽  
Suzan S. Gad ◽  
Mervat A. Hesham
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Pulmonary Hypertension ◽  
Mortality Rate ◽  
Kidney Injury ◽  
Persistent Pulmonary Hypertension ◽  
Term Neonates ◽  
Neonatal Icu ◽  
Criteria For Diagnosis ◽  
Suggested Link

OBJECTIVE: The study aimed to determine the prevalence of acute kidney injury (AKI) in term neonates with persistent pulmonary hypertension of the newborn (PPHN), to identify the probable risk factors, and to find its relation to mortality. METHODS: The study recruited 758 term neonates admitted to the neonatal ICU (NICU). Diagnosis of PPHN was established on the basis of clinical and echocardiographic criteria. For diagnosis of AKI, we adopted the modified Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition. This definition has three grades of AKI severity depending on degree of serum creatinine rise and urinary output. Patients were followed until they died or discharged from NICU. RESULTS: Among the 758 term neonates included in the study, there were 47 babies (6.2 %) fulfilling the criteria of PPHN. AKI was reported in 16 patients (34.0 %) and the reported mortality rate was 31.9 %. Neonates with AKI had significantly higher mortality rate when compared with patients without AKI (75.0 % versus 9.7 %; p = 0.0001). A significant association was noted between severe grades of PPHN and AKI. CONCLUSIONS: AKI is prevalent in neonates with PPHN. It is significantly associated with mortality. There is suggested link between AKI and severity of PPHN.

scholarly journals Prediction of risk factors and outcomes of neonatal acute kidney injury

2021 ◽  
Author(s):  
Abdulrahman Al-Matary
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Neonatal Intensive Care ◽  
Kidney Injury ◽  
Length Of Hospital Stay ◽  
Local Practices ◽  
Neonatal Icu ◽  
Study Population ◽  
High Risk Infants ◽  
Stage 1

Abstract Introduction Neonatal Acute kidney injury (AKI) is an underestimated morbidity in the neonatal intensive care unit (ICU). However, there is a paucity of information about risk factors, outcomes, and possible preventive measures to limit its occurrence. Aim This study aimed to determine the prevalence of neonatal AKI in a neonatal ICU. Data obtained from this study will help to better understand current local practices and investigate possible preventive strategies. Materials and methods Charts from January 2011 to December 2018 were reviewed. Neonates less than 2 weeks old who depended on intravenous fluid as a nutrition source for at least two days were included. Results Overall, the eight-year prevalence of neonatal AKI in the neonatal ICU was 19.6%, and severity was distributed as follows: stage 1 (46.2%), stage 2 (26.5%), and stage 3 (27.3%). Caffeine administration before 29 weeks’ gestational age significantly decreased the incidence of neonatal AKI. The incidence of neonatal AKI was independently associated with death (odds ratios (OR) = 7.11, P < 0.001) and extended length of hospital stay (OR = 2.47, P < 0.001). In the multivariate regression model, vancomycin (AOR = 1.637, P < 0.004), loop diuretics (AOR = 2.203, P < 0.001), intraventricular hemorrhage (AOR = 2.605, P < 0.001), surgical intervention (AOR = 1.566, P < 0.008), mechanical ventilation (AOR = 1.463, P < 0.015), and dopamine administration (AOR = 2.399, P < 0.001) were independently associated with neonatal AKI. Conclusion Neonatal AKI occurred in one-fifth of the study population in a neonatal ICU. Outcomes can be improved by identifying high-risk infants and cautiously monitoring kidney function.

scholarly journals Acute kidney injury in SARS-CoV2-related pneumonia ICU patients: a retrospective multicenter study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Guillaume Geri ◽  
Michael Darmon ◽  
Lara Zafrani ◽  
Muriel Fartoukh ◽  
Guillaume Voiriot ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Cox Model ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Icu Patients ◽  
Increased Risk ◽  
Stage 1

Abstract Background While acute kidney injury (AKI) is frequent in severe SARS-CoV2-related pneumonia ICU patients, few data are still available about its risk factors. Methods Retrospective observational study performed in four university affiliated hospitals in Paris. AKI was defined according to the KIDGO guidelines. Factors associated with AKI were picked up using multivariable mixed-effects logistic regression. Independent risk factors of day 28 mortality were assessed using Cox model. Results 379 patients (median age 62 [53,69], 77% of male) were included. Half of the patients had AKI (n = 195, 52%) including 58 patients (15%) with AKI stage 1, 44 patients (12%) with AKI stage 2, and 93 patients (25% with AKI stage 3). Chronic kidney disease (OR 7.41; 95% CI 2.98–18.4), need for invasive mechanical ventilation at day 1 (OR 4.83; 95% CI 2.26–10.3), need for vasopressors at day 1 (OR 2.1; 95% CI 1.05–4.21) were associated with increased risk of AKI. Day 28 mortality in the cohort was 26.4% and was higher in patients with AKI (37.4 vs. 14.7%, P < 0.001). Neither AKI (HR 1.35; 95% CI 0.78–2.32) nor AKI stage were associated with mortality (HR [95% CI] for stage 1, 2 and 3 when compared to no AKI of, respectively, 1.02 [0.49–2.10], 1.73 [0.81–3.68] and 1.42 [0.78–2.58]). Conclusion In this large cohort of SARS-CoV2-related pneumonia patients admitted to the ICU, AKI was frequent, mostly driven by preexisting chronic kidney disease and life sustaining therapies, with unclear adjusted relationship with day 28 outcome.

scholarly journals Risk Factors for Development of Acute Kidney Injury in COVID-19 Patients: A Retrospective Observational Cohort Study

Nephron ◽  
2021 ◽  
pp. 1-9
Author(s):  
Yong Pey See ◽  
Barnaby Edward Young ◽  
Li Wei Ang ◽  
Xi Yan Ooi ◽  
Chi Peng Chan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Enzyme Inhibitor ◽  
Kidney Injury ◽  
Tertiary Hospital ◽  
Multivariable Logistic Regression Model ◽  
Dominance Analysis ◽  
Increased Risk ◽  
Stage 1

<b><i>Introduction:</i></b> Acute kidney injury (AKI) in coronavirus infection disease (COVID-19) is associated with disease severity. We aimed to evaluate risk factors associated with AKI beyond COVID-19 severity. <b><i>Methods:</i></b> A retrospective observational study of COVID-19 patients admitted to a tertiary hospital in Singapore. Logistic regression was used to evaluate associations between risk factors and AKI (based on Kidney Disease Improving Global Outcomes criteria). Dominance analysis was performed to evaluate the relative importance of individual factors. <b><i>Results:</i></b> Seven hundred seven patients were included. Median age was 46 years (interquartile range [IQR]: 29–57) and 57% were male with few comorbidities (93%, Charlson Comorbidity Index [CCI] &#x3c;1). AKI occurred in 57 patients (8.1%); 39 were in AKI stage 1 (68%), 9 in stage 2 (16%), and 9 in stage 3 (16%). Older age (adjusted odds ratio [aOR] 1.04; 95% confidence interval [CI]: 1.01–1.07), baseline use of angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) (aOR 2.86; 95% CI: 1.20–6.83), exposure to vancomycin (aOR 5.84; 95% CI: 2.10–16.19), use of nonsteroidal anti-inflammatory drugs (NSAIDs) (aOR 3.04; 95% CI: 1.15–8.05), and severe COVID-19 with hypoxia (aOR 13.94; 95% CI: 6.07–31.98) were associated with AKI in the multivariable logistic regression model. The 3 highest ranked predictors were severe COVID-19 with hypoxia, vancomycin exposure, and age, accounting for 79.6% of the predicted variance (41.6, 23.1, and 14.9%, respectively) on dominance analysis. <b><i>Conclusion:</i></b> Severe COVID-19 is independently associated with increased risk of AKI beyond premorbid conditions and age. Appropriate avoidance of vancomycin and NSAIDs are potentially modifiable means to prevent AKI in patients with COVID-19.

scholarly journals Risk Factors and Outcomes of Acute Kidney Injury in Critically Ill Patients With Coronavirus Disease 2019

2020 ◽  
Author(s):  
Yichun Cheng ◽  
Nanhui Zhang ◽  
Ran Luo ◽  
Meng Zhang ◽  
Zhixiang Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Stage 1

Abstract Background: Coronavirus disease 2019 (COVID-19) has emerged as a major global health threat with a great number of deaths worldwide. Acute kidney injury (AKI) is a common complication in patients admitted to the intensive care unit. We aimed toassess the incidence, risk factors and in-hospital outcomes of AKI in COVID-19 patients admitted to intensive care unitMethods: we conducted a retrospective observational study in intensive care unit of Tongji hospital, which was assigned responsibility for the treatments of severe COVID-19 patients by Wuhan government. The AKI was defined and staged based onKidney Disease: Improving Global Outcomes (KDIGO) criteria. Mild AKI was defined as stage 1, and severe AKI was defined as stage 2 or stage 3. We used logistic regression analysis to evaluate AKI risk factors and the association between AKI and in-hospital mortality.Results: A total of 150 patients with COVID-19 were included in our study. The median age of patients was 70 (interquartile range, 60-80) years and 62.7% were male. 70 (46.7%) patients developed AKI during hospitalization, corresponding to the 17.3% in stage 1 and 9.3% in stage 2 and 20.0% in stage 3, respectively. Compared to patients without AKI, patients with AKI had higher proportion of mechanical ventilation mortality and higher in-hospital mortality. 95.5% patients with severe AKI received mechanical ventilation and in-hospital mortality was up to 79.5%. Severe AKI was independently associated with high in-hospital mortality (OR: 4.30; 95% CI: 1.83-10.10). Logistic regression analysis demonstrated that high serum interleukin-6 (OR: 2.54; 95%CI: 1.00-6.42) and interleukin-10 (OR: 3.02; 95%CI: 1.17-7.82) were risk factors for severe AKI development.Conclusions: severe AKI was associated with high in-hospital mortality and inflammatory response may play a role in AKI development in critically ill patients with COVID-19.

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