Association between acute kidney injury and mortality after successful cardiopulmonary resuscitation: a retrospective observational study
Associação entre lesão renal aguda e mortalidade após ressuscitação cardiopulmonar bem-sucedida: um estudo observacional retrospectivo
Ender Para; Mustafa Azizoğlu; Aslinur Sagün; Gülhan Orekici Temel; Handan Birbiçer
Abstract
Keywords
Resumo
Justificativa e objetivos: A Lesão Renal Aguda (LRA) afeta a mortalidade e morbidade em pacientes criticamente enfermos. Existem poucos estudos examinando a prevalência de IRA e mortalidade após a ressuscitação cardiopulmonar bem-sucedida. No presente estudo, investigamos a associação entre LRA e mortalidade em pacientes pós-parada cardíaca internados em Unidade de Terapia Intensiva (UTI).
Métodos: Nossa análise retrospectiva incluiu 109 pacientes internados na UTI após ressuscitação cardiopulmonar bem-sucedida entre 2014 e 2016. Comparamos dois sistemas de pontuação para estimar a mortalidade.
Resultados e discussão: LRA foi diagnosticada em 46,7% (n = 51) dos pacientes pelos critérios do RIFLE e em 66,1% (n = 72) pelo KDIGO. A taxa de mortalidade foi significativamente maior entre os pacientes com LRA diagnosticada pelos critérios RIFLE (p = 0,012) e aqueles com LRA diagnosticada pelos critérios KDIGO (p = 0,003). A análise de Característica de Operação do Receptor (COR) mostrou que ambos os sistemas de pontuação foram capazes de detectar com sucesso a mortalidade (área sob a curva COR = 0,693 para RIFLE e 0,731 para KDIGO).
Conclusão: LRA aumenta as taxas de mortalidade e morbidade após a parada cardíaca. Embora mais lesão renal e mortalidade tenham sido detectadas com KDIGO, a sensibilidade e especificidade de ambos os sistemas de pontuação foram semelhantes na previsão de mortalidade em pacientes com Retorno da Circulação Espontânea (RCE).
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References
1 Li PK, Burdmann EA, Mehta RL. World Kidney Day Steering Committee 2013. Acute kidney injury: global health alert. Kidney Int. 2013;83:372-6.
2 Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units-causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med. 1996;24:192-8.
3 Levi TM, de Souza SP, de Magalhães JG, et al. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva. 2013;25:290-6.
4 Adrie C, Adib-Conguy M, Laurent I, et al. Successful cardiopulmonary resuscitation after cardiac arrest as ‘‘sepsis-like’’ syndrome. Circulation. 2002;106:562-8.
5 Domanovits H, Schillinger M, Müllner M, et al. Acute renal failure after successful cardiopulmonary resuscitation. Intensive Care Med. 2001;27:1194-9.
6 Sasson C, Rogers MA, Dahl J, Kellerman AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and metaanalysis. Circ Cardiovasc Qual Outcomes. 2010;3:63-81.
7 Schneider A, Böttiger BW, Popp E. Cerebral resuscitation after cardiocirculatory arrest. Anesth Analg. 2009;108:971-9.
8 Nolan JP, Neumar RW, Adrie C, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke. Resuscitation. 2008;79:350-79.
9 Rundgren M, Ullen S, Morgan MPG, et al. Renal function after out-of-hospital cardiac arrest; the influence of temperature management and coronary angiography, a post-hoc study of the target temperature management trial. Crit Care. 2019;23:163.
10 Luo X, Jiang L, Du B, Wen Y, Wang M, Xi X. A comparison of different diagnostic criteria of acute kidney injury in critically ill patients. Crit Care. 2014;18:R144.
11 Chua HR, Glassford N, Bellomo R. Acute kidney injury after cardiac arrest. Resuscitation. 2012;83:721-7.
12 Kim YW, Cha KC, Cha YS, et al. Shock duration after resuscitation is associated with occurrence of post-cardiac arrest acute kidney injury. J Korean Med Sci. 2015;30:802-7.
13 Tujjar O, Mineo G, Dell’anna A, et al. Acute renal failure after cardiac arrest. Crit Care. 2015;19:169.
14 Geri G, Guillemet L, Dumas F, et al. Acute kidney injury after out-of-hospital cardiac arrest: risk factors and prognosis in a large cohort. Intensive Care Med. 2015;41:1273-80.
15 Fu ZY, Wu ZJ, Zheng JH, Qin T, Yang YG, Chen MH. The incidence of acute kidney injury following cardiac arrest and cardiopulmonary resuscitation in a rat model. Ren Fail. 2019;41:278-83.
16 Yanta J, Guyette FX, Doshi AA, Callaway CW, Rittenberger JC. Renal dysfunction is common following resuscitation from out-of-hospital cardiac arrest. Resuscitation. 2013;84:1371-4.
17 Hasper D, Von Haehling S, Storm C, Jörres A, Schefold JC. Changes in serum creatinine in the first 24 hours after cardiac arrest indicate prognosis: an observational cohort study. Crit Care. 2009;13:R168.
18 Sandroni C, Dell’anna AM, Tujjar O, Geri G, Cariou A, Taccone FS. Acute kidney injury after cardiac arrest: a systematic review and meta-analysis of clinical studies. Minerva Anestesiol. 2016;82:989-99.
19 Burne-Taney MJ, Kofler J, Yokota N, Weisfeldt M, Traystman RJ, Rabb H. Acute renal failure after whole body ischemia is characterized by inflammation and T cell mediated injury. Am J Physiol Renal Physiol. 2003;285:F87-94.
Submitted date:
07/03/2019
Accepted date:
01/15/2021
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