Inverse association between serum creatinine and mortality in acute kidney injury

Jornal Brasileiro de Nefrologia

Sergio Pinto De Souza¹  Rodrigo Santos Matos¹  Luisa Leite Barros¹  Paulo Novis Rocha¹ 

关键词: acute kidney injury;    creatinine;    intensive care units;    mortality;    renal dialysis;    risk factors;    creatinina;    diálise renal;    lesão renal aguda;    mortalidade;    risco;    unidades de terapia intensiva;   

DOI  :  10.5935/0101-2800.20140067

来源: SciELO

【 摘 要 】

Introduction: Sepsis is a leading precipitant of Acute Kidney Injury (AKI) in intensive care unit (ICU) patients, and is associated with a high mortality rate. Objective: We aimed to evaluate the risk factors for dialysis and mortality in a cohort of AKI patients of predominantly septic etiology. Methods: Adult patients from an ICU for whom nephrology consultation was requested were included. End-stage chronic renal failure and kidney transplant patients were excluded. Results: 114 patients were followed. Most had sepsis (84%), AKIN stage 3 (69%) and oliguria (62%) at first consultation. Dialysis was performed in 66% and overall mortality was 70%. Median serum creatinine in survivors and non-survivors was 3.95 mg/dl (2.63 - 5.28) and 2.75 mg/dl (1.81 - 3.69), respectively. In the multivariable models, oliguria and serum urea were positively associated with dialysis; otherwise, a lower serum creatinine at first consultation was independently associated with higher mortality. Conclusion: In a cohort of septic AKI, oliguria and serum urea were the main indications for dialysis. We also described an inverse association between serum creatinine and mortality. Potential explanations for this finding include: delay in diagnosis, fluid overload with hemodilution of serum creatinine or poor nutritional status. This finding may also help to explain the low discriminative power of general severity scores - that assign higher risks to higher creatinine levels - in septic AKI patients.

【 授权许可】

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