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      Prognostic factors for acute kidney injury development in critically ill cancer patients

      , 1 , 1 , 1 , 1 , 1 , 1 , 1 , 1 , 1

      Critical Care

      BioMed Central

      Sixth International Symposium on Intensive Care and Emergency Medicine for Latin America

      22-25 June 2011

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          Abstract

          Introduction Acute kidney injury (AKI) in cancer patients is a complication that causes substantial morbidity and mortality. Methods A total of 1,500 cancer patients admitted to the medical intensive care unit (ICU) between November 2008 and February-March 2011 were evaluated for AKI, defined as an increase in serum creatinine (SCr) >0.3 mg/dl over the baseline value, according to the AKIN stage I definition. Univariate analysis was used to study ICU admission parameters associated with AKI occurrence during the ICU stay. Results AKI incidence was 31%, with a mortality rate of 42%, compared with 20% for non-AKI patients. The mean age of all patients was 63.1 ± 11.3 years and 55% were male. Sepsis (44.8%) and respiratory failure (24.8%) were the major reasons for admission to the ICU. At univariate analysis, the following variables at ICU admission were significantly associated with AKI in cancer patients during the ICU stay: need for vasopressors (74.3% vs. 25.7%; P = 0.004), serum potassium (4.2, 3.6 to 4.6 mEq/l vs. 3.8, 3.5 to 4.2 mEq/l; P = 0.006), serum pH (7.35, 7.3 to 7.39 vs. 7.39, 7.34 to 7.42; P = 0.006), base excess (-5.5, -9.2 to -1.8 vs. -2, -5 to 0.1; P = 0.003), serum phosphorus (3.9, 3.4 to 4.6 mg/dl vs. 2.9, 2.4 to 3.9 mg/dl; P = 0.0001), baseline serum creatinine (1.2, 0.7 to 1.8 mg/dl vs. 0.6, 0.4 to 0.8 mg/dl; P = 0.01). At multivariate analysis, the following variables at ICU admission were associated with AKI: serum creatinine >1.0 mg/dl (OR = 9.2; 95% CI = 2.3 to 35.8), pH <7.38 (OR = 5.1; 95% CI = 1.6 to 15.6) and need for vasopressors in the first 24 hours (OR = 3.4; 95% CI = 1.2 to 9.6). Variables previously thought to be indicative of a poor prognosis (advanced age, metastatic or progressive disease, recent chemotherapy and performance status) were not predictive of AKI. Conclusions AKI is frequent in critically ill cancer patients and has a great impact on mortality. AKI incidence can be better estimated by an evaluation of the acute organ dysfunction at ICU admission than by the characteristics of the underlying malignancy.

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          Author and article information

          Conference
          Crit Care
          Critical Care
          BioMed Central
          1364-8535
          1466-609X
          2011
          22 June 2011
          : 15
          : Suppl 2
          : P33
          Affiliations
          [1 ]ICESP, São Paulo - SP, Brazil
          Article
          cc10181
          10.1186/cc10181
          3124183
          Copyright ©2011 Hajjar et al.

          This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

          Sixth International Symposium on Intensive Care and Emergency Medicine for Latin America
          São Paulo, Brazil
          22-25 June 2011
          Categories
          Poster Presentation

          Emergency medicine & Trauma

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