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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.
This is an Open Access article distributed under the terms of the Creative Commons
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Conference name:
Sixth International Symposium on Intensive Care and Emergency Medicine for Latin America