Pronóstico de pacientes nonagenarios ingresados por fracaso renal agudo Translated title: Prognosis of in hospital nonagenarians with acute kidney injury

Resumen

Fundamento

El desarrollo de un fracaso renal agudo (FRA, definido siguiendo las guías KDIGO) durante una hospitalización en pacientes nonagenarios ha sido poco estudiado. El objetivo del presente estudio es analizar la mortalidad en pacientes nonagenarios hospitalizados que desarrollan un FRA.

Métodos

Se recogieron todos los pacientes nonagenarios que desarrollaron FRA durante el ingreso hospitalario entre 2013 y 2014. Basalmente, se recogieron variables epidemiológicas, comorbilidades y, durante el ingreso, variables analíticas y mortalidad. Se analizaron las variables asociadas a mortalidad durante el episodio de FRA y los predictores independientes mediante regresión logística.

Resultados

Se incluyeron 264 pacientes nonagenarios con FRA. La edad media fue 93±3 años, siendo 73 (27,7 %) varones. Durante la hospitalización fallecieron 79 pacientes (29,9 %). Las comorbilidades asociadas a mortalidad fueron la insuficiencia cardiaca (p = 0,018), la disfunción diastólica (p = 0,042) y un mayor nivel o grado de dependencia (p = 0,003). Las variables clínicas en el momento del ingreso que se asociaron a mortalidad fueron presión arterial sistólica y diastólica más baja (p = 0,016 y 0,013, respectivamente), leucocitosis (p = 0,003), mayor severidad del FRA valorado por AKIN (p = 0,003) y valor de ácido L- láctico más alto (p = 0,005). Los predictores independientes de mortalidad fueron la insuficiencia cardiaca (OR = 2,31; IC95%: 1,07-5,00; p = 0,036), la dependencia valorada por el índice de Barthel modificado (OR = 0,80; IC95%: 0,67-0,97; p < 0,016) y el L- láctico al ingreso (OR = 1,31; IC95%: 1,06-1,61; p = 0,005).

Conclusión

La insuficiencia cardiaca, el nivel de dependencia y el ácido L- láctico al ingreso son predictores independientes de mortalidad en pacientes nonagenarios hospitalizados con FRA.

Abstract

Background

There has been little in the way of study of nonagenarians with acute kidney injury (AKI, defined in lines with KDIGO guidelines), but the rise in their life expectancy makes further study of this population necessary. The aim of this study is to assess mortality in nonagenarians with AKI during hospitalization.

Methods

In this retrospective study, patients with AKI during hospitalization between 2013-2014 were included. At baseline, epidemiological variables, comorbidities and treatments were collected. Analytics and mortality were studied during hospitalisation. Univariate analysis was carried out to evaluate mortality-associated variables. A logistic regression analysis was carried out to demonstrate independent predictors for mortality.

Results

Two hundred and sixty-four nonagenarian patients were included. Mean age was 93±3 years, 73 (27.7 %) of whom were men. During hospitalization, 79 patients (29.9 %) died. Comorbidities related to mortality were history of heart failure (p = 0.018), diastolic dysfunction (p < 0.042) and higher dependence according to the modified Barthel index (p = 0.003). The clinical variables related to mortality at hospital admission were lower systolic (p = 0.016) and diastolic blood pressure (p = 0.013), higher white blood cell count (p = 0.003), greater severity of AKI (p = 0.003) and L- lactic (p = 0.005). In an adjusted multivariate analysis, history of heart failure (OR = 2.31, 95%CI: 1.07-5.00, p = 0.036), dependence according to the Barthel index (OR = 0.80, 95%CI: 0.67-0.97, p = 0.016) and L- lactic acid (OR = 1.31, 95%IC: 1.06-1.61, p = 0.005) were independent predictors of mortality.

Conclusion

Heart failure, dependence according to the Barthel index and L- lactic acid at admission are independent predictors of mortality in nonagenarians hospitalized with AKI.