C Delmas1, T Zapetskaia2, J M Conil2, B Georges2, F Vardon-Bounes3, T Seguin2, L Crognier2, O Fourcade2, L Brouchet4, V Minville3, S Silva2. 1. Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France; Intensive Cardiac care, Cardiology department, Rangueil University Hospital, 1 Av Jean-Poulhes, 31059 Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, INSERM 1048, Rangueil, Toulouse, France. Electronic address: delmas.clement@chu-toulouse.fr. 2. Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France. 3. Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, INSERM 1048, Rangueil, Toulouse, France. 4. Thoracic Surgery department, Larrey University Hospital, 24 chemin de Pouvourville, TSA 30030, 31059 Toulouse, France.
Abstract
PURPOSE: Veno-venous ECMO is increasingly used for the management of refractory ARDS. In this context, acute kidney injury (AKI) is a major and frequent complication, often associated with poor outcome. We aimed to identify characteristics associated with severe renal failure (Kidney Disease Improving Global Outcome (KDIGO) 3) and its impact on 3-month outcome. METHODS: Between May 2009 and April 2016, 60 adult patients requiring VV-ECMO in our University Hospital were prospectively included. RESULTS: AKI occurrence was frequent (75%; n=45), 51% of patients (n=31) developed KDIGO 3 - predominantly prior to ECMO insertion - and renal replacement therapy was required in 43% (n=26) of cases. KDIGO 3 was associated with a lower mechanical ventilation weaning rate (24% vs 68% for patients with no AKI or other stages of AKI; p<0.001) and a higher 90-day mortality rate (72% vs 32%, p=0.002). Multivariate logistic regression suggested that KDIGO 3 occurrence prior to ECMO insertion, as well as PaCO2>57mmHg and mSOFA>12 were independent risks factors for 90-day mortality. CONCLUSION: KDIGO 3 AKI occurrence is correlated with the severity of patients' clinical condition prior to ECMO insertion and is negatively associated with 90-day survival.
PURPOSE: Veno-venous ECMO is increasingly used for the management of refractory ARDS. In this context, acute kidney injury (AKI) is a major and frequent complication, often associated with poor outcome. We aimed to identify characteristics associated with severe renal failure (Kidney Disease Improving Global Outcome (KDIGO) 3) and its impact on 3-month outcome. METHODS: Between May 2009 and April 2016, 60 adult patients requiring VV-ECMO in our University Hospital were prospectively included. RESULTS: AKI occurrence was frequent (75%; n=45), 51% of patients (n=31) developed KDIGO 3 - predominantly prior to ECMO insertion - and renal replacement therapy was required in 43% (n=26) of cases. KDIGO 3 was associated with a lower mechanical ventilation weaning rate (24% vs 68% for patients with no AKI or other stages of AKI; p<0.001) and a higher 90-day mortality rate (72% vs 32%, p=0.002). Multivariate logistic regression suggested that KDIGO 3 occurrence prior to ECMO insertion, as well as PaCO2>57mmHg and mSOFA>12 were independent risks factors for 90-day mortality. CONCLUSION: KDIGO 3 AKI occurrence is correlated with the severity of patients' clinical condition prior to ECMO insertion and is negatively associated with 90-day survival.
Authors: Antal Szabó-Biczók; Gabriella Varga; Zoltán Varga; Gábor Bari; Gyöngyvér Vigyikán; Ámos Gajda; Noémi Vida; Ádám Hodoniczki; Attila Rutai; László Juhász; Anna Nászai; Máté Gyöngyösi; Sándor Turkevi-Nagy; Dániel Érces; Mihály Boros Journal: Front Med (Lausanne) Date: 2022-04-28