Ulus Travma Acil Cerrahi Derg. 2017; 23(1): 39-45 | DOI: 10.5505/tjtes.2016.83451

Evaluation of risk factors and development of acute kidney injury in aneurysmal subarachnoid hemorrhage, head injury, and severe sepsis/septic shock patients during ICU treatment

Ceren Kamar¹, Achmet Ali¹, Demet Altun¹, Gunseli Orhun¹, Akin Sabanci², Altay Sencer¹, Ibrahim Ozkan Akinci^1
1Istanbul University, Istanbul Medical Faculty, Anesthesiology Department, Istanbul,Turkey
²Istanbul University, Istanbul Medical Faculty, Neurosurgery Department, Istanbul, Turkey

BACKGROUND: There are few studies examining development of acute kidney injury (AKI) in the various types of patients in intensive care units (ICUs). Presently described is evaluation of risk factors and development of AKI in different groups of ICU patients.
METHODS: Present study was performed in 3 different ICUs. Development of AKI was measured using Acute Kidney Injury Network (AKIN) classification system. Total of 300 patients who were treated in trauma, neurosurgery, or general ICU departments (due to head injury, aneurysmal subarachnoid hemorrhage [aSAH], or severe sepsis/septic shock, respectively) were assessed for incidence, risk factors, and development of AKI.
RESULTS: AKI did not develop in aSAH patients when evaluated based on serum creatinine level; however, it was observed in 5% of aSAH patients according to volume adjusted creatinine (VACr) level. AKI developed in 76% of sepsis group, and in 20% of head injury group, based on AKIN classification, according to both serum and VACr levels. Incidence of AKI was significantly higher in sepsis group (p<0.001). Only use of vasopressor was significantly related to AKI development in sepsis and head injury groups. Mortality rate was 8%, 22%, and 42% in aSAH, head injury, and sepsis groups, respectively. AKI development and vasopressor use were significantly related to mortality in sepsis group.
CONCLUSION: Despite similar characteristics and risk factors, there were fewer instances of AKI in aSAH group. Hypertension or hydration therapy used to treat vasospasm and polyuria due to cerebral salt-wasting syndrome may prevent aSAH patients from developing AKI.

Keywords: Head trauma, renal insufficiency, sepsis, subarachnoid hemorrhage.

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Anevrizmal subaraknoid kanama, kafa travmasý ve sepsis hastalarýnýn yoðun bakým tedavileri sýrasýnda akut böbrek hasarý geliþimi ve etkileyen risk faktörlerinin incelenmesi

Ceren Kamar¹, Achmet Ali¹, Demet Altun¹, Gunseli Orhun¹, Akin Sabanci², Altay Sencer¹, Ibrahim Ozkan Akinci^1
1Ýstanbul Üniversitesi, Ýstanbul Týp Fakültesi, Anesteziyoloji Ana Bilim Dalý, Ýstanbul, Türkiye
²Ýstanbul Üniversitesi, Ýstanbul Týp Fakültesi, Beyin Cerrahisi Ana Bilim Dalý, Ýstanbul, Türkiye

AMAÇ: Yoðun bakým ünitelerinde (YBÜ) takip edilen farklý hasta gruplarýnda akut böbrek hasarý (ABH) geliþimini inceleyen az çalýþma bulunmaktadýr. Çalýþmamýzda farklý yoðun bakým hasta gruplarýnda ABH geliþmesini ve bunda etkili risk faktörlerini incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþma üç farklý YBÜ’de gerçekleþtirildi ve AKI network (AKIN) sýnýflandýrmasýna göre ABH oluþumu karþýlaþtýrýldý. Travma, beyin cerrahi ve genel YBÜ’lerde yatan sýrasý ile kafa travmasý, anevrizmal subaraknoid kanama (aSAK) ve septik þok nedeniyle takip edilen 300 hasta ABH insidansý ve risk faktörleri açýsýndan incelendi.
BULGULAR: Anevrizmal subaraknoid kanama grubunda serum kreatin deðerine göre ABH geliþen hasta saptanmadý fakat volüm düzeltilmiþ kreatinin deðerine göre (VACr) hastalarýn %5’inde ABH geliþtiði görüldü. AKI network sýnýflandýrmasý baz alýndýðýnda sepsis grubunda %76, kafa travmasý grubunda hastalarýn %20’sinde hem serum kreatin hemde VACr deðerine göre ABH geliþtiði görüldü ve sepsis grubunda ABH insidansý anlamlý oranda yüksek bulundu (p<0.001). Sadece vazopresör kullanýmý sepsis ve kafa travmasý grubunda ABH geliþimi için risk faktörü olarak saptandý. Hastalarýn mortalite oranlarý aSAK, kafa travmasý ve sepsis grubu için sýrasý ile %8, %22 ve %42 saptandý. Vazopressör kullanýmý ve ABH geliþmesi sepsis grubunda mortalite için risk faktörü olarak saptandý.
TARTIÞMA: Benzer özellikler ve risk faktörlerine raðmen aSAK hastalarýnda ABH daha nadir görülmektedir. Vazospazm tedavisi için uygulanan hipertansiyon, hipervolemi ve tuz kaybettirici sendrom sonucu oluþan poliüri aSAK hastalarýnda ABH geliþimden koruyan faktörler olabilir.

Anahtar Kelimeler: Böbrek yetmezliði, kafa travmasý, sepsis, subaraknoid kanama.

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