Evaluation of mortality and acute kidney injury by KDIGO and RIFLE in patients treated with colistin in the intensive care unit

Year 2021, Volume: 4 Issue: 5, 610 - 614, 05.09.2021

Emre Aydın Önder Keserci Fatma Yılmaz Ali Kadiroğlu

https://doi.org/10.32322/jhsm.944502

Abstract

Introduction: Multidrug-resistant bacterial infections such as pseudomonas aeruginosa, acinetobacter baumannii, klebsiella pneumoniae are common in Intensive Care Units. Colistin is preferred today due to limited treatment options sensitive to these pathogens. However, colistin has a high potential for nephrotoxicity. Some classifications (KDIGO, RIFLE, AKIN) are used for the diagnosis of Acute Kidney Injury (AKI). The incidence of AKI varies according to these classifications. In our study, we aimed to evaluate and compare the development of Acute Kidney Injury according to KDIGO criteria and RIFLE classification in patients followed up in the intensive care unit and started colistin therapy.
Materials and Methods: The data of 145 patients who started colistin treatment in the Internal Medicine Intensive Care Unit between January 2016 and December 2019 were retrospectively reviewed. Patients were grouped as those with Acute Kidney Injury and those without. Acute Kidney Injury evaluation was made according to RIFLE classification and KDIGO criteria.
Results: In patients who received colistin treatment, 75 patients were evaluated as AKI when KDIGO criteria were used for the AKI diagnosis, and 54 patients were evaluated as AKI when the RIFLE classification was used. While the number of KDIGO Stage 1 patients was 44, the number of patients in the RIFLE classification risk group was determined as 23. The mean SOFA score was calculated as 7.91±2.8 and the mean APACHE II score as 22.77±5.3. The duration of stay in the ICU was 22.60±9.04. The duration of stay in the ICU was shorter in the group who developed AKI. 44.8% of the patients included in the study died. 52% of patients who developed AKI and 37.1% of those who did not develop AKI died. 30-day mortality in patients with AKI was significantly higher than both KDIGO staging and RIFLE classification (p=0.03, p=0.005, respectively). Mortality rate increased 1.42 times in KDIGO Stage 1, 2.79 times in KDIGO Stage 2 and 2.10 times in KDIGO Stage 3. When evaluated by the RIFLE classification, the mortality rate increased 2.32 times in the Risk group, 3.12 times in the Injury group, 2.06 times in the Failure group and 2.15 times in the Loss group.
Conclusion: We observed an increase in the frequency of AKI in patients using colistin in the ICU, both according to KDIGO criteria and the RIFLE classification. This situation also increases the 30-day mortality. We think that the KDIGO criteria are more sensitive to diagnose AKI in these patients.

Keywords

Colistin, Acute Kidney Injury, Intensive Care Units

Supporting Institution

No

Project Number

No

Thanks

No

References

• Cerceo E, Deitelzweig SB, Sherman BM, et al. Multidrug-resistant Gram-negative bacterial infections in the hospital setting: overview, implications for clinical practice, and emerging treatment options. Microb Drug Resist 2016; 22: 412–31.
• Kınıklı S, Cesur S, Yücel M, Hatipoğlu ÇA, Dinç B. Determination of polymyxin B, minocycline, colistin and phosphomycin susceptibilities in Acinetobacter baumannii strains showing carbapenem resistant multidrug resistance phenotype. J Health Sci Med 2019; 2: 49-53.
• Falagas ME, Kasiakou SK. Colistin: the revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections. Clin Infect Dis 2005; 40: 1333-41.
• Gunay E, Kaya S, Baysal B, Yuksel E, Arac E. Evaluation of prognosis and nephrotoxicity in patients treated with colistin in intensive care unit. Ren Fail 2020; 42: 704-9.
• Javan AO, Shokouhi S, Sahraei Z. A review on colistin nephrotoxicity. Eur j Clin Pharmacol 2015; 71: 801-10.
• Incı A, Toker MK, Bicer IG, Derbent A, Salihoglu Z. Determination of colistin-related nephrotoxicity and risk factors in intensive care unit. North Clin Istanb 2018; 5: 120-4.
• Hartzell JD, Neff R, Ake J, et al. Nephrotoxicity associated with intravenous colistin (Colistimethate sodium) Treatment at a Tertiary Care Medical Center. Clinical Infectious Diseases 2009; 48: 1724-8.
• Kwon JA, Lee JE, Huh W, et al. Predictors of acute kidney injury associated with intravenous colistin treatment. Int J Antimicrob Agents 2010; 35: 473-7.
• Kaya M, Tunçel Yİ, Kuru RN, et al. Onkoloji hastanesi yoğun bakım ünitesinde kolistin ilişkili nefrotoksisitenin retrospektif değerlendirilmesi. Türk Yoğun Bakım Derneği Derg 2014; 12: 51-6.
• Giacobbe DR, Masi AD, Leboffe L, et al. Hypoalbuminemia as a predictor of acute kidney injury during Colistin treatment. Sci Rep 2018 10; 8: 11968.
• Yu SN, Kim T, Park SY, et al. Predictors of acute kidney injury and 28-day mortality in carbapenem-resistant Acinetobacter baumannii complex bacteremia. Microb Drug Resist 2021; 10.1089/mdr.2020.0312.
• Ciftci A, Izdes S, Altintaş ND. Factors determining nephrotoxicity and mortality in critical care patients receiving colistin. J Infect Dev Ctries 2018; 11: 912-8.
• Deryke CA, Crawford AJ, Uddin N, Wallace MR. Colistin dosing and nephrotoxicity in a large community teaching hospital. Antimicrob Agents Chemother 2010; 54: 4503-5.
• Søvik S, Isachsen MS, Nordhuus KM, et al. Acute kidney injury in trauma patients admitted to the ICU: a systematic review and meta-analysis. Intensive Care Med 2019; 45: 407-19.
• Aydın E, Kadiroglu AK, Yılmaz Aydın F, et al. The relationship between acute kidney injury and inflammation-based parameters and mortality in oncologic intensive care patients. J Crit Intensive Care 2020; 11: 50−4.
• Vieira JM Jr, Castro I, Curvello-Neto A, et al. Effect of acute kidney injury on weaning from mechanical ventilation in critically ill patients. Crit Care Med 2007; 35: 184–91.
• Hoste EAJ, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med 2015; 41: 1411-23.