BackgroundAcute kidney injury (AKI) is common in patients in the intensive care unit (ICU) and may be present on admission or develop during ICU stay. Our objectives were (a) to identify factors independently associated with the development of new AKI during early stay in the ICU and (b) to determine the risk factors for non-recovery of AKI.MethodsWe retrospectively analysed prospectively collected data of patients admitted to a multi-disciplinary ICU in a single tertiary care centre in the UK between January 2014 and December 2016. We identified all patients without AKI or end-stage renal failure on admission to the ICU and compared the outcome and characteristics of patients who developed AKI according to KDIGO criteria after 24 h in the ICU with those who did not develop AKI in the first 7 days in the ICU. Multivariable logistic regression was applied to identify factors associated with the development of new AKI during the 24–72-h period after admission. Among the patients with new AKI, we identified those with full, partial or no renal recovery and assessed factors associated with non-recovery.ResultsAmong 2525 patients without AKI on admission, the incidence of early ICU-acquired AKI was 33.2% (AKI I 41.2%, AKI II 35%, AKI III 23.4%). Body mass index, Sequential Organ Failure Assessment score on admission, chronic kidney disease (CKD) and cumulative fluid balance (FB) were independently associated with the new development of AKI. By day 7, 69% had fully recovered renal function, 8% had partial recovery and 23% had no renal recovery. Hospital mortality was significantly higher in those without renal recovery. Mechanical ventilation, diuretic use, AKI stage III, CKD, net FB on first day of AKI and cumulative FB 48 h later were independently associated with non-recovery with cumulative fluid balance having a U-shape association.ConclusionsEarly development of AKI in the ICU is common and mortality is highest in patients who do not recover renal function. Extreme negative and positive FB were strong risk factors for AKI non-recovery.

中文翻译：

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累积积液与急性肾损伤的发生和肾功能无法恢复有关：回顾性分析

背景急性肾损伤 (AKI) 在重症监护病房 (ICU) 的患者中很常见，并且可能在入院时出现或在入住 ICU 期间出现。我们的目标是 (a) 确定在早期入住 ICU 期间与新 AKI 发展独立相关的因素和 (b) 确定 AKI 未恢复的危险因素。 2014 年 1 月至 2016 年 12 月期间，我们在英国一家三级医疗中心接受了多学科 ICU。我们确定了所有入住 ICU 时没有 AKI 或终末期肾功能衰竭的患者，并根据ICU 中 24 小时后的 KDIGO 标准，其中那些在 ICU 的前 7 天内未发生 AKI。应用多变量逻辑回归来确定与入院后 24-72 小时内发生新 AKI 相关的因素。在新发 AKI 患者中，我们确定了肾脏完全恢复、部分恢复或无恢复的患者，并评估了与未恢复相关的因素。 结果在 2525 名入院时未发生 AKI 的患者中，早期 ICU 获得性 AKI 的发生率为 33.2%（AKI I 41.2 %，AKI II 35%，AKI III 23.4%）。体重指数、入院时序贯器官衰竭评估评分、慢性肾病（CKD）和累积体液平衡（FB）与 AKI 的新发展独立相关。到第 7 天，69% 的肾功能完全恢复，8% 的部分恢复，23% 的肾功能未恢复。肾功能未恢复者的住院死亡率明显较高。机械通气、利尿剂使用、AKI III 期、CKD、AKI 第一天的净 FB 和 48 小时后的累积 FB 与不恢复独立相关，累积体液平衡呈 U 形关联。结论 ICU 早期发生 AKI 很常见，死亡率最高肾功能未恢复的患者。极端阴性和阳性 FB 是 AKI 未恢复的强烈危险因素。