Acute Respiratory Distress Syndrome and Risk of AKI among Critically Ill Patients

作者：Darmon Michael^*; Clec'h Christophe; Adrie Christophe; Argaud Laurent; Allaouchiche Bernard; Azoulay Elie; Bouadma Lila; Garrouste Orgeas Maite; Haouache Hakim; Schwebel Carole; Goldgran Toledano Dany; Khallel Hatem; Dumenil Anne Sylvie; Jamali Samir; Souweine Bertrand; Zeni Fabrice; Cohen Yves; Timsit Jean Francois

来源：Clinical Journal of the American Society of Nephrology, 2014, 9(8): 1347-1353.

DOI：10.2215/CJN.08300813

Background and objectives Increasing experimental evidence suggests that acute respiratory distress syndrome (ARDS) may promote AKI. The primary objective of this study was to assess ARDS as a risk factor for AKI in critically ill patients.
Design, setting, participants, & measurements This was an observational study on a prospective database fed by 18 intensive care units (ICUs). Patients with ICU stays >24 hours were enrolled over a 14-year period. ARDS was defined using the Berlin criteria and AKI was defined using the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria. Patients with AKI before ARDS onset were excluded.
Results This study enrolled 8029 patients, including 1879 patients with ARDS. AKI occurred in 31.3% of patients and was more common in patients with ARDS (44.3% versus 27.4% in patients without ARDS; P<0.001). After adjustment for confounders, both mechanical ventilation without ARDS (odds ratio [OR], 4.34; 95% confidence interval [95% CI], 3.71 to 5.10) and ARDS (OR, 11.01; 95% CI, 6.83 to 17.73) were independently associated with AKI. Hospital mortality was 14.2% (n=1140) and was higher in patients with ARDS (27.9% versus 10.0% in patients without ARDS; P<0.001) and in patients with AKI (27.6% versus 8.1% in those without AKI; P<0.001). AKI was associated with higher mortality in patients with ARDS (42.3% versus 20.2%; P<0.001).
Conclusions ARDS was independently associated with AKI. This study suggests that ARDS should be considered as a risk factor for AKI in critically ill patients.

• 出版日期2014-8