Incidence and risk factors for the development of acute renal failure in patients with ventilator-associated pneumonia.
OBJECTIVE
Infections are one of the most important risk factors for the development of acute renal failure (ARF) and ventilator-associated pneumonia (VAP) has been reported as one of the most frequent infection in intensive care units (ICU). Sepsis, shock, multiorgan dysfunction syndrome (MODS), use of nephrotoxic antibiotics and mechanical ventilation are potential risk factors for development of ARF during VAP. The objective of the study was to evaluate the incidence of ARF in patients with VAP and the role of VAP-related potential risk factors in the development of ARF.


METHODS
One hundred and eight patients who were admitted to the pulmonary ICU of a university hospital and developed VAP were included in this prospective observational cohort study. Only first episodes of VAP were studied. Diagnosis was based on microbiologically confirmed clinical findings. Potential outcome variables including responsible pathogens, recurrence, polymicrobial aetiology, bacteraemia, multidrug resistance of microorganisms, late/early VAP and sepsis and other known risk factors for development of ARF were evaluated. Risk factors were analysed by logistic regression analysis for significance.


RESULTS
Incidence of ARF was 38% (n = 41). Pneumonia with multidrug resistant pathogens (odds ratio, (OR) 5; 95% confidence interval (95%CI), 1.5-18; P = 0.011), sepsis (OR, 5.6; 95%CI, 1.7-18; P = 0.005) and severity of admission disease (Acute Physiology and Chronic Health Evaluation II score: OR, 1.1; 95%CI, 1.02-1.3; P = 0.017) were independent risk factors for the development of ARF during VAP episodes in multivariate analysis.


CONCLUSIONS
These results showed that the incidence of ARF is high during the VAP episodes and that VAP developed with multidrug resistant pathogens and sepsis have an independent effect on the development of ARF.
Gursel
Gul
G
Gazi University School of Medicine, Intensive Care Unit of Department of Pulmonary Diseases, Ankara, Turkey. ggursel@gazi.edu.tr
Demir
Nalan
N
D058186:Acute Kidney Injury / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D006801:Humans; D015994:Incidence; D011014:Pneumonia / Q000150:complications* / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D014421:Turkey
D000900:Anti-Bacterial Agents