title: Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection.
abstract: BACKGROUND
  Little information exists about the impact of acute kidney injury (AKI) in critically ill patients with the pandemic 2009 influenza A (H1N1) virus infection.
  
  
  METHODS
  We conducted a prospective, observational, multicenter study in 148 Spanish intensive care units (ICUs). Patients with chronic renal failure were excluded. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria.
  
  
  RESULTS
  A total of 661 patients were analyzed. One hundred eighteen (17.7%) patients developed AKI; of these, 37 (31.4%) of the patients with AKI were classified as AKI I, 15 (12.7%) were classified as AKI II and 66 (55.9%) were classified as AKI III, among the latter of whom 50 (75.7%) required continuous renal replacement therapy. Patients with AKI had a higher Acute Physiology and Chronic Health Evaluation II score (19.2 ± 8.3 versus 12.6 ± 5.9; P < 0.001), a higher Sequential Organ Failure Assessment score (8.7 ± 4.2 versus 4.8 ± 2.9; P < 0.001), more need for mechanical ventilation (MV) (87.3% versus 56.2%; P < 0.01, odds ratio (OR) 5.3, 95% confidence interval (CI) 3.0 to 9.4), a greater incidence of shock (75.4% versus 38.3%; P < 0.01, OR 4.9, 95% CI, 3.1 to 7.7), a greater incidence of multiorgan dysfunction syndrome (92.4% versus 54.7%; P < 0.01, OR 10.0, 95% CI, 4.9 to 20.21) and a greater incidence of coinfection (23.7% versus 14.4%; P < 0.01, OR 1.8, 95% CI, 1.1 to 3.0). In survivors, patients with AKI remained on MV longer and ICU and hospital length of stay were longer than in patients without AKI. The overall mortality was 18.8% and was significantly higher for AKI patients (44.1% versus 13.3%; P < 0.01, OR 5.1, 95% CI, 3.3 to 7.9). Logistic regression analysis was performed with AKIN criteria, and it demonstrated that among patients with AKI, only AKI III was independently associated with higher ICU mortality (P < 0.001, OR 4.81, 95% CI 2.17 to 10.62).
  
  
  CONCLUSIONS
  In our cohort of patients with H1N1 virus infection, only those cases in the AKI III category were independently associated with mortality.
authors.affiliation: Critical Care Department, Joan XXIII University Hospital-CIBER Enfermedades Respiratorias, URV, and IISPV, Mallafre i Guasch, ES-43007 Tarragona, Spain. drmartinloeches@gmail.com
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martin-Loeches
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Papiol
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rodríguez
authors.forename: Emili
authors.initials: E
authors.lastname: Diaz
authors.forename: Rafael
authors.initials: R
authors.lastname: Zaragoza
authors.forename: Rosa María
authors.initials: RM
authors.lastname: Granada
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Socias
authors.forename: Juan
authors.initials: J
authors.lastname: Bonastre
authors.forename: Montserrat
authors.initials: M
authors.lastname: Valverdú
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Pozo
authors.forename: Pilar
authors.initials: P
authors.lastname: Luque
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Juliá-Narvaéz
authors.forename: Lourdes
authors.initials: L
authors.lastname: Cordero
authors.forename: Antonio
authors.initials: A
authors.lastname: Albaya
authors.forename: Daniel
authors.initials: D
authors.lastname: Serón
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D000328:Adult; D016638:Critical Illness / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies