Impacto de la lesión renal aguda en la supervivencia de los sujetos que reciben ventilación mecánica no invasiva

Resumo

The treatment of patients with acute respiratory failure (ARF) in Hospital Emergency Departments (HED) is directed towards a clinical approach to the underlying disease and the use of ARF support measures aimed at achieving adequate arterial oxygenation and alveolar ventilation. Non-invasive mechanical ventilation (NIV) is a form of ventilatory support that does not require orotracheal intubation (OTI) and its immediate use in the ED reduces mortality in patients with ARF. Acute pulmonary oedema (PEA) and exacerbations of chronic obstructive pulmonary disease (COPD) are the most common ED conditions. Acute kidney injury (AKI) is a frequent complication in critically ill patients and is associated with increased morbidity and mortality. The RIFLE scale (Risk, Injury, Failure, Prolonged Loss of Renal Function (Loss) and Irreversible End of Renal Function (End)) is a classification tool that unifies the classic AKI criteria, facilitating patient stratification. As a modification of the RIFLE scale, the AKIN (Acute Kidney Injury Network) scale was designed, which has greater sensitivity and specificity for the evaluation of renal risk and prognosis. The main objective was to determine the relationship between acute kidney injury and survival in patients with acute respiratory failure who received non-invasive mechanical ventilation (NIV) in the Emergency Department of the Hospital (ED) General Universitario Reina Sofía de Murcia. A prospective observational study was carried out, which included all persons attended during the period from 1 June 2012 to 31 December 2015. A total of 675 patients were collected, of which 76 were excluded for not having previous creatinine (Cr), 173 for previous Cr greater than 3 months and 57 patients for not having Cr at 24-48 hours of ED admission, so that 369 patients were finally analyzed. Of these, 198 (53.7%) were men and 171 (46.3%) were women, with a mean age of 77.46 years ±10.47 years. The most frequent variables studied were arterial hypertension (HT), diabetes mellitus (DM), congestive heart failure (CHF) and COPD. The variables analyzed for acute renal failure (ARF) were baseline Cr, Cr extracted on arrival at the ED and Cr 24-48 hours after ED stay. Of the 369 patients 13.6% had AKI and 29.5% had ARF. The probability of patients with ARF developing AKI was 28%. Patients with AKI and ARF died in 45% and those with AKI without ARF died in 55%. The RR was 2.10 (95% CI 1.12-3.94, p=0.029). In conclusion, both acute renal failure and acute kidney injury were predictors of mortality, mainly acute kidney injury, the existence of which increased the probability of death or NIV failure but not the probability of ICU admission.