Prevalence, Outcomes and Risk factors of Acute Kidney Injury in Surgical Intensive Care Unit: A Multi-Center Thai University-Based Surgical Intensive Care Units Study (THAI-SICU Study)
Chawika Pisitsak MD*1, Kaweesak Chittawatanarat MD, PhD*2, Petch Wacharasint MD*3, Onuma Chaiwat MD*4, Rojnarin Komonhirun MEd*1, Sunthiti Morakul MD*1, the Thai SICU study group
Affiliation : *1 Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand *2 Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. *3 Department of Medicine, Faculty of Medicine, Phramongkutklao Hospital, Bangkok, Thailand *4 Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : Acute kidney injury (AKI) is one of the most common problems in critically ill patients. AKI associates with poor
outcome in ICU. The recognition of the prevalence and risk factors of AKI is important. This could lead to the prevention of
AKI and improve patient’s outcome. This study aims to identify the prevalence, outcomes and independent risk factors of AKI
in Thai surgical intensive care units.
Material and Method: We conducted the prospective cohort study from nine university-based SICUs. The patients were
diagnosed AKI by Acute Kidney Injury Network (AKIN) classification. The types of RRT and outcomes including mortality
were collected. The risk factors of AKI were identified.
Results : A total cohort of 4,652 patients was included for the present study. AKI was diagnosed in 786 (16.89%) patients. The
ICU mortality was higher in patients with AKI (29.90% vs. 5.48%, p-value <0.001). Among patients with AKI staging, we
found that those with AKIN III had higher ICU mortality compared to patients with AKIN II and AKIN I respectively (47.66%
vs. 26.67% vs. 14.69%, p-value <0.001). Patients with AKI had higher 28 day-mortality compared with those without AKI
(37.53% vs. 8.98%, p-value <0.001). The independent risk factors of AKI were higher APACHE II scores (OR 1.04, 95% CI
1.01-1.06, p-value = 0.001), lower serum albumin (OR 0.82, 95% CI 0.70-0.97, p-value = 0.020), organ failures which were
in the gastrointestinal system (OR 1.53, 95% CI 1.13-2.08, p-value = 0.007), cardiovascular system (OR 1.95, 95% CI 1.34-
2.83, p-value <0.001), neurological system (OR 1.37, 95% CI 1.02-1.85, p-value = 0.038) and urinary system (OR 7.00,
95% CI 5.21-9.40, p-value <0.001).
Conclusion : Acute kidney injury associates with poor outcomes including increased ICU and 28-day mortality. Independent
risk factors of AKI in the present study were higher APACHE II scores, lower serum albumin and organ failures on
admission.
Keywords : Acute kidney injury, AKIN, Prevalence, Risk factors, Acute renal failure
