Outcome and features of acute kidney injury complicating hypoxic hepatitis at the medical intensive care unit

Andreas Drolz; Thomas Horvatits; Kevin Roedl; Karoline Rutter; Katharina Staufer; Dominik G Haider; Christian Zauner; Gottfried Heinz; Peter Schellongowski; Stefan Kluge; Michael Trauner; Valentin Fuhrmann

doi:10.1186/s13613-016-0162-4

Outcome and features of acute kidney injury complicating hypoxic hepatitis at the medical intensive care unit

Ann Intensive Care. 2016 Dec;6(1):61. doi: 10.1186/s13613-016-0162-4. Epub 2016 Jul 8.

Authors

Andreas Drolz^{1

2}, Thomas Horvatits^{3

4}, Kevin Roedl^{3

4}, Karoline Rutter^{3

4}, Katharina Staufer^{3

5}, Dominik G Haider^{6

7}, Christian Zauner³, Gottfried Heinz⁸, Peter Schellongowski⁹, Stefan Kluge⁴, Michael Trauner³, Valentin Fuhrmann^{3

4}

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. [email protected].
² Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. [email protected].
³ Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
⁴ Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
⁵ Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria.
⁶ Division of Nephrology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
⁷ Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.
⁸ Intensive Care Unit 13H3, Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
⁹ Intensive Care Unit 13I2, Division of Oncology and Infectious Diseases, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.

Abstract

Background: Hypoxic hepatitis (HH) is a frequent and potentially life-threatening event typically occurring in critically ill patients as a consequence of hemodynamic impairment. While acute kidney injury (AKI) has been well described in patients with acute liver failure, incidence and outcome of AKI accompanying HH are unclear. The aim of this study was to assess incidence, clinical implications and outcome of AKI and renal replacement therapy (RRT) in critically ill patients with HH.

Methods: A total of 1948 consecutive critically ill admissions were studied at the Medical University of Vienna. Laboratory and clinical parameters as well as the presence of HH and AKI were assessed on a daily basis. Outcome, renal recovery and length of stay were assessed and documented, and patients were followed for 1 year.

Results: A total of 295 admissions (15 %) developed HH. Main precipitators were cardiogenic (44 %) and septic shock (36 %). Occurrence of HH was significantly associated with AKI [OR 4.50 (95 % CI 3.30-6.12)] and necessity of renal replacement therapy [RRT; OR 3.36 (95 % CI 2.58-4.37)], p < 0.001 for both. Two hundred forty admissions with HH (81 %) developed AKI, 159 of whom (66 %) had AKI stage 3. Both HH and AKI were significantly linked to mortality. AKI stage 3, international normalized ratio (INR, during HH) and the presence of septic shock were identified as independent predictors of 28-day mortality in admissions with HH, whereas RRT was identified as an independent protective factor. There was a synergistic effect of HH and AKI on length of stay at the ICU. Of all HH survivors treated with RRT, 71 % showed renal recovery during follow-up.

Conclusion: HH is frequently complicated by occurrence of AKI. Severity of HH, AKI stage and the presence of septic shock seem to contribute to poor outcome in these patients. Initiation of RRT in HH with AKI may enable renal recovery and should not be withheld in medical ICU patients.

Keywords: Acute kidney injury; Hypoxic hepatitis; Mortality; Renal replacement therapy.