Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study

<p>Abstract</p> <p>Background</p> <p>Despite the substantial progress in the quality of critical care, the incidence and mortality of acute kidney injury (AKI) continues to rise during hospital admissions. We conducted a national, multicenter, prospective, epidemiological survey to evaluate the importance of AKI in intensive care units (ICUs) in Hungary. The objectives of this study were to determine the incidence of AKI in ICU patients; to characterize the differences in aetiology, illness severity and clinical practice; and to determine the influencing factors of the development of AKI and the patients' outcomes.</p> <p>Methods</p> <p>We analysed the demographic, morbidity, treatment modality and outcome data of patients (n = 459) admitted to ICUs between October 1^st, 2009 and November 30^th, 2009 using a prospectively filled in electronic survey form in 7 representative ICUs.</p> <p>Results</p> <p>The major reason for ICU admission was surgical in 64.3% of patients and medical in the remaining 35.7%. One-hundred-twelve patients (24.4%) had AKI. By AKIN criteria 11.5% had Stage 1, 5.4% had Stage 2 and 7.4% had Stage 3. In 44.0% of patients, AKI was associated with septic shock. Vasopressor treatment, SAPS II score, serum creatinine on ICU admission and sepsis were the independent risk factors for development of any stage of AKI. Among the Stage 3 patients (34) 50% received renal replacement therapy. The overall utilization of intermittent renal replacement therapy was high (64.8%). The overall in-hospital mortality rate of AKI was 49% (55/112). The ICU mortality rate was 39.3% (44/112). The independent risk factors for ICU mortality were age, mechanical ventilation, SOFA score and AKI Stage 3.</p> <p>Conclusions</p> <p>For the first time we have established the incidence of AKI using the AKIN criteria in Hungarian ICUs. Results of the present study confirm that AKI has a high incidence and is associated with high ICU and in-hospital mortality.</p

A szepszishez társuló encephalopathia = Sepsis-associated encephalopathy

A szepszishez társuló encephalopathia a szisztémás gyulladásos reakció korai szakaszában jelentkező, gyakori, de klinikai szempontból elhanyagolt tünete. A szisztémás szepszis okozta diffúz agyi működészavar, újabb elnevezés szerint a szepszishez társuló encephalopathia (sepsis-associated encephalopathy – SAE) változatos megjelenésű lehet: az átmeneti, reverzíbilis encephalopathiával jellemezhető formától egészen a visszafordíthatatlan agyi károsodással járó súlyos formáig terjedhet a klinikai spektrum. A jelen közleményben a hazai és a nemzetközi szakirodalom áttekintése alapján össze kívántuk foglalni a kórkép kórélettani hátterét, a leggyakrabban előforduló klinikai tüneteket és a kezelés lehetséges módjait. Fel kívántuk hívni a figyelmet arra, hogy szepszisben a különböző súlyosságú tudatzavar az egyik legkorábbi figyelmeztető tünet, ezért a szepszis szempontjából veszélyeztetett betegekben felismerése nagy klinikai jelentőségű. | Sepsis-associated encephalopathy is a common but neglected clinical symptom of systemic inflammatory reaction in the early phase. The clinical spectrum of diffuse cerebral dysfunction induced by systemic sepsis – sepsis-associated encephalopathy according to the new terms- varies from transient, reversible encephalopathy, to severe irreversible brain damage. The aim of the present publication is to summarize the pathophysiology, frequent symptoms and possible treatments of the disease based on international and Hungarian articles on this topic. We want to emphasize the importance of monitoring the patient’s mental status due to the fact that consciousness’ disturbance of different severity is an early warning sign of sepsis, so it has high clinical significance