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A6057 - Factors Associated with Acute Kidney Injury and Mortality in Critically Ill Cancer Patients
Author Block: S. Namendys-Silva1, B. M. Córdova-Sánchez2, E. Ruiz-García3, A. López3, A. R. Bautista-Ocampo2, M. Barragán-Dessavre2, A. Meneses-García2, A. Herrera-Gomez2; 1Department of Critical Care Medicine, Instituto Nacional de Cancerologia, Mexico, Ciudad de Mexico, Mexico, 2Department of Critical Care Medicine, Instituto Nacional de Cancerologia, Mexico, Ciudad de Mexico (CDMX), Mexico, 3Translational Medicine Research Laboratory, Instituto Nacional de Cancerologia, Mexico, Ciudad de Mexico (CDMX), Mexico.
Rationale: Acute kidney injury (AKI) is a frequent complication in critically ill patients and its severity has been associated with mortality. In addition to common causes of AKI, cancer patients are at increased risk of renal damage associated with a neoplastic disease or its treatment. Previous studies performed in different clinical settings have investigated plasma and urinary neutrophil gelatinase-associated lipocalin (NGAL) to predict AKI. In adult critically ill patients, results are conflicting; with c-statistics ranging from 0.54 to 0.99, because severe systemic inflammation and organ damage can alter NGAL expression. Since oncologic patients are exposed to chronic inflammation, our aim was to assess risk factors associated with AKI and mortality, including plasma NGAL levels. Methods: From April 2014 to July 2015 we recruited 96 critically ill cancer patients and followed them prospectively. Plasma NGAL was determined at intensive care unit (ICU) admission and at 48 hours. We registered demographic characteristics, comorbidities, cancer status, sepsis, mechanical ventilation, severity scores, and laboratory values. We performed a Cox-regression analysis to evaluate 6-month mortality and a logistic regression analysis to determine risk factors associated with AKI during hospitalization, defined by Kidney Disease: Improving global outcomes (KDIGO) clinical guidelines. Results: From 96 patients, 60 (63%) developed AKI, 33 (55%) were classified as stage 2 and 3. At ICU admission, 28 patients already had AKI, and 32 developed AKI during their ICU stay. In this last group, plasma NGAL levels showed an area under the curve (AUC)=0.522 for all AKI stages and an AUC=0.573 for stage 2 and 3 AKI (85% sensitivity and 67% specificity for a 50.66 ng/ml cutoff). Although plasma NGAL did not predict AKI, plasma NGAL at 48 hours of admission showed a trend for predicting 6-month mortality (HR= 1.005, 95%CI: 0.999-1.010, p=0.087) in the multivariate analysis. Independent predictors for 6-month mortality were age (HR= 1.03, 95%CI: 1.01-1.05, p=0.043), metastatic disease (HR= 4.04, 95%CI: 1.45-11.29, p=0.008), dobutamine use (HR= 21.9, 95%CI: 3.68-130.5, p=0.001), lactate at admission (HR= 1.03, 95%CI: 1.01-1.05, p=0.003), stage 3 AKI (HR= 2.83, 95%CI: 1.07-7.48, p=0.036) and hemoglobin (HR= 0.809, 95%CI: 0.657-0.997, p=0.047). The Sequential Organ Failure Assessment score at ICU admission and male gender predicted AKI development. The hemoglobin level was a protective factor against AKI and 6-month mortality. Conclusion: Plasma NGAL at 48 hours may be associated with systemic inflammation and organ damage, which predicts 6-month mortality.