Xuan Song, MD, PhD
Physician
Mayo Clinic
Liaocheng, Shandong, United States
Disclosure information not submitted.
Yue Dong, MD, , FSSH
Research Scientist
Mayo Clinic
Rochester, Minnesota
Disclosure information not submitted.
Kianoush Kashani, MD, MS, FASN, FCCP
Consultant
Mayo Foundation
Rochester, Minnesota
Disclosure information not submitted.
Title:Temporal Relationship Between ARDS and AKI Among Critically Ill Patients
Introduction: Acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) are common and associated with significant morbidity and mortality. Up to 35% of patients with ARDS develop subsequent AKI, which further increases mortality. The relationship between the lung and kidney is elucidated in both animal and clinical models, demonstrating a strong cross-talk between the two organs. This study aimed to clarify the temporal relationship between ARDS and AKI and its impact on patient outcomes.
Methods: A single-center retrospective cohort study was performed, including adult patients admitted to the Mayo Clinic Rochester medical ICU from January 1, 2007, through May 1, 2018 (n=76,988). Patients were stratified according to the diagnosis of ARDS based on Berlin definition and/or AKI based on KDIGO. Patients who met the criteria for both diagnoses were further subdivided according to timing, 1) ARDS >1 day after AKI, 2) AKI >1 day after ARDS, or 3) simultaneous diagnosis of ARDS and AKI within 24 hours. Baseline characteristics and outcomes were compared.
Results: Patients with both ARDS and AKI had higher ICU (21.2%) and hospital (28.4%) mortality compared to patients with ARDS alone (9.0% ICU mortality, 14.0% hospital mortality) or AKI alone (4.4% ICU mortality, 8.4% hospital mortality) (p < 0.001). These findings were consistent after adjusting for illness severity and comorbidities. Of the 1,136 patients with both AKI and ARDS, 136 (12%) developed AKI first, 303 (27%) ARDS first, and 697 (61%) had simultaneous disease. Patients who developed ARDS after AKI had significantly increased ICU (29.4%) and hospital (36.8%) mortality compared to patients who developed AKI after ARDS (13.9% ICU mortality, 21.5% hospital mortality) (p < 0.001).
Conclusions: Patients with AKI and ARDS have significantly worse outcomes, including longer hospital and ICU lengths of stay, higher mortality, longer duration of renal replacement therapy, and longer duration of ventilation than patients with AKI or ARDS alone. Among patients with both diagnoses, those who developed ARDS after AKI had the highest mortality.