Acute kidney injury and its outcomes in melioidosis

Prabhu, Ravindra A and Shaw, Tushar and Rao, Indu Ramachandra and Eshwara, Vandana Kalwaje and Nagaraju, Shankar Prasad and Shenoy, Srinivas Vinayak and Mukhopadhyay, Chiranjay (2021) Acute kidney injury and its outcomes in melioidosis. Journal of Nephrology, 34 (6). pp. 1941-1948. ISSN 1121-8428

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Abstract

Background Melioidosis is a potentially fatal tropical infection caused by Burkholderia pseudomallei. Kidney involvement is possible, but has not been well described. Aim This study aimed to assess the risk of acute kidney injury (AKI) and its outcomes in melioidosis.Methods A retrospective observational cohort study was performed. Case records of consecutive patients with cultureconfrmed melioidosis, observed from January 1st, 2012 through December 31st, 2019 were analysed for demographics, presence of comorbidities, including chronic kidney disease (CKD), diabetes mellitus (DM), and presence of bacteraemia,sepsis, shock, AKI, and urinary abnormalities. The outcomes we studied were: mortality, need for hospitalisation in an intensive care unit (ICU), duration of hospitalization. We then compared the outcomes between patients with and without AKI.Results Of 164 patients, AKI was observed in 59 (35.98%), and haemodialysis was required in eight (13.56%). In the univariate analysis, AKI was associated with CKD (OR 5.83; CI 1.140–29.90, P=0.03), bacteraemia (OR 8.82; CI 3.67–21.22,P<0.001) and shock (OR 3.75; CI 1.63–8.65, P=0.04). In the multivariate analysis, CKD (adjusted OR 10.68; 95% CI 1.66–68.77; P=0.013) and bacteraemia (adjusted OR 8.22; 95% CI 3.15–21.47, P<0.001) predicted AKI. AKI was associated with a greater need for ICU care (37.3% vs. 13.3%, P=0.001), and mortality (32.2% vs. 5.7%, P<0.001). Mortality increased with increasing AKI stage, i.e. stage 1 (OR 3.52, CI 0.9–13.7, P=0.07), stage 2 (OR 6.79, CI 1.92–24, P=0.002)and stage 3 (OR 17.8, CI 5.05–62.8, P<0.001), however kidney function recovered in survivors. Hyponatremia was observed in 138 patients (84.15%) and isolated urinary abnormalities were seen in 31(18.9%).Conclusions AKI is frequent in melioidosis and occurred in 35.9% of our cases. Hyponatremia is likewise common. AKI was predicted by bacteraemia and CKD, and was associated with higher mortality and need for ICU care; however kidney function recovery was observed in survivors

Item Type: Article
Uncontrolled Keywords: Acute kidney injury; Melioidosis; Bacteraemia; Sepsis; Burkholderia pseudomallei
Subjects: Medicine > KMC Manipal > Microbiology
Medicine > KMC Manipal > Nephrology
Depositing User: KMC Library
Date Deposited: 29 Jan 2022 06:26
Last Modified: 29 Jan 2022 06:26
URI: http://eprints.manipal.edu/id/eprint/158212

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