Abstract

Introduction: Acute kidney injury is a leading cause of morbidity and mortality in critically ill patients. We hypothesized that inadequate fluid resuscitation and high vasopressor use before admission to the ICU can predict the occurrence of AKI in critically ill patients.
Objectives: The aim of this study was to determine the ability of IVC collapsibility index (measure of intravascular volume inadequacy) and the vasopressor therapy at ICU admission to predict the development of AKI.
Material and Methods: We prospectively recruited 103 patients in our 12 bed ICU from October 2017 to June 2018, after written informed consent from the next-of-kin, excluding Patients with CKD or transplanted kidneys and in whom IVC couldn’t be measured. Demographic data, baseline vital signs, investigations, ongoing inotrope dosage and duration were noted. Maximum and minimum IVC diameters were measured by 3.5 MHz ultrasound probe in M-mode in the transthoracic subxiphoid view and IVC collapsibility index was calculated. Daily urine output and serum creatinine values were collected up to 7 days. The AKI was diagnosed by KDIGO criteria. Multivariate logistic regression analysis was done with AKI as independent variable and age, gender, APACHE II score on admission, vasopressor use and number of vasopressor at admission and the collapsibility index as possible predictors.
Results: 78% of the patients developed AKI by the 7^th day of ICU stay. Only APACHE II score at admission was significantly associated with AKI.
Discussion: The IVC collapsibility index and vasopressor use were not predictive of AKI. Vasopressor use in our sample was only 22%. It is possible that collapsibility index at admission to ICU is not a good indicator of pre-ICU volume status. Future studies should concentrate on volume status estimation and resuscitation in the wards before ICU transfer.