• Elizabeth F Daher, Cristina N Marques, Rafael S A Lima, Geraldo B Silva Júnior, Aline S Barbosa, Eveline S Barbosa, Rosa M S Mota, Sônia Leite da Silva, Sônia M H A Araújo, and Alexandre B Libório.
• Department of Internal Medicine, Faculdade de Medicina, Hospital Universitario Walter Cantidio, Unversidade Federal do Ceara, Fortaleza, Ceará, Brazil. ef.daher@uol.com.br
• Swiss Med Wkly. 2008 Mar 8; 138 (9-10): 128-33.

BackgroundAcute kidney injury (AKI) is a common complication in many infectious diseases. There are few studies to investigate risk factors for death in infectious diseases-associated AKI.MethodsThis is a retrospective study including all patients with acute kidney injury (AKI) admitted to an infectious diseases intensive care unit (ICU) in Brazil between October 2003 and September 2006.ResultsA total of 722 patients were admitted to the infectious disease ICU in the study period. AKI occurred in 147 cases (17.7%). The mean age was 45 +/- 5.6 years, and 77% were male. The mean length of hospital stay was 11.5 +/- 10.3 days. The main causes of ICU hospitalization were acquired immunodeficiency syndrome (AIDS)-related diseases (28 .6%), pneumonia 13%), leptospirosis (11.6%), meningitis (8.2%), disseminated histoplasmosis (6.8%) and tetanus (5.4%). The main cause of AKI was sepsis (41.5%). Patients were classified according to RIFLE as "Risk" (5.6%), "Injury" (21.7%) and "Failure" (72.7%). Patients in "Failure" showed a higher mortality (p = 0.007). Multivariate analysis showed that dependent risk factors for death were oliguria (OR = 5.59, P = 0.002), metabolic acidosis (OR = 5.13, P = 0.01), sepsis (OR = 4.79, P = 0.001), hypovolaemia (OR = 4.11, P = 0.01), use of vasoactive drugs (OR = 3.34, P = 0.02), use of mechanical ventilation (OR = 2.94, P = 0.03) and high APACHE II score (OR = 1.14, P = 0.001).ConclusionThere are important risk factors for death among critically ill patients with infectious diseases associated with AKI.

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