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Incidence, Characteristics and Risk Factors of Acute Kidney Injury among Dengue Patients: A Retrospective Analysis.

Mallhi TH, Khan AH, Adnan AS, Sarriff A, Khan YH, Jummaat F - PLoS ONE (2015)

Bottom Line: Two groups were compared by using appropriate statistical methods.Presence of dengue hemorrhagic fever [OR (95% CI): 8.0 (3.64-17.59), P<0.001], rhabdomyolysis [OR (95% CI): 7.9 (3.04-20.49)], multiple organ dysfunction [OR (95% CI): 34.6 (14.14-84.73), P<0.001], diabetes mellitus [OR (95% CI): 4.7 (1.12-19.86), P = 0.034], late hospitalization [OR (95% CI): 2.1 (1.12-19.86), P = 0.033] and use of nephrotoxic drugs [OR (95% CI): 2.9 (1.12-19.86), P = 0.006] were associated with AKI.Overall mortality was 1.2% and all fatal cases had AKI.

View Article: PubMed Central - PubMed

Affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia; Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerain, Kelantan, Malaysia.

ABSTRACT

Background: Dengue induced acute kidney injury (AKI) imposes heavy burden of illness in terms of morbidity and mortality. A retrospective study was conducted to investigate incidence, characteristics, risk factors and clinical outcomes of AKI among dengue patients.

Methodology: A total 667 dengue patients (2008-2013) were retrospectively evaluated and were stratified into AKI and non-AKI groups by using AKIN criteria. Two groups were compared by using appropriate statistical methods.

Results: There were 95 patients (14.2%) who had AKI, with AKIN-I, AKIN-II and AKIN-III in 76.8%, 16.8% and 6.4% patients, respectively. Significant differences (P<0.05) in demographics and clinico-laboratory characteristics were observed between patients with and without AKI. Presence of dengue hemorrhagic fever [OR (95% CI): 8.0 (3.64-17.59), P<0.001], rhabdomyolysis [OR (95% CI): 7.9 (3.04-20.49)], multiple organ dysfunction [OR (95% CI): 34.6 (14.14-84.73), P<0.001], diabetes mellitus [OR (95% CI): 4.7 (1.12-19.86), P = 0.034], late hospitalization [OR (95% CI): 2.1 (1.12-19.86), P = 0.033] and use of nephrotoxic drugs [OR (95% CI): 2.9 (1.12-19.86), P = 0.006] were associated with AKI. Longer hospital stay (>3 days) was also observed among AKI patients (OR = 1.3, P = 0.044). Additionally, 48.4% AKI patients had renal insufficiencies at discharge that were signicantly associated with severe dengue, secondary infection and diabetes mellitus. Overall mortality was 1.2% and all fatal cases had AKI.

Conclusions: The incidence of AKI is high at 14.2% among dengue patients, and those with AKI portended significant morbidity, mortality, longer hospital stay and poor renal outcomes. Our findings suggest that AKI in dengue is likely to increase healthcare burden that underscores the need of clinicians' alertness to this highly morbid and potentially fatal complication for optimal prevention and management.

No MeSH data available.


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pone.0138465.g001: Study Methodology Flow Diagram.

Mentions: We retrospectively reviewed medical records of all dengue patients admitted from January 2008 to December 2013. All dengue patients were identified by registration number using hospital record management system. Patients having age ≥ 12 years admitted with primary and confirmed diagnosis of DVI, irrespective of severity, were included in this study. Methodology of study flow is given in Fig 1. Patients having incomplete demographics and hospital stay less than 2 days were excluded from the study. Suspected DVI cases were diagnosed by using at least one of the following criteria: (1) positive reverse transcriptase polymerase chain reaction (RT-PCR) result, (2) presence of dengue immunoglobulin M and G antibodies in acute phase serum by enzyme linked immunosorbent assay [Pan Bio Dengue IgM ELISA, Dengue IgM Dot Enzyme Immunoassay, SD Dengue IgM and IgG capture ELISA Kits; Standard Diagnostics, Korea], and (3) at least 4-fold increase of dengue-specific hemagglutination inhibition titers in convalescent serum when compared with acute phase serum. The serum samples were also tested for dengue-specific NS1 [pan-E Early dengue ELISA kit by Panbio, Australia and Platelia dengue NS1Ag assay by Bio-Rad Laboratories, USA). Primary dengue infection was distinguished from secondary infection by using IgM/IgG ratio where dengue infection was defined as primary if ratio > 1.2 and as secondary if < 1.2 [24] or if there was a 4-fold increase of HAI and the titers were ≤1:1280 and ≥1:2560, respectively [9]. Serologically confirmed dengue patients were subjected to clinical case definition and disease severity was classified according to the WHO criteria, where clinical diagnosis of DF requires fever and two or more of following symptoms; headache, retro-orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestations and leucopenia; DHF requires presence of fever, thrombocytopenia (≤100 × 109/L), any bleeding and plasma leakage described as either hematocrit change ≥20%, clinical fluid accumulation (pleural effusion or ascites), or hypoproteinemia; and DSS requires presence of one of rapid and weak pulse with narrow pulse pressure <20 mmHg or hypotension for age in a patient with DHF. Presence of warning signs indicates the presence of at least one of the following; abdominal pain/tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleed, lethargy/restlessness, liver enlargement> 2 centimeter, concurrent increase in hematocrit with thrombocytopenia [25].


Incidence, Characteristics and Risk Factors of Acute Kidney Injury among Dengue Patients: A Retrospective Analysis.

Mallhi TH, Khan AH, Adnan AS, Sarriff A, Khan YH, Jummaat F - PLoS ONE (2015)

Study Methodology Flow Diagram.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4589349&req=5

pone.0138465.g001: Study Methodology Flow Diagram.
Mentions: We retrospectively reviewed medical records of all dengue patients admitted from January 2008 to December 2013. All dengue patients were identified by registration number using hospital record management system. Patients having age ≥ 12 years admitted with primary and confirmed diagnosis of DVI, irrespective of severity, were included in this study. Methodology of study flow is given in Fig 1. Patients having incomplete demographics and hospital stay less than 2 days were excluded from the study. Suspected DVI cases were diagnosed by using at least one of the following criteria: (1) positive reverse transcriptase polymerase chain reaction (RT-PCR) result, (2) presence of dengue immunoglobulin M and G antibodies in acute phase serum by enzyme linked immunosorbent assay [Pan Bio Dengue IgM ELISA, Dengue IgM Dot Enzyme Immunoassay, SD Dengue IgM and IgG capture ELISA Kits; Standard Diagnostics, Korea], and (3) at least 4-fold increase of dengue-specific hemagglutination inhibition titers in convalescent serum when compared with acute phase serum. The serum samples were also tested for dengue-specific NS1 [pan-E Early dengue ELISA kit by Panbio, Australia and Platelia dengue NS1Ag assay by Bio-Rad Laboratories, USA). Primary dengue infection was distinguished from secondary infection by using IgM/IgG ratio where dengue infection was defined as primary if ratio > 1.2 and as secondary if < 1.2 [24] or if there was a 4-fold increase of HAI and the titers were ≤1:1280 and ≥1:2560, respectively [9]. Serologically confirmed dengue patients were subjected to clinical case definition and disease severity was classified according to the WHO criteria, where clinical diagnosis of DF requires fever and two or more of following symptoms; headache, retro-orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestations and leucopenia; DHF requires presence of fever, thrombocytopenia (≤100 × 109/L), any bleeding and plasma leakage described as either hematocrit change ≥20%, clinical fluid accumulation (pleural effusion or ascites), or hypoproteinemia; and DSS requires presence of one of rapid and weak pulse with narrow pulse pressure <20 mmHg or hypotension for age in a patient with DHF. Presence of warning signs indicates the presence of at least one of the following; abdominal pain/tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleed, lethargy/restlessness, liver enlargement> 2 centimeter, concurrent increase in hematocrit with thrombocytopenia [25].

Bottom Line: Two groups were compared by using appropriate statistical methods.Presence of dengue hemorrhagic fever [OR (95% CI): 8.0 (3.64-17.59), P<0.001], rhabdomyolysis [OR (95% CI): 7.9 (3.04-20.49)], multiple organ dysfunction [OR (95% CI): 34.6 (14.14-84.73), P<0.001], diabetes mellitus [OR (95% CI): 4.7 (1.12-19.86), P = 0.034], late hospitalization [OR (95% CI): 2.1 (1.12-19.86), P = 0.033] and use of nephrotoxic drugs [OR (95% CI): 2.9 (1.12-19.86), P = 0.006] were associated with AKI.Overall mortality was 1.2% and all fatal cases had AKI.

View Article: PubMed Central - PubMed

Affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia; Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerain, Kelantan, Malaysia.

ABSTRACT

Background: Dengue induced acute kidney injury (AKI) imposes heavy burden of illness in terms of morbidity and mortality. A retrospective study was conducted to investigate incidence, characteristics, risk factors and clinical outcomes of AKI among dengue patients.

Methodology: A total 667 dengue patients (2008-2013) were retrospectively evaluated and were stratified into AKI and non-AKI groups by using AKIN criteria. Two groups were compared by using appropriate statistical methods.

Results: There were 95 patients (14.2%) who had AKI, with AKIN-I, AKIN-II and AKIN-III in 76.8%, 16.8% and 6.4% patients, respectively. Significant differences (P<0.05) in demographics and clinico-laboratory characteristics were observed between patients with and without AKI. Presence of dengue hemorrhagic fever [OR (95% CI): 8.0 (3.64-17.59), P<0.001], rhabdomyolysis [OR (95% CI): 7.9 (3.04-20.49)], multiple organ dysfunction [OR (95% CI): 34.6 (14.14-84.73), P<0.001], diabetes mellitus [OR (95% CI): 4.7 (1.12-19.86), P = 0.034], late hospitalization [OR (95% CI): 2.1 (1.12-19.86), P = 0.033] and use of nephrotoxic drugs [OR (95% CI): 2.9 (1.12-19.86), P = 0.006] were associated with AKI. Longer hospital stay (>3 days) was also observed among AKI patients (OR = 1.3, P = 0.044). Additionally, 48.4% AKI patients had renal insufficiencies at discharge that were signicantly associated with severe dengue, secondary infection and diabetes mellitus. Overall mortality was 1.2% and all fatal cases had AKI.

Conclusions: The incidence of AKI is high at 14.2% among dengue patients, and those with AKI portended significant morbidity, mortality, longer hospital stay and poor renal outcomes. Our findings suggest that AKI in dengue is likely to increase healthcare burden that underscores the need of clinicians' alertness to this highly morbid and potentially fatal complication for optimal prevention and management.

No MeSH data available.


Related in: MedlinePlus