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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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ROC Curve analysis of Multivariate regression model of AKI among dengue patients.
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pone.0138465.g002: ROC Curve analysis of Multivariate regression model of AKI among dengue patients.

Mentions: Aiming to determine the factors independently associated with the development of AKI, we developed a series of logistic regression analysis, which are presented in Table 3. Clinically relevant and statistically tested variables were subjected univariate analysis. The variables with P values less than 0.25 were considered as candidates for multivariate analysis. The use of univariate P values <0.25 has advantage of tending to include more variables in multivariate analysis while traditional levels of P value such as 0.05 can fail in identifying variables known to be important [27]. We noted that the factors independently associated with AKI development were male gender (OR: 2.7), DHF (OR: 8), rhabdomyolosis (OR: 7.9), multiple organ dysfunction (OR: 17.9), diabetes mellitus (OR: 10.5), delayed hospital consultation (OR: 2.1) and use of nephrotoxic drugs (OR: 2.9). ROC curve analysis with AUC as 0.94 (P<0.001, 95%CI: 0.916–0.964) demonstrated that logistic model has excellent predictive ability for AKI (Fig 2).


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)

ROC Curve analysis of Multivariate regression model of AKI among dengue patients.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0138465.g002: ROC Curve analysis of Multivariate regression model of AKI among dengue patients.
Mentions: Aiming to determine the factors independently associated with the development of AKI, we developed a series of logistic regression analysis, which are presented in Table 3. Clinically relevant and statistically tested variables were subjected univariate analysis. The variables with P values less than 0.25 were considered as candidates for multivariate analysis. The use of univariate P values <0.25 has advantage of tending to include more variables in multivariate analysis while traditional levels of P value such as 0.05 can fail in identifying variables known to be important [27]. We noted that the factors independently associated with AKI development were male gender (OR: 2.7), DHF (OR: 8), rhabdomyolosis (OR: 7.9), multiple organ dysfunction (OR: 17.9), diabetes mellitus (OR: 10.5), delayed hospital consultation (OR: 2.1) and use of nephrotoxic drugs (OR: 2.9). ROC curve analysis with AUC as 0.94 (P<0.001, 95%CI: 0.916–0.964) demonstrated that logistic model has excellent predictive ability for AKI (Fig 2).

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