In-hospital Mortality of Critically Ill Patients with Interactions of Acute Kidney Injury and Acute Respiratory Failure in the Resource-limited Settings: Results from SEA-AKI Study

Background: While the theory of kidney-lung interorgan cross-talk has been postulated for several years, their clinical outcomes and causal relationship remained unclear. Thus, our goal was to describe clinical outcomes and explore the interactions between acute kidney injury (AKI) and acute respiratory failure (ARF) in critically ill patients. Methods: : Data were retrieved from the SEA-AKI study, a multinational multicenter database of adult ICUs from Thailand, Laos, and Indonesia. AKI was defined using KDIGO criteria stage 2-3. ARF was defined by being mechanically ventilated. Patients were assigned into 6 patterns based on AKI and ARF sequence: “no AKI/ARF”, “ARF alone”, “AKI alone”, “ARF first”, “AKI first”, and “Concurrent AKI-ARF”. The primary outcome was in-hospital mortality of each pattern. Results: : A final cohort of 5468 patients were eligible for the analysis. The “Concurrent AKI-ARF” had the highest in-hospital mortality of 69.6%. The “AKI first” and the “ARF first” had in-hospital mortality of 54.4% and 53%, respectively. Among patients with single organ failure, in-hospital mortality was 14.6% and 31.5% in the “AKI alone” and the “ARF alone”, accordingly. In-hospital mortality was 12.4% in patients without AKI and ARF. Conclusion: Critically ill patients with ARF and AKI are at higher risk of in-hospital death. Further analysis and experiment is suggested to better understand the nature of this relationship.