Parente Filho Sérgio Luiz Arruda, Lima Livia Maria Barbosa, Dantas Gilberto Loiola de Alencar, Silva Débora de Almeida, Rolim Victor de Matos, Oliveira Filho Antônio Mendes Ponte de, Melo Iamê Tavares Vale E, Silva Junior Geraldo Bezerra da, Daher Elizabeth De Francesco
Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Clínica, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brasil.
Programa de Pós-Graduação em Saúde Pública, Centro de Ciências da Saúde, Faculdade de Medicina, Universidade de Fortaleza - Fortaleza (CE), Brasil.
Rev Bras Ter Intensiva. 2018 Apr-Jun;30(2):153-159. doi: 10.5935/0103-507X.20180030.
To investigate prognostic factors among critically ill patients with community-acquired bacterial meningitis and acute kidney injury.
A retrospective study including patients admitted to a tertiary infectious disease hospital in Fortaleza, Brazil diagnosed with community-acquired bacterial meningitis complicated with acute kidney injury. Factors associated with death, mechanical ventilation and use of vasopressors were investigated.
Forty-one patients were included, with a mean age of 41.6 ± 15.5 years; 56% were males. Mean time between intensive care unit admission and acute kidney injury diagnosis was 5.8 ± 10.6 days. Overall mortality was 53.7%. According to KDIGO criteria, 10 patients were classified as stage 1 (24.4%), 18 as stage 2 (43.9%) and 13 as stage 3 (31.7%). KDIGO 3 significantly increased mortality (OR = 6.67; 95%CI = 1.23 - 36.23; p = 0.028). Thrombocytopenia was not associated with higher mortality, but it was a risk factor for KDIGO 3 (OR = 5.67; 95%CI = 1.25 - 25.61; p = 0.024) and for mechanical ventilation (OR = 6.25; 95%CI = 1.33 - 29.37; p = 0.02). Patients who needed mechanical ventilation by 48 hours from acute kidney injury diagnosis had higher urea (44.6 versus 74mg/dL, p = 0.039) and sodium (138.6 versus 144.1mEq/L; p = 0.036).
Mortality among critically ill patients with community-acquired bacterial meningitis and acute kidney injury is high. Acute kidney injury severity was associated with even higher mortality. Thrombocytopenia was associated with severer acute kidney injury. Higher urea was an earlier predictor of severer acute kidney injury than was creatinine.
探讨社区获得性细菌性脑膜炎合并急性肾损伤的重症患者的预后因素。
一项回顾性研究，纳入巴西福塔莱萨一家三级传染病医院收治的诊断为社区获得性细菌性脑膜炎合并急性肾损伤的患者。研究与死亡、机械通气和使用血管加压药相关的因素。
纳入41例患者，平均年龄41.6±15.5岁；56%为男性。重症监护病房入院至急性肾损伤诊断的平均时间为5.8±10.6天。总体死亡率为53.7%。根据KDIGO标准，10例患者分类为1期（24.4%），18例为2期（43.9%），13例为3期（31.7%）。KDIGO 3期显著增加死亡率（OR=6.67；95%CI=1.23-36.23；p=0.028）。血小板减少与较高死亡率无关，但它是KDIGO 3期（OR=5.67；95%CI=1.25-25.61；p=0.024）和机械通气（OR=6.25；95%CI=1.33-29.37；p=0.02）的危险因素。急性肾损伤诊断后48小时内需要机械通气的患者尿素水平较高（44.6对74mg/dL，p=0.039）和钠水平较高（138.6对144.1mEq/L；p=0.036）。
社区获得性细菌性脑膜炎合并急性肾损伤的重症患者死亡率高。急性肾损伤的严重程度与更高的死亡率相关。血小板减少与更严重的急性肾损伤相关。与肌酐相比，较高的尿素是更严重急性肾损伤的更早预测指标。
