Acute kidney injury in patients admitted to a liver intensive therapy unit with paracetamol-induced hepatotoxicity

Background. Paracetamol overdose can cause acute kidney injury (AKI) independent of its hepatotoxic effects. We aimed to determine the prevalence of AKI (AKI Network definition) in those with paracetamol-induced hepatotoxicity, identify factors associated with development, assess impact on the outco...

Full description

Saved in:
Bibliographic Details
Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2011-11, Vol.26 (11), p.3501-3508
Main Authors: O'Riordan, Aisling, Brummell, Zoe, Sizer, Elizabeth, Auzinger, Georg, Heaton, Nigel, O'Grady, John G., Bernal, William, Hendry, Bruce M., Wendon, Julia A.
Format: Article
Language:English
Subjects:
Acetaminophen - adverse effects
Acute Kidney Injury - etiology
Acute Kidney Injury - mortality
Adult
Analgesics, Non-Narcotic - adverse effects
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Chemical and Drug Induced Liver Injury - complications
Creatinine - blood
Emergency and intensive care: renal failure. Dialysis management
Female
Follow-Up Studies
Glomerular Filtration Rate
Hospital Mortality
Humans
Intensive care medicine
Intensive Care Units
Length of Stay
Male
Medical sciences
Middle Aged
Prognosis
Prospective Studies
Risk Factors
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Survival Rate
Young Adult
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background. Paracetamol overdose can cause acute kidney injury (AKI) independent of its hepatotoxic effects. We aimed to determine the prevalence of AKI (AKI Network definition) in those with paracetamol-induced hepatotoxicity, identify factors associated with development, assess impact on the outcomes of patient survival and length of stay and determine the proportion of patients recovering renal function (estimated glomerular filtration rate > 60 mL/min) by the time of hospital discharge or transfer out. Methods. Between 2000 and 2007, patients admitted to a tertiary referral liver intensive therapy unit (LITU) with paracetamol-induced hepatotoxicity were identified from a prospectively maintained database and evaluated. Results. Those receiving a liver transplant were excluded (n = 54), leaving 302 patients. Renal function remained normal in 21%, the remainder developing AKI (Stages 1-8%, 2-6% and 3-65%). Vasopressor requirement, mechanical ventilation, higher admission phosphate and lower sodium levels along with a higher Day 3 lactate and lower haematocrit were associated with AKI. In survivors with AKI, 51% had recovery of renal function, while 7% remained dialysis dependant although none required it chronically. Overall, there was 25% mortality, all having Stage 3 AKI but AKI was only a univariate not multivariate predictor of reduced patient survival. AKI independently predicted longer length of stay. Conclusions. AKI is very common in critically ill patients with paracetamol-induced hepatotoxicity requiring LITU admission. Although outcomes are poorer with AKI than with normal renal function, they are better than those found in other intensive therapy unit populations. Gradual recovery of renal function is seen in all patients.
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/gfr050