[Investigation regarding the correlation between hydroxyethyl starch administration and acute kidney injury in critically ill patients].

OBJECTIVE: To explore the risk factors of the occurrence of acute kidney injury (AKI) in critically ill patients, and to investigate the effect of hydroxyethyl starch (HES) on renal function in these patients.

METHODS: A prospective investigation was conducted. Critically ill patients admitted to Department of Critical Care Medicine of People's Hospital of Huangshan, Wannan Medical College from March 2012 to October 2013 were enrolled. For all the patients under observation, the following data were collected: demography, comorbidities, clinical presentation, severity of illness, and the use of blood product and drugs. All patients were divided into AKI group and non-AKI group by means of Acute Kidney Injury Network (AKIN) criteria, then the risk factors of AKI were investigated by means of univariate and multivariate logistic regression analysis. The effect of HES 130/0.4 administration on renal function in critically ill patients was evaluated.

RESULTS: 314 patients were enrolled for study out of 1 152 patients admitted. Among these patients enrolled, 89 of them were found to suffer from AKI. AKI was classified as stage 1 in 59 patients, stage 2 in 19 patients, and stage 3 in 11 patients. It was shown by the univariate analysis that 12 variables were the risk factors of AKI, including age, hypertension, diabetes mellitus, acute physiology and chronic health evaluation II (APACHEII) score, sequential organ failure assessment (SOFA) score, coagulation SOFA score, neurological SOFA score, cardiovascular SOFA score, blood pH on intensive care unit (ICU) admission, blood glucose on ICU admission, accumulating dose of HES, and presence of shock (P < 0.05 or P < 0.01). However, HES administration and daily maximum dose of HES were not the risk factors of AKI in critically ill patients (both P > 0.05). Using the multivariate logistic regression analysis, it was shown that total SOFA score [ odds ratio (OR) = 1.20, 95% confidence interval (95%CI) = 1.09-1.32, P < 0.001 ], hypertension (OR = 2.44, 95%CI = 1.22-4.89, P = 0.012), blood glucose level on ICU admission (OR = 1.85, 95%CI = 1.32-2.59, P < 0.001), and presence of shock (OR = 3.81, 95%CI = 1.93-7.53, P < 0.001) were independent predictors of AKI in critically ill patients, however, the cumulative dose of HES was not independent risk factor for AKI (OR = 0.77, 95%CI = 0.68-0.87, P < 0.001).

CONCLUSIONS: Total SOFA score, hypertension, blood glucose level on ICU admission, and presence of shock were independent risk factors for AKI in critically ill patients. HES administration may not be a causative factor of an increased risk of AKI in the ICU.