Acute Kidney Injury as a Risk Factor for Delirium and Coma during Critical Illness.

Siew ED, Fissell WH, Tripp CM, Blume JD, Wilson MD, Clark AJ, Vincz AJ, Ely EW, Pandharipande PP, Girard TD
Am J Respir Crit Care Med. 2017 195 (12): 1597-1607

PMID: 27854517 · PMCID: PMC5476907 · DOI:10.1164/rccm.201603-0476OC

RATIONALE - Acute kidney injury may contribute to distant organ dysfunction. Few studies have examined kidney injury as a risk factor for delirium and coma.

OBJECTIVES - To examine whether acute kidney injury is associated with delirium and coma in critically ill adults.

METHODS - In a prospective cohort study of intensive care unit patients with respiratory failure and/or shock, we examined the association between acute kidney injury and daily mental status using multinomial transition models adjusting for demographics, nonrenal organ failure, sepsis, prior mental status, and sedative exposure. Acute kidney injury was characterized daily using the difference between baseline and peak serum creatinine and staged according to Kidney Disease Improving Global Outcomes criteria. Mental status (normal vs. delirium vs. coma) was assessed daily with the Confusion Assessment Method for the ICU and Richmond Agitation-Sedation Scale.

MEASUREMENTS AND MAIN RESULTS - Among 466 patients, stage 2 acute kidney injury was a risk factor for delirium (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.07-2.26) and coma (OR, 2.04; 95% CI, 1.25-3.34) as was stage 3 injury (OR for delirium, 2.56; 95% CI, 1.57-4.16) (OR for coma, 3.34; 95% CI, 1.85-6.03). Daily peak serum creatinine (adjusted for baseline) values were also associated with delirium (OR, 1.35; 95% CI, 1.18-1.55) and coma (OR, 1.44; 95% CI, 1.20-1.74). Renal replacement therapy modified the association between stage 3 acute kidney injury and daily peak serum creatinine and both delirium and coma.

CONCLUSIONS - Acute kidney injury is a risk factor for delirium and coma during critical illness.

MeSH Terms (18)

Acute Kidney Injury Aged Causality Cohort Studies Coma Comorbidity Creatinine Critical Illness Delirium Female Humans Intensive Care Units Male Middle Aged Prospective Studies Respiratory Insufficiency Risk Factors Shock

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