128 Clinical Variables in Poor Outcome Patient With Acute Kidney Injury Receiving Continuous Veno Venous Hemofiltration Therapy

Abstract

Introduction: Leptospirosis, a zoonosis cause by Leptospira, is endemic in the tropics and is a relatively important cause of acute kidney injury (AKI) in this region. Mortality has been reported to be as high as 15-18% in those with AKI in the 1990's but there is lack of data on renal and patient outcome in this current age with the improvement of diagnostic techniques [microscopic agglutination test (MAT) is currently the gold standard], renal support and medical care. Objective: To study the incidence and outcome of acute kidney injury in patients with leptospirosis Methodology: This retrospective study was performed on all patients admitted from 1 st January 2015 to 31 st December 2016. Patients with confirmed leptospirosis (ie positive for both IgM antibodies and MAT) were identified from the Hospital Laboratory Information System (LIS). Patients' demography, relevant clinical data, laboratory results, renal outcome and patient outcome were retrieved from hospital's electronic medical record. Subjects with incomplete data were excluded. Results were analysed using SPSS version 23. Results: Of a total of 125,243 admissions, 35 patients were admitted with confirmed leptospirosis. Twenty-three patients (65.7%) developed AKI. The mean age of those with AKI was 35.7 AE 19.2 years and 21 (92.3%) were male. Thirteen (56.5%) were Malay while Chinese, Indians and others accounted 5 (21.7%), 4 (17.4%) and 1 (4.3%) respectively. Only 14 (60.9%) received renal consults and 4 (17.4%) required dialysis support. One patient who required dialysis, died during the admission giving a mortality rate of 4.3%. At time of discharge, 18 (78.3%) had complete renal recovery, 4 (17.4%) developed chronic kidney disease and 1 (4.3%) died before discharge. None of the patients required dialysis support at discharge. Compared to the 12 patients who did not develop AKI, male gender was found to be a risk factor of developing AKI (p¼0.023). There was a suggestion that older patients have a higher preponderance of developing AKI but this did not reach statistical significance. Conclusion: AKI is common in leptospirosis with an incidence of 65.7% but with a favorable outcome where 78.3% have a complete AKI recovery. Male gender appeared to be a risk factor of developing leptospirosis associated AKI.