Factors Determining Nephrotoxicity and Mortality in Critical Care Patients Receiving Colistin

  • Ali Ciftci Ankara Numune Training and Research Hospital, Ankara, Turkey
  • Seval Izdes Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
  • Neriman Defne Altintas İbni Sina Hospital, Ankara University, Ankara, Turkey

Abstract

Introduction: We aimed to determine risk factors for nephrotoxicity and factors affecting mortality in patients who received colistin.


Methodology: Critical patients who received colistin were enrolled. Pregnancy, age < 18 years, basal creatinine level > 2 mg/dL, colistin use for < 48 hours, and previous renal replacement therapy were exclusion criteria. KDIGO stages were determined according to creatinine levels. Patients were grouped as those with no acute kidney injury (Group N0) and those with acute kidney injury (Group N). Their demographic data, APACHE II and SOFA scores, treatments, and laboratory results were recorded.


Results: A total of 91 patients were included: 27 in Group N0 and 64 in Group N. Demographic data were similar between groups; however, higher admission APACHE-II scores (OR:1.179, 95% CI:1.033-1.346, p = 0.015) and need for vasopressors (OR:5.486, 95% CI:1.522–19.769, p = 0.009) were found to be independent risk factors for nephrotoxicity. Higher APACHE II scores (OR:1.253, %95 CI:1.093-1.437, p = 0.001), presence of coronary artery disease (OR:7.720, % 95 CI: 1.613-36.956, p = 0.011), need for vasopressors (OR: 4.587, % 95 CI: 1.224 – 17.241, p = 0.024), hypoalbuminemia (OR: 4.721, % 95 CI: 1.088 – 20.469, p = 0.038), and higher direct bilirubin levels (OR: 1.806, % 95 CI: 1.055 – 3.092, p = 0.031) were independent risk factors for mortality.


Conclusion: When use of colistin is considered in ICU patients, presence of modifiable risk factors for nephrotoxicity such as hypoalbuminemia, nephrotoxic drug administration, and presence of shock should be determined and managed to prevent nephrotoxicity.

Author Biographies

Ali Ciftci, Ankara Numune Training and Research Hospital, Ankara, Turkey

Anesthesiologist

Fellow in Critical Care 

Ankara Numune Training and Research Hospital

Department of Anesthesiology and Reanimation 

Seval Izdes, Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey

Professor

Anesthesiologist and Intensivist

Head of Division of Critical Care

Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital 

Department of Anesthesiology and Reanimation

 

Neriman Defne Altintas, İbni Sina Hospital, Ankara University, Ankara, Turkey

Internist and intensivist

Associate Professor

Head of Division of Critical Care

Ankara University, Faculty of Medicine, İbni Sina Hospital

Department of Internal Medicine

Published
2018-01-10
How to Cite
Ciftci A, Izdes S, Altintas N (2018) Factors Determining Nephrotoxicity and Mortality in Critical Care Patients Receiving Colistin. The Journal Of Infection In Developing Countries 11 (12): 912-917. https://doi.org/10.3855/jidc.9443
Section
Original Articles