Acute Kidney Injury in Critically Ill Pregnant Women:A Retrospective Study on Risk Factors and Outcomes.

Abstract

Introduction: Despite the significant decline in the incidence of pregnancy-related acute kidney injury (AKI) in recent decades due to advancements in medicine and increased awareness of this disease, it remains an important risk factor for maternal morbidity and mortality. However, as fertilization techniques allow women of advanced age to become pregnant, the incidence of pregnancy-related AKI has increased. Consequently, early identification of and intervention for pregnancy-related AKI are particularly important.

Methods: This was a retrospective clinical analysis. Data were collected from pregnant patients who were treated in the ICU of Shengjing Hospital of China Medical University from January 2014 to June 2020; The patients were divided into two groups based on their kidney function status: AKI and non-AKI. Additionally, they were further categorized into recovered and non-recovered groups based on their prognosis. The Wilcoxon rank sum test and the chi-square test were used for multigroup comparisons, while logistic regression analysis was used for the analysis of risk factors. P < .05 was considered to indicate a statistically significant difference in all correlation analyses.

Results: Among 874 pregnant women in this study, 136 had AKI (15.56%), while 36 developed chronic renal insufficiency (26.47%). Statistically significant associations were shown for shock (P = .002), sepsis (P < .001), coagulopathies (P = .001), liver insufficiency (P < .001), postpartum hemorrhage (P = .016), intrauterine fetal death (P = .042) and mechanical ventilation (P = .006) between the AKI-group and the non-AKI group. The development of AKI based on an elevated baseline creatinine level was significantly related to the outcome of renal function (P < .001), while a significant difference was shown in the use of continuous renal replacement therapy (CRRT) between the recovery group and the non-recovery group (P = .023).

Conclusion: We identified the relevant risk factors leading to pregnancy-related AKI and affecting the patients' prognosis. Shock, sepsis, coagulation disorders, liver insufficiency, postpartum hemorrhage, intrauterine fetal death and mechanical ventilation are independent risk factors for pregnancy-related AKI, while an elevated baseline creatine level is a key factor for poor prognosis. Meanwhile, early CRRT can effectively reverse renal outcomes.