Analysis of prognostic markers in patients diagnosed with acute renal failure in the emergency department

Acute kidney injury (AKI) is a clinical syndrome characterized with accumulation of toxic metabolites and disruption of the internal homeostasis and acute decrease in renal functions because of the decline in GFR that develops over hours, days or weeks. Diagnosis of AKI and initial treatment usually happens in the emergency department. Despite the contemporary diagnostic and treatment opportunities and widespread use of dialysis, mortality of AKI has not been changed in a long time. Primary outcomes of our study are determining mortality predictors at 28 and 90 days in emergency department patients. Secondary outcome is to determining the predictors for continuous Renal Replacement Therapy need. We included 400 patients who presented to our emergency department between 2016-2019 who got diagnosed with AKI. We analyzed the effect of age, sex, comorbid diseases, use of medications (NSAIDs, aminoglycosides, lithium, statins, diuretics, phenytoin etc), IV contrast material exposure, triage vital signs, Glasgow Coma Scale (GCS), lactate in venous blood gas analysis, GFR in venous blood sample, serum creatinine levels, BUN, serum potassium level, cardiac Troponin I, thrombocyte levels, and albumin levels of 28 and 90 day mortality and continuous RRT need. Out of 400 patients included in the study, 207 (51,7%) were male. Patient ages were between 19-96 with a mean of 66,12±16,25 years. Mortality rates at 28 days and 90 days were 15,3% and 22% respectively. Regression analysis of the data showed diuretic use (p 0.01; OR 4.57, CI95% 1,35-15,45), high cTnI levels (p 0.03; OR 3.71, CI 95% 1.12-12.26), tachypnea (p 0.001; OR 0.104, CI 95%, 0.02-0.40) and hyperkalemia (p 0,04; OR 3.7, CI 95% 1,0-13,5) were statistically significant predictors of mortality at 28 days. Regression analysis of the data showed age above 65 years (p 0,07; OR 2,63, CI 95% 0,90-7,63), high BUN levels (p 0,01; OR 1,01, CI 95% 1,00-1,03), diuretic use (p 0,03; OR 2,56, CI 95% 1,07-6,01) and cTnI levels >0.06 ng/L (p 0,01; OR 2,97, CI 95% 1,25-7,07) were statistically significant predictors of mortality at 90 days. In predicting continuous RRT need age >65 years (p 0,01; OR 0,38, CI 95% 0,17-0,85), diuretic use (p 0,02; OR 2,88, CI 95% 1,22-6,79), CRD existence (p <0.001; OR 4,83, CI 95% 2,21-10,57), high BUN levels (p 0,02; OR 2,58, CI 95% 1,12-5,94), and low GFR levels (p <0.001; OR 0,85, 0,79-0,91) were statistically significant predictors.