Evaluation of admission hyperglycemia on acute kidney injury in non-diabetic patients with the ICU admi̇ssi̇on of diagnosis of acute stroke

Aim: Acute kidney injury (AKI) affects upto 30% of patients admitted to the ICU. When AKI develops mortality increases to 40-90 % during a critical illness. AKI increases mortality, prolongs in-hospital stays and augments costs by requiring expensive treatment modalities like dialysis. Hyperglycemia is one of the frequently encountered problem among ICU population. Previous studies have shown hyperglycemia is associated with poor prognosis even in non-diabetic patients with critical conditions. However its not well known the relationship between hyperglycemia and development of AKI in criticly ill patients. In ligth of these data we investigated the association between admission hyperglycemia and incidence of AKI in non-diabetic patients diagnosed with acute stroke which is a life threatining condition. Methods: This study included 520 patients without diabetes and chronic kidney disease admitted in the acute phase of stroke to the medical or neurology ICU of Dicle University Education and Training Hospital between the dates of 2010-2014. Patient data were analyzed retrospectively. Demographic features, comorbid illness, length of stay in the ICU, clinical outcome, serum glucose and creatinine levels obtained at the admission were recorded. Daily serum creatinine levels were assessed for detection of AKI on follow up. CPR levels obtained in the acute phase of stroke were recorded. AKI diagnosis based on KDIGO guideline and admission hyperglycemia assumed to be serum glucose of ≥ 126 mg/dl, Patients were divided into 4 groups according to development of admission hyperglycemia and/or AKI. Regression analysis and ROC analysis was applied on data set. Results: 249 (% 47.9) of patients were male and 271 (%52.1) were women. Mean age was 68.6 ± 17.0 years. Mean admission serum glucose in AKI group was 156 mg/dl±55.1 whereas in non-AKI group was 132 mg/dl ± 46,1. Compared to non-AKI group mean admission serum glucose level was found significantly higher in AKI group (p<0.001). %35.2 of patients with admission hyperglycemia and % 16.6 of patients without admission hyperglycemia developed AKI on follow up.(OR=2.7 CI=1.8-4.1, p<0.001). Admission serum glucose at the threshold level of 142 mg/dl maximized the combined sensitivity (%50.7) and specificity (%74.2) in predicting development of AKI . According to these data admission hyperglycemia is associated with 2.7 fold increase in development of AKI and is determined as an early independent predictor of AKI in non-diabetic patients with acute stroke. Mortality was estimated %40.4 in patients with admission hyperglycemia whereas %20.9 in patients without admission hyperglycemia (OR=2,5 CI=1.7-3.7, p<0.001) That suggests admission hyperglycemia is a contributing factor and a marker of increased mortality. Conclusion: Admission hyperglycemia is an early independent predictor of AKI and mortality in non-diabetic patients admitted to the ICU with acute stroke.This may be helpful for early diagnosis of AKI, actuation of preventive and therapeutic measures and prediction of prognosis.