Stage-Specific Predictors and Outcomes of Colistin-Associated Acute Kidney Injury in Surgical and Medical ICU Patients

Abstract

Background:

Acute kidney injury (AKI) is a critical concern in intensive care unit (ICU) patients, especially those treated with colistin. However, existing research often includes mixed patient populations, including non-ICU patients, and lacks stratification of factors associated with varying severities of AKI. The AKI prevalence and predicting variables should be further explored due to the diversity in AKI development and outcomes in colistin-treated ICU patients.

Methods:

This study analyzed electronic medical records of 174 surgical and medical ICU patients treated with intravenous colistin at a tertiary university hospital. Multinomial regression analysis was used to analyze the prevalence of AKI stages using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria and identify predictive factors across different stages of AKI.

Results:

Among 174 colistin-treated ICU patients, 83.9% developed AKI with a median stage of 3. The presence of AKI did not significantly influence the mortality rates. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score was a consistent predictor across AKI stages (P < 0.05). Colistin dosage was as a significant predictor when distinguishing Stage 1 AKI from no AKI (adjusted OR 1.46, 95% CI: 1.09-1.94), but was not identified as a significant predictor for the progression to Stages 2 to 3 AKI.

Conclusion:

The impact of colistin-associated nephrotoxicity in ICU patients is primarily at the initial stage of AKI and does not extend to more advanced stages. Patient safety may be enhanced by using the APACHE II score as one of the deciding variables when deciding between colistin and other antibiotic treatments, particularly for vulnerable critically ill patients.