EVALUATION OF FACTORS AFFECTING ACUTE KIDNEY INJURY AND IN-HOSPITAL MORTALITY IN PATIENTS FOLLOWED UP IN INTENSIVE CARE UNIT DUE TO COPD EXACERBATION

Abstract

Objective: Acute kidney injury (AKI) is a frequent complication among patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) who are admitted to intensive care units (ICUs). The presence of systemic inflammation in both COPD and AKI has been associated with increased disease severity and mortality. This study aimed to evaluate the incidence of AKI and identify factors associated with in-hospital mortality among ICU patients with acute COPD exacerbation.Material and Methods: A total of 421 patients hospitalized in the ICU due to acute exacerbation of COPD between June 2017 and September 2023 were retrospectively analyzed. AKI was diagnosed according to KDIGO 2020 criteria (an increase in serum creatinine ≥0.3 mg/dL within 48 hours). Demographic, clinical, and laboratory parameters including white blood cell (WBC), neutrophil (NE), hemoglobin (HGB), albumin, procalcitonin (PCT), blood urea nitrogen (BUN), creatinine, uric acid, and phosphorus levels were recorded. Logistic regression analysis was performed to identify independent predictors of in-hospital mortality. Results: The mean age of the patients was 71.1±10.4 years, and 34.9% were female. The incidence of AKI was 25.6% (n=108), and in-hospital mortality occurred in 14% (n=59) of patients. Those who died had significantly higher WBC, NE, BUN, creatinine, PCT, uric acid, and phosphorus levels, while HGB and albumin levels were significantly lower (p<0.05). Logistic regression analysis revealed that advanced age, higher APACHE-II score, and invasive mechanical ventilation were independent predictors of mortality. Conclusion: AKI is a common and clinically important complication in ICU patients with acute COPD exacerbation, contributing to higher mortality rates. Monitoring commonly used biomarkers such as WBC, NE, HGB, albumin, PCT, creatinine, BUN, phosphorus, and uric acid may provide useful insight into independent mortality prediction. Further large-scale, prospective, multicenter studies are warranted to confirm these findings.