Supplementary Material for: Clinical characteristics and the prognostic impact of acute kidney injury in critically ill patients with invasive pulmonary Aspergillosis in the intensive care unit: A retrospective, single-center study

Introduction: The incidence and impact of acute kidney injury (AKI) in patients with invasive pulmonary aspergillosis (IPA) admitted to the intensive care unit (ICU) are unknown. Methods: This retrospective study included 140 patients who were diagnosed IPA and admitted to the medical ICU of China–Japan Friendship Hospital in Beijing, China. AKI was defined according to the kidney disease improving global outcomes guidelines. Data on demographic characteristics, comorbidities, laboratory tests, treatments, and prognosis at ICU admission were collected. Results: The rate of AKI was 71.4% (n = 100), and approximately 30% of the patients had preadmission acute kidney dysfunction. Of the 100 patients with AKI, 19, 8, and 73 patients had stage I, II, and III AKI, respectively, and 64 (87.6%) patients required continuous renal replacement therapy. Overall ICU mortality rate was 52.1%. Irreversible AKI was a strong independent risk factor for ICU mortality (odds ratio 13.36, 95% confidence interval 4.52–39.48, p < 0.001), followed by chronic lung disease, use of intermittent positive-pressure ventilation, and long-term corticosteroid treatment within 1 year prior to ICU admission. Higher cardiac troponin I levels at admission and worse volume control during the first 7 days of ICU stay were potential predictive factors of irreversible kidney dysfunction. Patients with irreversible AKI and those who died during the ICU stay had greater volume overload during the first 14 days of ICU stay. Patients who survived received earlier renal replacement therapy support after ICU admission compared to those who died (median, 2 vs. 5 days; p = 0.026). Conclusion: Compared to the patients with IPA in the absence of AKI, those with AKI presented with more volume overload, worse disease burden, and required stronger respiratory support, while experiencing worse prognosis. Irreversible AKI was a strong predictor of mortality in patients with critical IPA. Better volume control and earlier CRRT initiation should be considered key points in AKI management and prognostic improvement.

引言：入住重症监护病房（intensive care unit, ICU）的侵袭性肺曲霉病（invasive pulmonary aspergillosis, IPA）患者发生急性肾损伤（acute kidney injury, AKI）的情况及其影响尚不明确。
方法：本回顾性研究纳入了中国北京中日友好医院医疗ICU收治的140例确诊IPA患者。急性肾损伤依据改善全球肾脏病预后（Kidney Disease: Improving Global Outcomes, KDIGO）指南进行定义。收集患者入住ICU时的人口统计学特征、合并症、实验室检查、治疗方案及预后相关数据。
结果：本研究中AKI发生率为71.4%（n=100），约30%的患者存在入院前急性肾功能不全。在100例AKI患者中，分别有19例、8例和73例处于AKIⅠ、Ⅱ、Ⅲ期，其中64例（87.6%）需接受连续性肾脏替代治疗（continuous renal replacement therapy, CRRT）。总体ICU病死率为52.1%。不可逆性AKI是ICU死亡的强独立危险因素（比值比13.36，95%置信区间4.52~39.48，P<0.001），其次为慢性肺部疾病、入院前1年内使用间歇正压通气及长期糖皮质激素治疗。入院时较高的心肌肌钙蛋白I水平及ICU住院前7天内容量控制不佳是不可逆性肾功能不全的潜在预测因素。发生不可逆性AKI的患者及ICU住院期间死亡的患者，其ICU住院前14天内容量负荷过重情况更为显著。与死亡患者相比，存活患者在ICU入院后更早接受肾脏替代治疗支持（中位时间：2天 vs. 5天；P=0.026）。
结论：与未合并AKI的IPA患者相比，合并AKI的患者容量负荷过重情况更显著、疾病负担更重，且需要更强的呼吸支持，同时预后更差。不可逆性AKI是重症IPA患者死亡的强预测因子。优化容量控制及早期启动CRRT应作为AKI管理及改善预后的核心要点。