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：目前尚不明确重症监护病房（intensive care unit, ICU）收治的侵袭性肺曲霉病（invasive pulmonary aspergillosis, IPA）患者中急性肾损伤（acute kidney injury, AKI）的发生率及其影响。
方法：本回顾性研究纳入了中国北京中日友好医院内科ICU收治的140例确诊IPA患者。AKI的诊断依据《改善全球肾脏病预后组织（Kidney Disease: Improving Global Outcomes, KDIGO）指南》。收集了患者入住ICU时的人口统计学特征、合并症、实验室检查、治疗措施及预后相关数据。
结果：AKI的发生率为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AKI I期、II期和III期，其中64例（87.6%）患者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病死率的强独立危险因素（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、间歇性正压通气使用以及入住ICU前1年内的长期糖皮质激素治疗史。入院时较高的肌钙蛋白I（cardiac troponin I）水平及入住ICU最初7天内较差的容量控制情况是不可逆肾功能不全的潜在预测因素。入住ICU最初14天内，不可逆AKI患者及ICU期间死亡患者的容量负荷过载更为显著。与死亡患者相比，存活患者在入住ICU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的患者容量负荷过载更显著、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。优化容量管理及尽早启动CRRT应被视为AKI管理及改善预后的关键要点。