Acute kidney injury following colistin treatment in critically-ill patients: may glucocorticoids protect?


Heybeli C., Canaslan K., Oktan M. A., Yildiz S., ARDA H. Ü., ÇAVDAR C., ...More

JOURNAL OF CHEMOTHERAPY, vol.33, no.2, pp.85-94, 2021 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 33 Issue: 2
  • Publication Date: 2021
  • Doi Number: 10.1080/1120009x.2020.1770027
  • Journal Name: JOURNAL OF CHEMOTHERAPY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, PASCAL, BIOSIS, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.85-94
  • Keywords: Acute-kidney injury, Anti-infective agents, Colistin, Critical care, Glucocorticoids, Gram-negative bacteria, Kidney, INTRAVENOUS COLISTIN, RISK-FACTORS, METHANESULFONATE, NEPHROTOXICITY, INFECTIONS, CARE, MULTICENTER, THERAPY, DISEASE
  • Dokuz Eylül University Affiliated: Yes

Abstract

Nephrotoxicity following colistin administration is common and factors alleviating nephrotoxicity are yet to be determined. We retrospectively evaluated outcomes of subjects who were treated with colistin (n = 133) and with antibiotics other than colistin (control, n = 133) in intensive care units. Acute kidney injury (AKI) occurred in 69.2% and 29.3% of patients in colistin and control groups, respectively (p < 0.001). In the colistin group, glucocorticoid exposure was more common in subjects who did not develop AKI (p < 0.001). This was not the case in the control group. In the colistin cohort, older age (per 10 years, odds ratio [OR] 1.41, 95% CI 1.05-1.91;p = 0.025), PPI use (OR 3.30, 95% CI 1.18-9.23;p = 0.023) and furosemide treatment (OR 2.66, 95% CI 1.01-6.98;p = 0.047) were independently associated with the development of AKI while glucocorticoid treatment (OR 0.23, 95% CI 0.10-0.53;p = 0.001) was independently associated with reduced risk of AKI. Mortality was observed in 74 patients in the colistin cohort (55.6%). A higher APACHE-II score (OR 1.17, 95% CI 1.08-1.26;p < 0.001) was independently associated with mortality while a higher serum albumin level (per 1 g/dL increase, OR 0.20, 95% CI 0.070-0.60;p = 0.004) was associated with a lower risk of mortality. In conclusion, glucocorticoid exposure is associated with a lower risk of AKI caused by colistin therapy in critically-ill patients. Prospective studies are needed to confirm these findings and determine the optimal type, dose and duration of glucocorticoid therapy.