EPIDEMIOLOGY AND OUTCOME OF ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS ADMITTED TO THE MEDICAL ICU AT COMBINED MILITARY HOSPITAL, BAHAWALPUR: A DESCRIPTIVE STUDY

Abstract

Acute Kidney Injury (AKI) represents a significant independent risk factor for mortality and morbidity in critical care settings, yet local epidemiological data from military tertiary care centers in Pakistan remains limited. Consequently, the primary objective of this study was to comprehensively determine the frequency, precipitating risk factors, and clinical outcomes of AKI among critically ill patients admitted to the Medical Intensive Care Unit (ICU) at Combined Military Hospital (CMH), Bahawalpur. This prospective cohort study was conducted over a six-month duration following institutional approval. A sample of 203 adult patients (aged ≥18 years) was recruited using a non-probability consecutive sampling technique to minimize selection bias. To ensure the study focused strictly on acute dysfunction, stringent exclusion criteria were applied, removing patients with pre-existing End-Stage Renal Disease (ESRD), those receiving chronic renal replacement therapy, patients with hepatorenal syndrome, or those presenting with acute drug overdose. The diagnosis and staging of AKI were rigorously established according to the kidney disease: Improving Global Outcomes (KDIGO) guidelines, utilizing both serum creatinine elevation and urine output criteria. Detailed demographic profiling, comorbidity assessment (specifically Diabetes Mellitus and Hypertension), and clinical parameters including the Sequential Organ Failure Assessment (SOFA) score were recorded for every patient. Data analysis was performed using SPSS version 23.0, employing the Chi-square test to evaluate the statistical significance of mortality differences between groups.The results revealed that out of the 203 critically ill patients monitored, 89 patients (43.8%) developed AKI during their ICU stay, with the study population exhibiting a mean age of 58.4 ± 12.5 years and a male predominance. In terms of severity, the majority of cases were Stage 1 (50.6%), while 21.3% progressed to Stage 3. Sepsis was identified as the predominant precipitating factor, accounting for 62.9% of all AKI cases, followed by hypovolemia and nephrotoxic drug exposure. Clinical outcomes were starkly divergent between the two cohorts; the in-hospital mortality rate was significantly elevated in the AKI group at 41.6% (37 deaths), compared to just 15.8% (18 deaths) in the non-AKI group (p < 0.001). Furthermore, 15.7% of AKI patients required hemodialysis. The study concludes that AKI is a highly prevalent and lethal complication within the medical ICU at CMH Bahawalpur, driven primarily by sepsis. These findings underscore the urgent need for early risk stratification and the implementation of aggressive sepsis management protocols to improve survival rates in this high-risk population