Browse ATS 2021 Abstracts

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ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Acute Kidney Injury Adds Fuel to the Fire in Patients with Acute Pulmonary Embolism

Session Title
TP53 - TP053 SEPSIS AND MULTIORGAN FAILURE
Abstract
A2750 - Acute Kidney Injury Adds Fuel to the Fire in Patients with Acute Pulmonary Embolism
Author Block: D. Sacher1, O. O'Corragain1, T. Thakur2, J. Noto3, H. Zhao1, G. J. Criner1, P. Rali1; 1Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, United States, 2Nephrology, Temple University Hospital, Philadelphia, PA, United States, 3Internal Medicine, Temple University Hospital, Philadelphia, PA, United States.
Introduction Acute Kidney Injury (AKI) is known to be associated with adverse short and long-term morbidity and mortality, including increased bleeding risk, cardiopulmonary failure, and progression to dialysis dependence. Severity of acute pulmonary embolism (PE) has been associated with increased risk of AKI but has not been well studied. In acute PE, AKI is likely related to cardiogenic shock with renal hypoperfusion and hypoxia, with massive PE found to be an independent risk factor. We examined our PE response team (PERT) database to investigate the association of AKI in acute PE and possible adverse outcomes. Methods A retrospective review of all PERT patients was performed. Patients with baseline creatinine one year prior to presentation with PE were included. AKI was graded according to the Kidney Disease: Improving Global Outcomes (KDIGO) definition. Patient demographics, comorbidities, treatment, and outcomes were assessed. Multivariate analysis was used to evaluate whether the presence of AKI influenced the risk for 30-day mortality. Results From a total of 366 patients in the PERT database, 241 patients were excluded for an unknown creatinine baseline, and 125 patients were identified. There were 79 patients that did not have AKI, and 46 patients that had AKI Stage 1 through 3. Compared to the non-AKI group, patients with AKI were older age (65.2 vs 57.2 years) with higher rates of diabetes mellitus (37.4% vs 17.7%) and cardiopulmonary disease (56.5% vs 41.7%). Most patients with AKI had KDIGO stage 1-2 (87%), and a small minority required renal replacement therapy or hemodialysis during hospitalization (6.5%). Patients with AKI received more anticoagulation with reperfusion therapy (23.9% vs 21.5%) and had higher bleeding complications (17.4% vs 10.1%), although not statistically significant. Increased AKI was seen in massive or high risk PE (15.2% vs 2.5%), with longer length of stay (7.8 vs 4 days), and higher in-hospital mortality (15.2% vs 3.8%). Of the 46 patients discharged, 30 (65.2%) had renal function normalize by discharge. At 90 days post-hospitalization there was available data on 24 patients, of these 5 (20.8%) had ongoing renal dysfunction. Discussion Our data show that patients with an acute PE and AKI had longer lengths of stay, higher rates of massive PE, higher use of reperfusion therapy, higher bleeding complications, and increased mortality. We found that AKI was associated with severity of PE and greater adverse outcomes. AKI can be used as a marker for PE risk stratification along with existing risk stratification tools.