ĐẶC ĐIỂM, KẾT CỤC VÀ YẾU TỐ LIÊN QUAN CỦA TỔN THƯƠNG THẬN CẤP THEO DIỄN TIẾN TẠI KHOA HỒI SỨC TÍCH CỰC BỆNH VIỆN VINMEC CENTRAL PARK

Abstract

Background: Acute kidney injury (AKI) in critically ill patients is a heterogeneous condition; its prognosis depends not only on the initial severity but also on the course of kidney dysfunction over time. This study aimed to (1) describe the distribution of AKI trajectories, (2) compare baseline characteristics and outcomes across trajectory groups, and (3) identify clinical factors associated with the persistent severe phenotype in an intensive care population in Vietnam. Methods: We conducted a single-center retrospective cohort study in the Intensive Care Unit of Vinmec Central Park Hospital from January 2024 to June 2025, enrolling adults aged ≥18 years. AKI was defined according to KDIGO 2012 criteria and categorized into four trajectories: stage 1; transient (recovery within 48 hours); persistent mild–moderate; persistent severe (stage 3 lasting ≥72 hours, requiring renal replacement therapy, or followed by death after reaching stage 3). Outcomes included in-hospital mortality, renal recovery at discharge, and ICU and hospital length of stay. Results: Among 106 eligible patients, the distribution of AKI trajectories was: stage 1 (42%), transient (22%), persistent mild–moderate (13%), and persistent severe (23%). Prognosis worsened progressively with increasing persistence and severity, being poorest in the persistent severe group (mortality 54%; renal recovery 17%). Compared with the other trajectories, persistent severe AKI was associated with a higher risk of in-hospital death (HR 4.42; 95% CI 1.47–13.32; p=0.008). This phenotype was more frequently associated with lower platelet counts, higher neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels, and greater illness severity (SOFA and APACHE II scores). Conclusion: Trajectory-based classification provides additional value for risk stratification beyond conventional KDIGO staging. The persistent severe trajectory carries a particularly poor prognosis and should be recognized early to guide prevention, management, and future research.