Fibrinolytic Capacity and Risk of Bleeding in Intensive Care Patients with Acute Kidney Injury

Area of Science:

• Critical Care Medicine
• Nephrology
• Hematology

Background:

• Acute kidney injury (AKI) is a common complication in intensive care unit (ICU) patients.
• AKI is associated with an increased risk of bleeding.
• The role of fibrinolysis in AKI-related bleeding has not been previously investigated.

Purpose of the Study:

• To compare fibrinolytic capacity between ICU patients with and without AKI.
• To examine the association between fibrinolytic capacity, clinical variables, and bleeding risk in AKI patients during the first 7 ICU days.

Main Methods:

• Prospective enrollment of adult ICU patients, stratified by AKI presence and severity.
• Assessment of fibrinolytic capacity using a modified rotational thromboelastometry (ROTEM-tPA) assay on ICU day 1.
• Primary outcome: difference in ROTEM-tPA lysis time between AKI and non-AKI groups.

Main Results:

• AKI patients experienced more bleeding and higher 30-day mortality compared to non-AKI patients.
• Fibrinolysis was progressively impaired with increasing AKI severity, notably in AKI stage 3.
• Bleeding in severe AKI (stage 2-3) was associated with more pronounced fibrinolytic impairment and higher non-renal SOFA scores.

Conclusions:

• AKI severity in ICU patients correlates with progressively impaired fibrinolysis.
• Despite impaired fibrinolysis, AKI patients exhibited a higher incidence of bleeding within the first week of ICU admission.