One-Year Progression and Risk Factors for the Development of Chronic Kidney Disease in Septic Shock Patients with Acute Kidney Injury: A Single-Centre Retrospective Cohort Study

Kim, June-Sung; Kim, Youn-Jung; Ryoo, Seung Mok; Sohn, Chang Hwan; Seo, Dong Woo; Kim, Won Young; Lim, Kyoung Soo

doi:10.3390/jcm7120554

Cited by 19 publications

(17 citation statements)

References 28 publications

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“…There are many factors affecting mortality in patients with septic shock, but this study focused on patient's factors. Demographic and clinical data including age, sex, previous medical history, symptoms, initial vital signs, site of infection, and the first laboratory values at the time of admission were retrieved from the septic shock registry [11][12][13][14][15]. Data on initial hemoglobin levels at the time of admission to ED and on whether blood transfusions were performed were also examined to determine the relationship between hemoglobin and mortality.…”

Section: Data Collection and Definitionmentioning

confidence: 99%

Relationship between low hemoglobin levels and mortality in patients with septic shock

et al. 2019

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Relationship between low hemoglobin levels and mortality in patients with septic shock Background: Hemoglobin levels are a critical parameter for oxygen delivery in patients with shock. On comparing target hemoglobin levels upon transfusion initiation, the correlation between the severity of decrease in hemoglobin levels and patient outcomes remains unclear. We evaluated the association between initial hemoglobin levels and mortality in patients with septic shock treated with protocol-driven resuscitation bundle therapy at an emergency department. Methods: Data of adult patients diagnosed with septic shock between June 2012 and December 2016 were extracted from a prospectively compiled septic shock registry at a single academic medical center. Patients were classified into four groups according to initial hemoglobin levels: ≥ 9.0 g/dl, 8.0−8.9 g/dl, 7.0−7.9 g/dl, and < 7.0 g/dl. The primary endpoint was 90-day mortality. Results: In total, 2,265 patients (male, 58.3%; median age, 70.0 years [interquartile range, 60 to 78 years]) with septic shock were included. For the four groups, 90-day mortality rates were as follows: 29.1%, 43.0%, 46.5%, and 46.9% for ≥ 9.0 g/dl (n = 1,808), 8.0−8.9 g/dl (n = 217), 7.0−7.9 g/dl (n = 135), and < 7.0 g/dl (n = 105), respectively (P < 0.001). Multivariate logistic regression showed that initial hemoglobin levels were an independent factor associated with 90-day mortality and mortality proportionally increased with decreasing hemoglobin levels (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.36 to 2.61 for 8.0−8.9 g/dl; OR, 1.97; 95% CI, 1.31 to 2.95 for 7.0-7.9 g/dl; and OR, 2.35; 95% CI, 1.52 to 3.63 for < 7.0 g/dl). Conclusions: Low hemoglobin levels (< 9.0 g/dl) were observed in approximately 20% of patients with septic shock, and the severity of decrease in these levels correlated with mortality.

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Section: Data Collection and Definitionmentioning

confidence: 99%

Relationship between low hemoglobin levels and mortality in patients with septic shock

et al. 2019

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“…The MAP of the septic shock group and the vasoplegic shock group were significantly lower than that of the cryptic shock group (71 [59-90], 71 [61-81] and 88 [75-100] mm Hg, respectively; P < .001). The mean SOFA score of the cryptic shock group was lower than that of the septic shock group and that of the vasoplegic shock group score (8 [6][7][8][9][10], 7 [5][6][7][8][9], 3 [2][3][4]; P < .001) ( Table 1).…”

Section: Resultsmentioning

confidence: 95%

“…Patient data were prospectively collected in our Septic Shock Registry. 8,10,11 Septic shock was defined as per the previous septic shock definition, which included suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion. 8,12 Refractory hypotension was defined as persistent hypotension: systolic blood pressure <90 mm Hg, MAP < 65 mm Hg or systolic blood pressure decrease >40 mm Hg after adequate intravenous fluid challenge (20-30 mL/kg or at least 1 L of crystalloid solution administered over 30 minutes), or as the need for vasopressors after fluid resuscitation.…”

Section: Study Design and Populationmentioning

confidence: 99%

A mortality analysis of septic shock, vasoplegic shock and cryptic shock classified by the third international consensus definitions (Sepsis‐3)

Yang

Kang

Jung

et al. 2020

Clinical Respiratory J

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Introduction This study aimed to compare the 28‐day mortality of patients with septic shock, defined by Sepsis‐3 criteria and patients with vasoplegic or cryptic shock who are excluded from this new definition. Objectives This retrospective observational study was performed using a tertiary emergency department's septic shock registry and investigated the records of patients managed between January 2010 and December 2015. In 2,138 total patients, 1004 (47.0%) had septic shock, 476 (22.2%) had vasoplegic shock and 655 (30.6%) had cryptic shock. Results There was significant variation in 28‐day mortality among the three groups: 23.4% for septic shock, 8.8% for vasoplegic shock and 12.2% for cryptic shock (P < .001). In subgroup analysis of cryptic shock or septic shock according to lactate levels (2‐3, 3‐4 and >4 mmol/L), the mortality rate increased as lactate increased (cryptic shock: 9.5%, 14.8% and 18.0%; septic shock: 18.6%, 22.6% and 27.0%, respectively; P < .001). Multivariable analysis revealed odds ratios for mortality of 0.31 (95% CI 0.22‐0.44; P < .001) for vasoplegic shock and 0.46 (95% CI 0.35‐0.61; P < .001) for cryptic shock relative to septic shock. Survival curve analysis showed significant differences among patients with septic shock, vasoplegic shock and cryptic shock (Log rank test: P < .0001). Conclusion The new septic shock definition may be useful for identifying high‐risk patients requiring intensive care. However, cryptic shock‐associated mortality increased to 18.0% as serum lactate increased, which suggests that some cryptic shock patients may also require intensive management.

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“…The association between AKI and CKD was also reported in non-surgical patients [32,33]. However, this association was not found in patients with a history of septic shock during one-year follow-up [34]. Furthermore, there have been only a few studies investigating the association between AKI and long-term renal functional decline for radical nephrectomy.…”

Section: Discussionmentioning

confidence: 93%

“…Our primary outcome developed in 40.5% (n = 226/558) of patients. The median follow-up of renal function was 35 (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) months. The numbers of patients lost to follow-up at 2 and 3 years after surgery were 143 (24.7%) and 305 (52.8%) (Table S1).…”

Section: Resultsmentioning

confidence: 99%

Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function

Shin

Jang

et al. 2020

JCM

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The association between acute kidney injury (AKI) and long-term renal function after radical nephrectomy has not been evaluated fully. We reviewed 558 cases of radical nephrectomy. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Values of estimated glomerular filtration rate (eGFR) were collected up to 36 months (median 35 months) after surgery. The primary outcome was new-onset chronic kidney disease (CKD) stage 3a or higher or all-cause mortality within three years after nephrectomy. The functional change ratio (FCR) of eGFR was defined as the ratio of the most recent GFR (24–36 months after surgery) to the new baseline during 3–12 months. A multivariable Cox proportional hazard regression analysis for new-onset CKD and a multivariable linear regression analysis for FCR were performed to evaluate the association between AKI and long-term renal outcomes. A correlation analysis was performed with the serum creatinine ratio and used to determine AKI and FCR. AKI occurred in 43.2% (n = 241/558) and our primary outcome developed in 40.5% (n = 226/558) of patients. The incidence of new-onset CKD was significantly higher in patients with AKI than those without at all follow-up time points after surgery. The Cox regression analysis showed a graded association between AKI and our primary outcome (AKI stage 1: Hazard ratio 1.71, 95% confidence interval 1.25–2.32; AKI stage 2 or 3: Hazard ratio 2.72, 95% confidence interval 1.78–4.10). The linear regression analysis for FCR showed that AKI was significantly associated with FCR (β = −0.168 ± 0.322, p = 0.011). There was a significant negative correlation between the serum creatinine ratio and FCR. In conclusion, our analysis demonstrated a robust and graded association between AKI after radical nephrectomy and long-term renal functional deterioration.

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One-Year Progression and Risk Factors for the Development of Chronic Kidney Disease in Septic Shock Patients with Acute Kidney Injury: A Single-Centre Retrospective Cohort Study

Cited by 19 publications

References 28 publications

Relationship between low hemoglobin levels and mortality in patients with septic shock

Relationship between low hemoglobin levels and mortality in patients with septic shock

A mortality analysis of septic shock, vasoplegic shock and cryptic shock classified by the third international consensus definitions (Sepsis‐3)

Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function

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