Renal Function Outcome Prognosis in Septic and Non-septic Acute Kidney Injury Patients

Abstract

Aim:The objective of this study was to evaluate prognostic impact of clinical factors on outcome of renal function in septic and non-septic acute kidney injury (AKI) patients.Methods:The prospective, observational, clinical study was performed at Nephrology Clinic and Clinic for Infectious Diseases, University Clinical Centre Sarajevo. One hundred patients with diagnosis of AKI were enrolled in the study, and divided into two groups: septic and non-septic AKI patients. Clinical parameters included causes and type of AKI, pre-existing comorbidities and different treatment modalities. Patients were followed up until discharge or death. Renal function outcome was defined by creatinine clearance values at discharge.Results:Septic AKI patients had significantly longer hospital stay (p=0.03), significantly worse renal function outcome (p<0.001), and higher burden of comorbidities (70.6% vs. 60.6%), compared to non-septic patients. Septic AKI patients were almost three times less likely to receive renal replacement therapy (8.8% vs. 24.4%) and they had significant delay in initiation of dialysis (p=0.03). By multivariate analysis, sepsis (95% CI 0.128-0.967, p=0.043) and hypertension (95% CI 0.114-0.788, p=0.015) were independent predictors of adverse renal function outcome in AKI patients. Postrenal type of AKI was independent predictor of renal function recovery in non-septic AKI patients (95% CI 1.174-92.264, p=0.035), while Failure, as third class of AKI, was independent predictor of non-recovered renal function only in septic AKI patients (95% CI 0.026 to 0.868, p=0.034).Conclusion:Septic AKI patients are clinically distinct compared to non-septic AKI patients with different prognostic factors and poorer renal function outcome.

The Japanese clinical practice guideline for acute kidney injury 2016

“…As for AKI diagnostic criteria, six studies used the RIFLE criteria [ 80 , 101 – 105 ]; the remaining three studies [ 100 , 106 , 107 ] were published before the RIFLE criteria were proposed. Percentages of patients by RIFLE criteria severity were listed in four studies [ 80 , 101 , 102 , 104 ]; Risk was the most common level of severity in one study [ 102 ], while Injury was the most common in two studies [ 80 , 101 ], and Failure was the most common in one study [ 104 ]. Causes of sepsis were demonstrated in two studies [ 101 , 103 ]; in these studies, sepsis was caused by intrathoracic infections (such as pneumonia) and intra-abdominal infections in approximately 30 and 25% of cases, respectively, thus accounting for more than half of all cases.…”

The Japanese Clinical Practice Guideline for acute kidney injury 2016

“…As for AKI diagnostic criteria, six studies used the RIFLE criteria [ 78 , 99 – 103 ]; the remaining three studies [ 98 , 104 , 105 ] were published before the RIFLE criteria were proposed. Percentages of patients by RIFLE criteria severity were listed in four studies [ 78 , 99 , 100 , 102 ]; Risk was the most common level of severity in one study [ 100 ], while Injury was the most common in two studies [ 78 , 99 ], and Failure was the most common in one study [ 102 ]. Causes of sepsis were demonstrated in two studies [ 99 , 101 ]; in these studies, sepsis was caused by intrathoracic infections (such as pneumonia) and intra-abdominal infections in approximately 30 and 25% of cases, respectively, thus accounting for more than half of all cases.…”

The Japanese Clinical Practice Guideline for acute kidney injury 2016

“…In developing the present guideline, PubMed was used to identify papers which compared septic and non-septic AKI. Nine observational studies were identified [78,[98][99][100][101][102][103][104][105]; seven of these studies were prospective, while two were retrospective. One of these studies was a retrospective study by Bagshaw et al which utilized the Australian and New Zealand Intensive Care Society (ANZICS) database [78]; the study featured 14,039 septic AKI patients and 29,356 non-septic AKI patients, a prominently large number of patients compared to other studies.…”

“…One of these studies was a retrospective study by Bagshaw et al which utilized the Australian and New Zealand Intensive Care Society (ANZICS) database [78]; the study featured 14,039 septic AKI patients and 29,356 non-septic AKI patients, a prominently large number of patients compared to other studies. Seven studies compared in-hospital mortality [78,[98][99][100][101][102][103], while five studies compared ICU mortality [78,100,101,104,105].…”

“…As for AKI diagnostic criteria, six studies used the RI-FLE criteria [78,[99][100][101][102][103]; the remaining three studies [98,104,105] were published before the RIFLE criteria were proposed. Percentages of patients by RIFLE criteria severity were listed in four studies [78,99,100,102]; Risk was the most common level of severity in one study [100], while Injury was the most common in two studies [78,99], and Failure was the most common in one study [102]. Causes of sepsis were demonstrated in two studies [99,101]; in these studies, sepsis was caused by intrathoracic infections (such as pneumonia) and intra-abdominal infections in approximately 30 and 25% of cases, respectively, thus accounting for more than half of all cases.…”