Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study

Abstract

Purpose The Acute Disease Quality Initiative (ADQI) Workgroup recently released a consensus definition of sepsis-associated acute kidney injury (SA-AKI), combining Sepsis-3 and Kidney Disease Improving Global Outcomes (KDIGO) AKI criteria. This study aims to describe the epidemiology of SA-AKI. Methods This is a retrospective cohort study carried out in 12 intensive care units (ICUs) from 2015 to 2021. We studied the incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes of SA-AKI based on the ADQI definition. Results Out of 84,528 admissions, 13,451 met the SA-AKI criteria with its incidence peaking at 18% in 2021. SA-AKI patients were typically admitted from home via the emergency department (ED) with a median time to SA-AKI diagnosis of 1 day (interquartile range (IQR) 1–1) from ICU admission. At diagnosis, most SA-AKI patients (54%) had a stage 1 AKI, mostly due to the low urinary output (UO) criterion only (65%). Compared to diagnosis by creatinine alone, or by both UO and creatinine criteria, patients diagnosed by UO alone had lower renal replacement therapy (RRT) requirements (2.8% vs 18% vs 50%; p < 0.001), which was consistent across all stages of AKI. SA-AKI hospital mortality was 18% and SA-AKI was independently associated with increased mortality. In SA-AKI, diagnosis by low UO only, compared to creatinine alone or to both UO and creatinine criteria, carried an odds ratio of 0.34 (95% confidence interval (CI) 0.32–0.36) for mortality. Conclusion SA-AKI occurs in 1 in 6 ICU patients, is diagnosed on day 1 and carries significant morbidity and mortality risk with patients mostly admitted from home via the ED. However, most SA-AKI is stage 1 and mostly due to low UO, which carries much lower risk than diagnosis by other criteria. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-023-07138-0.

Comparison of diagnostic criteria for sepsis-associated acute kidney injury in the pediatric intensive care unit: a retrospective cohort study

“…Among the three standards, high PRISM scores and elevated PCT level were independent risk factors for SA-AKI. KDIGO had more independent risk factors, which is consistent with similar research ( 21 , 22 ). The PRISM score is currently the most widely used assessment scale in the PICU and shows good ability to predict the severity and mortality risk of critically ill children ( 21 ).…”

Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study

“…In line with our results, this may indicate that FA in the presence of AKI has more of an impact on renal recovery than FA before the onset of AKI. Thus, patients with FA and severe AKI should be considered especially “at risk” for a delayed or no renal recovery that is associated with end-stage renal disease and dialysis-dependency [ 32 , 42 , 43 ] as well as higher mortality [ 32 , 42 – 44 ].…”

“…Finally, since no urine output values were available for our patient cohort, AKI definition was based on creatinine values alone. However, a recent study in patients with sepsis-associated AKI showed a better prognosis regarding renal recovery and mortality in patients with AKI diagnosed by low urine output alone [ 32 ].…”

“…MAKE30 is a well-established composite outcome of death, need for new RRT of any duration, or prolonged kidney dysfunction within 30 days after ICU admission [ 5 , 25 – 32 ].…”

Which Patient Phenotype Is the Ideal Candidate for Hemoadsorption in Acute and Chronic Kidney Disease?

“…[26] It is now evident that both sepsis and SA-AKI are a mixture of syndromes in which the cause and the response of the host play an important role in creating specific endotypes with peculiar characteristics and clinical pictures. [27–29] For this reason, it seems unlikely to foresee a positive response to a therapy of the overall studied population, especially in light of the different pathophysiological mechanisms involved.…”