Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study.
Acute kidney injury
Critical care
Sepsis
Sepsis-associated acute kidney injury
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
26
04
2023
accepted:
09
06
2023
medline:
14
9
2023
pubmed:
11
7
2023
entrez:
11
7
2023
Statut:
ppublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 37432520
doi: 10.1007/s00134-023-07138-0
pii: 10.1007/s00134-023-07138-0
pmc: PMC10499944
doi:
Substances chimiques
Creatinine
AYI8EX34EU
Types de publication
Observational Study
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1079-1089Investigateurs
Mahesh Ramanan
(M)
Prashanti Marella
(P)
Patrick Young
(P)
Pip McIlroy
(P)
Ben Nash
(B)
James McCullough
(J)
Mandy Tallott
(M)
Andrea Marshall
(A)
David Moore
(D)
Hayden White
(H)
Sunil Sane
(S)
Lynette Morrison
(L)
Pam Dipplesman
(P)
Stephen Luke
(S)
Anni Paasilahti
(A)
Ray Asimus
(R)
Jennifer Taylor
(J)
Kyle White
(K)
David Cook
(D)
Peter Kruger
(P)
Jason Meyer
(J)
Rod Hurford
(R)
Kevin Plumpton
(K)
Andrew Barlow
(A)
Alexis Tabah
(A)
Hamish Pollock
(H)
Patrick Young
(P)
Antony G Attokaran
(AG)
Jacobus Poggenpoel
(J)
Josephine Reoch
(J)
Kevin B Laupland
(KB)
Felicity Edwards
(F)
Jayesh Dhanani
(J)
Marianne Kirrane
(M)
Pierre Clement
(P)
Nermin Karamujic
(N)
Paula Lister
(P)
Vikram Masurkar
(V)
Lauren Murray
(L)
Jane Brailsford
(J)
Todd Erbacher
(T)
Kiran Shekar
(K)
Jayshree Lavana
(J)
George Cornell
(G)
Siva Senthuran
(S)
Stephen Whebell
(S)
Gail Henson
(G)
Michelle Gatton
(M)
Zephanie Tyack
(Z)
Robert Andrews
(R)
Arthur Ter Hofstede
(A)
Moe Wynn
(M)
Kevin B Laupland
(KB)
Felicity Edwards
(F)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2023. The Author(s).
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