Sepsis-Linked Kidney Injury in ICUs Is Common and Lethal

TOPLINE:

A retrospective analysis using the updated definition of sepsis-associated acute kidney injury (SA-AKI) reported this condition affects nearly half of patients admitted to the intensive care unit (ICU) with sepsis, with 25% dying during their hospital stay.

METHODOLOGY:

• Sepsis and AKI are complex heterogeneous syndromes. In 2023, the definition of SA-AKI was updated to reflect the concurrence of sepsis (per Sepsis-3 criteria) and AKI (per Kidney Disease: Improving Global Outcomes criteria) within 7 days of sepsis diagnosis.
• Researchers retrospectively analyzed the epidemiology and clinical outcomes of SA-AKI using the updated consensus definition in adult patients admitted to the ICU at two separate academic centers between 2010 and 2022.
• SA-AKI was characterized as either concurrent with septic shock or not and occurring either early (within 48 hours) or late (2-7 days) of the sepsis diagnosis.
• The primary outcomes were hospital mortality and major adverse kidney events at hospital discharge, defined as death, kidney replacement therapy, or reduced kidney function from baseline.

TAKEAWAY:

• Researchers included 187,888 adult patients admitted to the ICU, with 63,536 meeting the criteria for sepsis and 29,615 for SA-AKI, representing 46.6% of all sepsis patients and 15.8% of all ICU admissions.
• Among those with SA-AKI, 63.9% had the early phenotype and 36.1% the late phenotype. Septic shock within 7 days of onset was observed in 7831 individuals.
• Incident AKI in patients with SA-AKI peaked on the day of sepsis onset and decreased daily over the subsequent week.
• SA-AKI was associated with higher mortality (adjusted hazard ratio, 1.59) and increased odds of major adverse kidney events (odds ratio, 3.35) than sepsis or AKI alone.
• Patients with both septic shock and SA-AKI had double the hospital mortality rate and experienced major adverse kidney events in approximately 50% of cases.
• Although the late SA-AKI phenotype occurred less commonly, it was associated with an increased risk for major adverse kidney events.

IN PRACTICE:

“The presence of septic shock significantly worsens outcomes in SA-AKI. Updated epidemiology of a common condition, such as SA-AKI, is a critical first step toward identifying vulnerable populations, guiding quality assurance, and informing policy to promote health equity,” the authors concluded.

SOURCE:

The study was led by Tomonori Takeuchi, the University of Alabama at Birmingham, Alabama. It was published online in Critical Care.

LIMITATIONS:

The retrospective study design relied on the accuracy and completeness of electronic health record data. Missing urine output data for patients without urinary catheters may have led to the underdiagnosis of AKI. The study included only patients admitted to the ICU and those transferred from outside hospitals, which may have affected the timing and severity of SA-AKI diagnosis.

DISCLOSURES:

This study was funded by an award from the National Institutes of Health and grants from the National Institute of Diabetes and Digestive and Kidney Diseases. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.