Abstract
BackgroundAcute kidney injury (AKI) occurs in more than half critically ill patients admitted in intensive care units (ICU) and increases the mortality risk. The main cause of AKI in ICU is sepsis. AKI severity and other related variables such as recurrence of AKI episodes may influence mortality risk. While AKI recurrence after hospital discharge has been recently related to an increased risk of mortality, little is known about the rate and consequences of AKI recurrence during the ICU stay. Our hypothesis is that AKI recurrence during ICU stay in septic patients may be associated to a higher mortality risk.MethodsWe prospectively enrolled all (405) adult patients admitted to the ICU of our hospital with the diagnosis of severe sepsis/septic shock for a period of 30 months. Serum creatinine was measured daily. ‘In-ICU AKI recurrence’ was defined as a new spontaneous rise of ≥0.3 mg/dl within 48 h from the lowest serum creatinine after the previous AKI episode.ResultsExcluding 5 patients who suffered the AKI after the initial admission to ICU, 331 patients out of the 400 patients (82.8%) developed at least one AKI while they remained in the ICU. Among them, 79 (19.8%) developed ≥2 AKI episodes.Excluding 69 patients without AKI, in-hospital (adjusted HR = 2.48, 95% CI 1.47–4.19), 90-day (adjusted HR = 2.54, 95% CI 1.55–4.16) and end of follow-up (adjusted HR = 1.97, 95% CI 1.36–2.84) mortality rates were significantly higher in patients with recurrent AKI, independently of sex, age, mechanical ventilation necessity, APACHE score, baseline estimated glomerular filtration rate, complete recovery and KDIGO stage.ConclusionsAKI recurred in about 20% of ICU patients after a first episode of sepsis-related AKI. This recurrence increases the mortality rate independently of sepsis severity and of the KDIGO stage of the initial AKI episode. ICU physicians must be aware of the risks related to AKI recurrence while multiple episodes of AKI should be highlighted in electronic medical records and included in the variables of clinical risk scores.
Highlights
Acute kidney injury (AKI) occurs in more than half critically ill patients admitted in intensive care units (ICU) and increases the mortality risk
The important advance in AKI severity grading achieved by recent definitions and classification systems such as RIFLE, Acute kidney Injury network (AKIN), Kidney Disease/Improving Global Outcomes (KDIGO) and creatinine kinetics has allowed identifying a specific metrics in epidemiology and outcome studies [7,8,9,10]
Excluding 69 patients without AKI, in-hospital, 90-day and end of follow-up mortality rates were significantly higher in patients with recurrent AKI, independently of the covariates above and KDIGO stage and ‘complete recovery’ (Table 2)
Summary
Acute kidney injury (AKI) occurs in more than half critically ill patients admitted in intensive care units (ICU) and increases the mortality risk. Acute kidney injury (AKI) occurs in more than half critically ill patients admitted in intensive care units (ICU), being sepsis and septic shock the main causes of AKI in ICU patients [1, 2]. The important advance in AKI severity grading achieved by recent definitions and classification systems such as RIFLE, AKIN, KDIGO and creatinine kinetics has allowed identifying a specific metrics in epidemiology and outcome studies [7,8,9,10] These four classifications have demonstrated the relationship between AKI severity and patient outcomes (mortality and hospital length of stay) and have improved our knowledge about AKI epidemiology [1, 11,12,13,14,15]. The identification of all the AKI-related variables is quintessential to predict AKI occurrence, severity and outcome
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