Abstract
BackgroundAcute kidney injury (AKI) is associated with increased short-term mortality of septic patients; however, the exact influence of AKI on long-term mortality in such patients has not yet been determined.MethodsWe retrospectively evaluated the impact of AKI, defined by the "Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease" (RIFLE) classification based on creatinine criteria, on 2-year mortality in a cohort of 234 hospital surviving septic patients who had been hospitalized at the Infectious Disease Intensive Care Unit of our Hospital.ResultsMean-follow-up was 21 ± 6.4 months. During this period, 32 patients (13.7%) died. At 6 months, 1 and 2 years of follow-up, the cumulative probability of death of patients with previous AKI was 8.3, 16.9 and 34.2%, respectively, as compared with 2.2, 6 and 8.9% in patients without previous AKI (log-rank, P < 0.0001). In the univariate analysis, age (hazard ratio 1.4, 95% CI 1.2-1.7, P < 0.0001), as well as pre-existing cardiovascular disease (hazard ratio 3.6, 95% CI 1.4-9.4, P = 0.009), illness severity as evaluated by nonrenal APACHE II (hazard ratio 1.3, 95% CI 1.1-1.6, P = 0.002), and previous AKI (hazard ratio 4.2, 95% CI 2.1-8.5, P < 0.0001) were associated with increased 2-year mortality, while gender, race, pre-existing hypertension, cirrhosis, HIV infection, neoplasm, and baseline glomerular filtration rate did not. In the multivariate analysis, however, only previous AKI (hazard ratio 3.2, 95% CI 1.6-6.5, P = 0.001) and age (hazard ratio 1.4, 95% CI 1.2-1.6, P < 0.0001) emerged as independent predictors of 2-year mortality.ConclusionsAcute kidney injury had a negative impact on long-term mortality of patients with sepsis.
Highlights
Acute kidney injury (AKI) is associated with increased short-term mortality of septic patients; the exact influence of AKI on long-term mortality in such patients has not yet been determined
Acute kidney injury was defined as an increase of baseline serum creatinine × 1.5, and in patients with baseline serum creatinine > 4 mg/dl it was considered if there was an acute rise in serum creatinine of at least 0.5 mg/dl; Class R (Risk) was considered if there was an increase of baseline serum creatinine × 1.5; class I (Injury) was considered if there was an increase of baseline serum creatinine × 2; and Class F (Failure) was considered if there was an increase of baseline serum creatinine × 3, or in patients with baseline serum creatinine > 4 mg/dl if there was an acute rise in serum creatinine of at least 0.5 mg/dl
Acute kidney injury Baseline serum creatinine was available in 293 patients (68.8%), and in the remaining cases (n = 133; 31.2%) it was estimated by the Modification of Diet in Renal Disease equation
Summary
Acute kidney injury (AKI) is associated with increased short-term mortality of septic patients; the exact influence of AKI on long-term mortality in such patients has not yet been determined. Acute kidney injury (AKI) is a common complication among hospitalized patients, in the Intensive Care Unit (ICU) setting, and it portends an ominous outcome. AKI is a common complication in the hospital and has an immediate impact on morbidity, mortality, and resource utilization, its detrimental effect appears to persist after recovery, since AKI has shown to increase long-term mortality [5,6,7]. Despite the detrimental effect of AKI on short-term outcome, to our knowledge, there is no study evaluating the influence of AKI on long-term mortality of hospital surviving septic patients
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