O052 / #846: SEPSIS ASSOCIATED AKI PHENOTYPES ARE ASSOCIATED WITH UNIQUE PATIENT OUTCOMES

Abstract

Aims & Objectives: Although sepsis associated acute kidney injury (S-AKI) is generally associated with poor patient outcomes, the majority of epidemiology utilize an all-inclusive and binary classification for AKI. The clinical phenotype of AKI, however, varies considerably. We sought to delineate the associations of AKI phenotypes with outcomes in septic patients. Methods: Post-hoc analysis of a multi-national study of critically ill children. AKI was defined by KDIGO stage in the first 48 hours. Temporal phenotype was defined as transient (return to baseline by 48 hours) or persistent (injury beyond 48 hours). Severity phenotype was delineated as mild (stage 1) or severe (stage 2-3). The primary outcome was mortality censored at 28-days. ICU course complexity was assessed by mechanical ventilation, length of stay, and use of extracorporeal therapy. Results: Sepsis was present in 757 (15.4%), AKI in 1275 (26.1%), and S-AKI in 307 (6.3%) of 4898 patients (male, 54.8%). S-AKI was associated with increased mortality versus sepsis alone (12.1% vs. 4.7%, p-value <0.001). Mortality in S-AKI varied by AKI duration: persistent (13.9%), transient (12.1%) (p<0.001 vs. no AKI for both). Mortality also varied by AKI severity: severe (18.6%), mild (4.4%) (p<0.001 versus no AKI only for severe). Sub-phenotyping associated with unique mortality incidence: mild-transient (4.4%), mild-persistent (9.4%), severe-transient (21.6%), and severe-persistent (15.8%). Complex ICU outcome ranged from 15% to 55% between the S-AKI phenotypes versus 34.5% for “any” S-AKI. Conclusions: Our data indicate clinical S-AKI subphenotypes are associated with unique outcomes. Refinement in S-AKI classification may allow population enrichment facilitating biologic analysis, trial design, and targeted therapeutics.