Risk factors for mortality in patients with septic acute kidney injury in intensive care units in Beijing, China: a multicenter prospective observational study.

Xin Wang,Zhi-Qiang Li,Xiu-Ming Xi,Wei Li,Li Jiang,Mei-Ping Wang,Ying Wen

doi:10.1155/2014/172620

Abstract

Objective. To discover risk factors for mortality of patients with septic AKI in ICU via a multicenter study. Background. Septic AKI is a serious threat to patients in ICU, but there are a few clinical studies focusing on this. Methods. This was a prospective, observational, and multicenter study conducted in 30 ICUs of 28 major hospitals in Beijing. 3,107 patients were admitted consecutively, among which 361 patients were with septic AKI. Patient clinical data were recorded daily for 10 days after admission. Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define and stage AKI. Of the involved patients, 201 survived and 160 died. Results. The rate of septic AKI was 11.6%. Twenty-one risk factors were found, and six independent risk factors were identified: age, APACHE II score, duration of mechanical ventilation, duration of MAP <65 mmHg, time until RRT started, and progressive KIDGO stage. Admission KDIGO stages were not associated with mortality, while worst KDIGO stages were. Only progressive KIDGO stage was an independent risk factor. Conclusions. Six independent risk factors for mortality for septic AKI were identified. Progressive KIDGO stage is better than admission or the worst KIDGO for prediction of mortality. This trial is registered with ChiCTR-ONC-11001875.

Highlights

The incidence of acute kidney injury (AKI) has increased steadily in recent years [1,2,3,4]
39.4% (361/917) of patients were diagnosed with septic AKI; among which 55% (201/361) of patients survived and 44.4% (160/361) died
The age, sex, BMI, hospital acquired infection, ways of admission, duration in ICU, nonrenal organ failure, comorbid diseases, and first 24 h Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores in the ICU were compared between survivors and nonsurvivors

Summary

Introduction

The incidence of acute kidney injury (AKI) has increased steadily in recent years [1,2,3,4]. The risk of death in AKI patients shows an incremental increase corresponding to disease stage [10]. Known risk factors of AKI include sepsis, critical illness, circulatory shock, burns, trauma, cardiac surgery, chronic diseases (heart, lung, and liver), major noncardiac surgery, and nephrotoxic drugs [11]. The cause of AKI in critically ill patients is usually multifactorial; sepsis is one of the leading causes of AKI, contributing to more than half of all reported cases [12,13,14]. The clinical presentation, outcome, and responses to therapy may differ between septic and nonseptic AKI. Only a limited number of clinical studies focusing on septic AKI in ICUs have been reported [19,20,21,22,23]. Thorough investigation is urgently required to reveal the epidemiology, pathophysiology, clinical features, BioMed Research International

Methods

Results

Conclusion