Risk of developing severe sepsis after acute kidney injury: a population-based cohort study

Tai-Shuan Lai,Tao-Min Huang,Chun-Fu Lai,Cheng-Yi Wang,Che-Hsiung Wu,Meng-Chun Lin,Sung-Ching Pan,Vin-Cent Wu,Kuo-Liong Chien

doi:10.1186/cc13054

Abstract

IntroductionSepsis has been a factor of acute kidney injury (AKI); however, little is known about dialysis-requiring AKI and the risk of severe sepsis after survival to discharge.MethodsWe conducted a population-based cohort study based on the Taiwan National Health Insurance Research Database from 1999 to 2009. We identified patients with AKI requiring dialysis during hospitalization and survived for at least 90 days after discharge, and matched them with those without AKI according to age, sex, and concurrent diabetes. The primary outcome was severe sepsis, defined as sepsis with a diagnosis of acute organ dysfunction. Individuals who recovered enough to survive without acute dialysis were further analyzed.ResultsWe identified 2983 individuals (mean age, 62 years; median follow-up, 3.96 years) with dialysis-requiring AKI and 11,932 matched controls. The incidence rate of severe sepsis was 6.84 and 2.32 per 100 person-years among individuals with dialysis-requiring AKI and without AKI in the index hospitalization, respectively. Dialysis-requiring AKI patients had a higher risk of developing de novo severe sepsis than the non-AKI group. In subgroup analysis, even individuals with recovery from dialysis-requiring AKI were at high risk of developing severe sepsis.ConclusionsAKI is an independent risk factor for severe sepsis. Even patients who recovered from AKI had a high risk of long-term severe sepsis.

Highlights

Sepsis has been a factor of acute kidney injury (AKI); little is known about dialysis-requiring AKI and the risk of severe sepsis after survival to discharge
Dialysis was an important predictor of sepsis after AKI diagnosis, our results show that patients who recovered from dialysis still had a higher risk of subsequent severe sepsis, suggesting that chronic dialysis itself is not the crucial source of post-AKI sepsis in these patients
We further adjusted for advanced chronic kidney disease (CKD) status represented by erythropoietin use, and we found that the AKI group requiring dialysis was still at a higher risk for developing severe sepsis

Summary

Introduction

Sepsis has been a factor of acute kidney injury (AKI); little is known about dialysis-requiring AKI and the risk of severe sepsis after survival to discharge. Sepsis can cause multiorgan dysfunction, especially of the heart, lung and kidney, causing high morbidity and mortality in hospitalized patients [1]. Unique systemic inflammatory patterns have been observed for different mechanisms of AKI [9], as the deleterious interaction arises, at least in part, from systemic inflammatory changes, activation of proapoptotic pathways, increases in leukocyte trafficking and dysregulated channel expression [10]. These in turn can lead to long-term sepsis. We hypothesized that AKI might be an independent risk factor for developing severe sepsis, regardless of recovery of renal function recovery

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