Role of serial urine sediment examination in progression and outcome of sepsis-associated acute kidney injury

Abstract

ABSTRACT Introduction Sepsis-associated acute kidney injury (SA-AKI) is common in hospitalized patients. There is a rising interest in validating new tools for predicting its prognosis and outcome. We aimed to assess the role of serial urine sediment examination in the progression and outcome of SA-AKI. Material and Methods This research is a prospective study which included 80 patients with SA-AKI stage 1 or 2. Urine sediment examination was done with calculations of Perazella score (PS) and Chawla score (CS) at days 1, 3, and 7 and correlated with AKI progression and outcomes. Results Fifty-eight females and 22 males were enrolled in the study with a mean age of 61.10 ± 11.26 years, and initial serum creatinine at presentation was 2.06 ± 0.51 mg/dl.47.5% of patients progressed to stage 3 AKI, while 52.5% did not progress. Patients who progressed to stage 3 AKI had a significantly lower urine output at presentation, higher need for dialysis, higher mortality, higher serum creatinine, and lower eGFR at discharge and after 3 months. Both PS and CS at the time of diagnosis (day 1) showed no statistical difference between those with and without AKI progression. However, examination at day 3 and 7 revealed that AKI progressors had significantly higher PS and CS (p < 0.001 and < 0.001), respectively. P2 and P3 in Perazella score showed an AUC of 0.902 and 0.932, while C2 and C3 in Chawla score showed an AUC of 0.914 and 0.945 for prediction of AKI progression. Regarding prediction for mortality, the AUC for P1, P2, and P3 of Perazella score was 0.625, 0.767, and 0.791, respectively. While that of C1, C2, and C3 was 0.568, 0.794, and 0.788, respectively. Conclusions Serial urine sediment examination can be helpful in predicting SA-AKI outcomes. Larger randomized clinical trials are needed to support its use.