Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes.
Sepsis is the most common cause of acute kidney injury (AKI) in critical illness, but there is limited information on septic AKI. A prospective, observational study of critically ill patients with septic and nonseptic AKI was performed from September 2000 to December 2001 at 54 hospitals in 23 countries. A total of 1753 patients were enrolled. Sepsis was considered the cause in 833 (47.5%); the predominant sources of sepsis were chest and abdominal (54.3%). Septic AKI was associated with greater aberrations in hemodynamics and laboratory parameters, greater severity of illness, and higher need for mechanical ventilation and vasoactive therapy. There was no difference in enrollment kidney function or in the proportion who received renal replacement therapy (RRT; 72 versus 71%; P = 0.83). Oliguria was more common in septic AKI (67 versus 57%; P < 0.001). Septic AKI had a higher in-hospital case-fatality rate compared with nonseptic AKI (70.2 versus 51.8%; P < 0.001). After adjustment for covariates, septic AKI remained associated with higher odds for death (1.48; 95% confidence interval 1.17 to 1.89; P = 0.001). Median (IQR) duration of hospital stay for survivors (37 [19 to 59] versus 21 [12 to 42] d; P < 0.0001) was longer for septic AKI. There was a trend to lower serum creatinine (106 [73 to 158] versus 121 [88 to 184] mumol/L; P = 0.01) and RRT dependence (9 versus 14%; P = 0.052) at hospital discharge for septic AKI. Patients with septic AKI were sicker and had a higher burden of illness and greater abnormalities in acute physiology. Patients with septic AKI had an increased risk for death and longer duration of hospitalization yet showed trends toward greater renal recovery and independence from RRT.
Bagshaw
Sean M
SM
Department of Intensive Care and Department of Medicine, Austin & Repatriation Medical Centre, Melbourne, Australia. bagshaw.sean@gmail.com
Uchino
Shigehiko
S
Bellomo
Rinaldo
R
Morimatsu
Hiroshi
H
Morgera
Stanislao
S
Schetz
Miet
M
Tan
Ian
I
Bouman
Catherine
C
Macedo
Ettiene
E
Gibney
Noel
N
Tolwani
Ashita
A
Oudemans-van Straaten
Heleen M
HM
Ronco
Claudio
C
Kellum
John A
JA
D000368:Aged; D015331:Cohort Studies; D017281:Cost of Illness; D003404:Creatinine / Q000097:blood; D016638:Critical Illness; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D017582:Renal Replacement Therapy; D018570:Risk Assessment; D018805:Sepsis / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D012720:Severity of Illness Index
D003404:Creatinine