Long-term risk of mortality after acute kidney injury in patients with sepsis: a contemporary analysis.
BACKGROUND
Acute kidney injury (AKI) is associated with increased short-term mortality of septic patients; however, the exact influence of AKI on long-term mortality in such patients has not yet been determined.


METHODS
We retrospectively evaluated the impact of AKI, defined by the "Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease" (RIFLE) classification based on creatinine criteria, on 2-year mortality in a cohort of 234 hospital surviving septic patients who had been hospitalized at the Infectious Disease Intensive Care Unit of our Hospital.


RESULTS
Mean-follow-up was 21 +/- 6.4 months. During this period, 32 patients (13.7%) died. At 6 months, 1 and 2 years of follow-up, the cumulative probability of death of patients with previous AKI was 8.3, 16.9 and 34.2%, respectively, as compared with 2.2, 6 and 8.9% in patients without previous AKI (log-rank, P < 0.0001). In the univariate analysis, age (hazard ratio 1.4, 95% CI 1.2-1.7, P < 0.0001), as well as pre-existing cardiovascular disease (hazard ratio 3.6, 95% CI 1.4-9.4, P = 0.009), illness severity as evaluated by nonrenal APACHE II (hazard ratio 1.3, 95% CI 1.1-1.6, P = 0.002), and previous AKI (hazard ratio 4.2, 95% CI 2.1-8.5, P < 0.0001) were associated with increased 2-year mortality, while gender, race, pre-existing hypertension, cirrhosis, HIV infection, neoplasm, and baseline glomerular filtration rate did not. In the multivariate analysis, however, only previous AKI (hazard ratio 3.2, 95% CI 1.6-6.5, P = 0.001) and age (hazard ratio 1.4, 95% CI 1.2-1.6, P < 0.0001) emerged as independent predictors of 2-year mortality.


CONCLUSIONS
Acute kidney injury had a negative impact on long-term mortality of patients with sepsis.
Lopes
José António
JA
Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, Lisboa, 1649-035, Portugal. jalopes93@hotmail.com
Fernandes
Paulo
P
Jorge
Sofia
S
Resina
Cristina
C
Santos
Carla
C
Pereira
Alvaro
A
Neves
José
J
Antunes
Francisco
F
Gomes da Costa
António
A
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000150:complications* / Q000401:mortality*; D012720:Severity of Illness Index; D013997:Time Factors