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.
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
José António
JA
Lopes
Paulo
P
Fernandes
Sofia
S
Jorge
Cristina
C
Resina
Carla
C
Santos
Alvaro
A
Pereira
José
J
Neves
Francisco
F
Antunes
António
A
Gomes da Costa
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