title: Sepsis as a cause and consequence of acute kidney injury: Program to Improve Care in Acute Renal Disease.
abstract: OBJECTIVE
  Sepsis commonly contributes to acute kidney injury (AKI); however, the frequency with which sepsis develops as a complication of AKI and the clinical consequences of this sepsis are unknown. This study examined the incidence of, and outcomes associated with, sepsis developing after AKI.
  
  
  METHODS
  We analyzed data from 618 critically ill patients enrolled in a multicenter observational study of AKI (PICARD). Patients were stratified according to their sepsis status and timing of incident sepsis relative to AKI diagnosis.
  
  
  RESULTS
  We determined the associations among sepsis, clinical characteristics, provision of dialysis, in-hospital mortality, and length of stay (LOS), comparing outcomes among patients according to their sepsis status. Among the 611 patients with data on sepsis status, 174 (28%) had sepsis before AKI, 194 (32%) remained sepsis-free, and 243 (40%) developed sepsis a median of 5 days after AKI. Mortality rates for patients with sepsis developing after AKI were higher than in sepsis-free patients (44 vs. 21%; p < 0.0001) and similar to patients with sepsis preceding AKI (48 vs. 44%; p = 0.41). Compared with sepsis-free patients, those with sepsis developing after AKI were also more likely to be dialyzed (70 vs. 50%; p < 0.001) and had longer LOS (37 vs. 27 days; p < 0.001). Oliguria, higher fluid accumulation and severity of illness scores, non-surgical procedures after AKI, and provision of dialysis were predictors of sepsis after AKI.
  
  
  CONCLUSIONS
  Sepsis frequently develops after AKI and portends a poor prognosis, with high mortality rates and relatively long LOS. Future studies should evaluate techniques to monitor for and manage this complication to improve overall prognosis.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, 200 W Arbor Drive, San Diego, CA 92103, USA. rmehta@ucsd.edu
authors.forename: Ravindra L
authors.initials: RL
authors.lastname: Mehta
authors.forename: Josée
authors.initials: J
authors.lastname: Bouchard
authors.forename: Sharon B
authors.initials: SB
authors.lastname: Soroko
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
authors.forename: Emil P
authors.initials: EP
authors.lastname: Paganini
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D000328:Adult; D000368:Aged; D005260:Female; D005544:Forecasting; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D006435:Renal Dialysis; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology