title: Predictors of acute kidney injury in septic shock patients: an observational cohort study.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is a frequent complication in critically ill patients and sepsis is the most common contributing factor. We aimed to determine the risk factors associated with AKI development in patients with septic shock.
  
  
  METHODS
  Observational cohort study consisted of consecutive adults with septic shock admitted to a medical intensive care unit (ICU) of a tertiary care academic hospital from July 2005 to September 2007. AKI was defined according to RIFLE criteria (urine output and creatinine criteria). Demographic, clinical, and treatment variables were reviewed. Main outcomes measured were AKI occurrence, all-cause hospital mortality, and hospital and ICU length of stay.
  
  
  RESULTS
  Three hundred ninety patients met inclusion criteria, of which 237 (61%) developed AKI. AKI development was independently associated with delay to initiation of adequate antibiotics, intra-abdominal sepsis, blood product transfusion, use of angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker, and body mass index (kg/m²). Higher baseline GFR and successful early goal directed resuscitation were associated with a decreased risk of AKI. Hospital mortality was significantly greater in patients who developed AKI (49 versus 34%).
  
  
  CONCLUSIONS
  In a contemporary cohort of patients with septic shock, both patient and health care delivery risk factors seemed to be important for AKI development.
authors: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors: Maria
authors: M
authors: Plataki
authors: Kianoush
authors: K
authors: Kashani
authors: Javier
authors: J
authors: Cabello-Garza
authors: Fabien
authors: F
authors: Maldonado
authors: Rahul
authors: R
authors: Kashyap
authors: Daryl J
authors: DJ
authors: Kor
authors: Ognjen
authors: O
authors: Gajic
authors: Rodrigo
authors: R
authors: Cartin-Ceba
mesh_terms: D000046:Academic Medical Centers; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015992:Body Mass Index; D016009:Chi-Square Distribution; D003695:Delivery of Health Care; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012772:Shock, Septic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D065227:Transfusion Reaction
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000900:Anti-Bacterial Agents