title: Acute kidney injury in patients with severe sepsis in Finnish Intensive Care Units.
abstract: BACKGROUND
  Severe sepsis is one of the leading causes of acute kidney injury (AKI). Patients with sepsis-associated AKI demonstrate high-hospital mortality. We evaluated the incidence of severe sepsis-associated AKI and its association with outcome in intensive care units (ICUs) in Finland.
  
  
  METHODS
  This was a predetermined sub-study of the prospective, observational, multicentre FINNAKI study conducted in 17 ICUs during 1 September 2011 and 1 February 2012. All emergency ICU admissions and elective admissions exceeding 24 hours in the ICU were screened for presence of severe sepsis and AKI up to 5 days in ICU. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria and severe sepsis according to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) criteria.
  
  
  RESULTS
  Of the 2901 included patients, severe sepsis was diagnosed in 918 (31.6%, 95% confidence interval [CI] 29.9-33.4%) patients. Of these 918 patients, 488 (53.2% [95% CI 49.9-56.5%]) had AKI. The 90-day mortality rate was 38.1% (95% CI 33.7-42.5%) for severe sepsis patients with AKI and 24.7% (95% CI 20.5-28.8%) for those without AKI. After adjusting for covariates, KDIGO stage 3 AKI was associated with an increased risk for 90-day mortality with an adjusted odds ratio (OR) of 1.94 (95% CI 1.28-2.94), but stages 1 and 2 were not.
  
  
  CONCLUSIONS
  More than half of the patients with severe sepsis had AKI according to the KDIGO classification, and AKI stage 3 was independently associated with 90-day mortality.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Lapland Central Hospital, Rovaniemi, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Poukkanen
authors.forename: S T
authors.initials: ST
authors.lastname: Vaara
authors.forename: V
authors.initials: V
authors.lastname: Pettilä
authors.forename: K-M
authors.initials: KM
authors.lastname: Kaukonen
authors.forename: A-M
authors.initials: AM
authors.lastname: Korhonen
authors.forename: S
authors.initials: S
authors.lastname: Hovilehto
authors.forename: O
authors.initials: O
authors.lastname: Inkinen
authors.forename: R
authors.initials: R
authors.lastname: Laru-Sompa
authors.forename: T
authors.initials: T
authors.lastname: Kaminski
authors.forename: M
authors.initials: M
authors.lastname: Reinikainen
authors.forename: V
authors.initials: V
authors.lastname: Lund
authors.forename: S
authors.initials: S
authors.lastname: Karlsson
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D000368:Aged; D003102:Colloids / Q000627:therapeutic use; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D005387:Finland / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D018805:Sepsis / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D003102:Colloids; D003404:Creatinine