Acute Kidney Injury in Patients with Sepsis and Septic Shock: Risk Factors and Clinical Outcomes

Abstract Objective: To investigate the epidemiology of acute kidney injury and to clarify the risk factors associated with the prognosis of acute kidney injury in critically ill patients in the Gansu Province.Methods : This was a multicenter, retrospective study. The clinical data of all patients from January 1, 2017, to December 31, 2019, in the intensive care unit of the selected hospitals were screened. Descriptive statistical analysis was performed first, and then the patients were divided into a survival group and a nonsurvival group based on survival status at discharge. Logistic regression analyses were used to determine the risk factors for in-hospital mortality in patients with acute kidney injury. RESULTS : (1) Among the 8106 patients admitted, a total of 3019 patients were excluded according to the exclusion criteria. Among the included patients, 890 patients met the diagnostic criteria for AKI, with an incidence of 17.5% and mortality of 41.3%. The etiology of acute kidney injury was 64% prerenal, 33% renal, and 2.7% postrenal. Prerenal AKI was the most common, among which cases caused by sepsis and septic shock accounted for 44.7%. Among the selected AKI patients, AKI stage I accounted for 22.02%, AKI stage II accounted for 31.01%, AKI stage III accounted for 46.97%, and 35.8% of the AKI patients received renal replacement therapy. (2) Logistic regression analysis showed that sex , age, AKI stage, RRT, infection, cardio-pulmonary resuscitation, cardiac output, mechanical ventilation, diuretics, white blood cells, platelets, blood urea nitrogen, prothrombin time and activated partial thromboplastin time were significantly associated with the prognosis of acute kidney injury (P <0.05). Further analysis showed that male sex, old age, high AKI stage, RRT treatment, low cardiac output, mechanical ventilation, elevated leukocyte count, reduced platelet count and reduced serum albumin were independent risk factors for a poor prognosis of acute kidney injury.Conclusions : Large-scale epidemiological data from several representative general hospitals in the Gansu Province showed that the incidence and mortality of acute kidney injury in intensive care units were still very high. Sepsis and septic shock are the main causes of AKI.

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The incidence, risk factors, and clinical outcomes of acute kidney injury (staged using the RIFLE classification) associated with intravenous acyclovir administration

Renal Failure ◽

10.1080/0886022x.2018.1487866 ◽

2018 ◽

Vol 40 (1) ◽

pp. 687-692 ◽

Cited By ~ 9

Author(s):

Eun Ju Lee ◽

Ha Nee Jang ◽

Hyun Seop Cho ◽

Eunjin Bae ◽

Tae Won Lee ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Clinical Outcomes ◽

Kidney Injury ◽

Rifle Classification ◽

Intravenous Acyclovir ◽

Incidence Risk

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Rates, predictors and mortality of sepsis-associated acute kidney injury: systematic review and meta-analysis

10.21203/rs.3.rs-18145/v3 ◽

2020 ◽

Author(s):

Jie feng Liu ◽

Hebin Xie ◽

ziwei ye ◽

Lesan Wang

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Septic Shock ◽

Acute Kidney Injury ◽

Meta Analysis ◽

Kidney Injury ◽

Predisposing Factors ◽

Cochrane Library ◽

Patient Specific ◽

Cumulative Number

Abstract Objective:The incidence and mortality of sepsis-induced acute kidney injury is high. Many studies have explored the causes of sepsis-induced acute kidney injury (AKI). However, its predictors are still uncertain; additionally, a complete overview is missing. A systematic review and a meta-analysis were performed to determine the predisposing factors for sepsis-induced AKI. Method: A systematic literature search was performed in the Medline, Embase, Cochrane Library, PubMed and Web of Science databases, with an end date parameter of May 25, 2019. Valid data were retrieved in compliance with the inclusion and exclusion criteria. Result: Forty-seven observational studies were included for analysis. A cumulative number of 55911sepsis patients were evaluated. The incidence of AKI caused by septic shock is the highest. 30 possible risk factors were included in the meta-analysis. The results showed that 20 factors were found to be significant. The odds ratio(OR),95% confidence interval (CI) and Prevalence of the most prevalent predisposing factors for sepsis-induced AKI were as the following: Septic shock[2.88(2.36-3.52), 60.47%], Hypertension[1.43(1.20-1.70),38.39%), Diabetes mellitus[1.59(1.47-1.71),27.57%],Abdominal infection[1.44(1.32-1.58),30.87%], Vasopressors use[2.95(1.67-5.22),64.61%],vasoactive drugs use [3.85(1.89-7.87),63.22%], Mechanical ventilation[1.64(1.24-2.16),68.00%), Positive blood culture[1.60(1.35-1.89), 41.19%], Smoke history[1.60(1.09-2.36),43.09%]. Other risk factors include cardiovascular, coronary artery disease, liver disease, unknow infection, diuretics use, ACEI or ARB, gram-negative bacteria and organ transplant. Conclusion: A large number of factors are associated with AKI development in sepsis patients. Our review can guide risk-reducing interventions, clinical prediction rules, and patient-specific treatment and management strategies for sepsis-induced acute kidney injury.

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Relation of neutrophil-to-lymphocyte ratio to acute kidney injury in patients with sepsis and septic shock: A retrospective study

International Immunopharmacology ◽

10.1016/j.intimp.2019.02.043 ◽

2019 ◽

Vol 70 ◽

pp. 372-377 ◽

Cited By ~ 8

Author(s):

Xi Bu ◽

Lian Zhang ◽

Peina Chen ◽

Xiaoyan Wu

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Retrospective Study ◽

Kidney Injury ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Sepsis And Septic Shock

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ICU treatment of acute kidney injury

10.1093/med/9780199568741.003.0151 ◽

2018 ◽

Author(s):

Matt Wise ◽

Paul Frost

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Acute Kidney Injury ◽

Haematological Malignancy ◽

Previous History ◽

Kidney Injury ◽

History Of ◽

Nephrotoxic Drugs ◽

Abdominal Compartment ◽

Icu Treatment

Traditionally, the etiology of acute kidney injury (AKI) is considered in terms of prerenal, renal, and obstructive causes. However, this categorization is less useful in the ICU, where the etiology of AKI is usually multifactorial and often occurs in the context of multi-organ failure. Hypotension, nephrotoxic drugs, and severe sepsis or septic shock are the most important identifiable factors. Less frequently encountered causes include pancreatitis, abdominal compartment syndrome, and rhabdomyolysis. Primary intrinsic renal disease such as glomerulonephritis is extremely uncommon. A previous history of cirrhosis, cardiac failure, or haematological malignancy, and age >65 years, are important risk factors. This chapter covers symptoms, complications, diagnosis, investigations, prognosis, and treatment of renal failure in the ITU.

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Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock

Journal of Critical Care ◽

10.1016/j.jcrc.2014.09.002 ◽

2015 ◽

Vol 30 (1) ◽

pp. 97-101 ◽

Cited By ~ 70

Author(s):

Fernando Saes Vilaça de Oliveira ◽

Flavio Geraldo Resende Freitas ◽

Elaine Maria Ferreira ◽

Isac de Castro ◽

Antonio Toneti Bafi ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Severe Sepsis ◽

Prognostic Factor ◽

Fluid Balance ◽

Kidney Injury ◽

Positive Fluid Balance ◽

Sepsis And Septic Shock

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Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy

Yearbook of Critical Care Medicine ◽

10.1016/s0734-3299(09)79299-8 ◽

2010 ◽

Vol 2010 ◽

pp. 265-266

Author(s):

J.S. Rachoin ◽

L.S. Weisberg

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Clinical Outcomes ◽

Antimicrobial Therapy ◽

Kidney Injury

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The Current State of Renal Replacement Therapy in the Treatment of Sepsis

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2021-18-4-80-89 ◽

2021 ◽

Vol 18 (4) ◽

pp. 80-89

Author(s):

T. G. Kim ◽

M. А. Magomedov ◽

D. N. Protsenko ◽

M. V. Zakharov ◽

А. V. Marukhov ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Results Of Treatment ◽

Current State ◽

Sepsis And Septic Shock ◽

Positive Results ◽

Organ Dysfunctions

Of all cases of acute kidney injury (AKI), 45-70% are associated with sepsis. Lethality in sepsis-associated AKI requiring renal replacement therapy (RRT) ranges from 40 to 50%, and in AKI combined with other organ dysfunctions - 60-80%. In order to improve the results of treatment of sepsis and septic shock, various methods of extracorporeal detoxification (ECD) have been developed. The effectiveness of these methods is controversial. In the treatment of sepsis, RRT is used not only to replace the impaired detoxification function of kidneys, but also to remove excess cytokines from the systemic bloodstream. The literature describes mainly positive results of the use of dialyzers with an adsorbing membrane, however, these data do not have the necessary degree of evidence. Currently, there are no clear criteria for the initiation of RRT, its duration and doses, the choice of methodology determined by specific clinical and laboratory parameters, and staging of this therapy. All this highlights the need for further research in this field.

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One-Year Progression and Risk Factors for the Development of Chronic Kidney Disease in Septic Shock Patients with Acute Kidney Injury: A Single-Centre Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm7120554 ◽

2018 ◽

Vol 7 (12) ◽

pp. 554 ◽

Cited By ~ 9

Author(s):

June-sung Kim ◽

Youn-Jung Kim ◽

Seung Ryoo ◽

Chang Sohn ◽

Dong Seo ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Septic Shock ◽

Acute Kidney Injury ◽

Cohort Study ◽

Retrospective Cohort ◽

Kidney Injury ◽

One Year ◽

Stage 1

(1) Background: Sepsis-associated acute kidney injury (AKI) can lead to permanent kidney damage, although the long-term prognosis in patients with septic shock remains unclear. This study aimed to identify risk factors for the development of chronic kidney disease (CKD) in septic shock patients with AKI. (2) Methods: A single-site, retrospective cohort study was conducted using a registry of adult septic shock patients. Data from patients who had developed AKI between January 2011 and April 2017 were extracted, and 1-year follow-up data were analysed to identify patients who developed CKD. (3) Results: Among 2208 patients with septic shock, 839 (38%) had AKI on admission (stage 1: 163 (19%), stage 2: 339 (40%), stage 3: 337 (40%)). After one year, kidney function had recovered in 27% of patients, and 6% had progressed to CKD. In patients with stage 1 AKI, 10% developed CKD, and mortality was 13% at one year; in patients with stage 2 and 3 AKI, the CKD rate was 6%, and the mortality rate was 42% and 47%, respectively. Old age, female, diabetes, low haemoglobin levels and a high creatinine level at discharge were seen to be risk factors for the development of CKD. (4) Conclusions: AKI severity correlated with mortality, but it did not correlate with the development of CKD, and patients progressed to CKD, even when initial AKI stage was not severe. Physicians should focus on the recovery of renal function, and ensure the careful follow-up of patients with risk factors for the development of CKD.

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