Yonsei Med J.  2013 Jul;54(4):965-972. 10.3349/ymj.2013.54.4.965.

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

• Suh SH
• Kim CS
• Choi JS
• Bae EH
• Ma SK
• Kim SW

• KMID: 2158233
• DOI: http://doi.org/10.3349/ymj.2013.54.4.965

Abstract

PURPOSE
The aim of this study was to investigate clinical characteristics and risk factors of acute kidney injury (AKI) in patients with sepsis and septic shock. Additionally, we explored whether the severity of AKI affects on the clinical outcomes.
MATERIALS AND METHODS
Data were collected retrospectively in a single center. Among 5680 patients who visited emergency department from January to December 2010, 992 patients with sepsis and septic shock were enrolled. Patients were divided into two groups, patients who developed AKI or not, to compare the baseline characteristics, and laboratory and physiologic data. Patients with AKI were subdivided according to its stages for survival analysis.
RESULTS
AKI was developed in 57.7% of patients. Multivariable logistic regression analysis revealed that development of septic AKI was associated with older age, pre-existing chronic kidney disease, use of angiotensin converting enzyme inhibitor or angiotensin receptor blocker, presence of shock, positive blood culture results, and low white blood cell and platelet counts. Hospital mortality was higher in AKI group. Crude Kaplan-Meier survival curves demonstrated reduced 30-day survival rate was significantly associated with the severity of acute kidney injury.
CONCLUSION
The development of septic AKI was associated with poor clinical outcomes. Furthermore, the severity of AKI was associated with increased mortality.

Keyword

Acute kidney injury; mortality; risk factors; sepsis; septic shock

MeSH Terms

Acute Kidney Injury/*etiology/mortality
Age Factors
Aged
Angiotensin-Converting Enzyme Inhibitors/therapeutic use
Female
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Renal Insufficiency, Chronic/complications
Retrospective Studies
Risk Factors
Sepsis/*complications/*mortality
Shock, Septic/*complications/*mortality
Survival Rate
Angiotensin-Converting Enzyme Inhibitors

Figure

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  Fig. 1 Study design. AKI, acute kidney injury.

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  Fig. 2 Survival curves for 30 days. Kaplan-Meier survival for 30 days by AKI stages in patients with sepsis and septic shock demonstrated reduced survival rate was significantly associated with the severity of AKI (p<0.001 by log-rank test). AKI, acute kidney injury.

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