Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study
Authors' conclusion
SA-AKI occurs in 1 in 6 ICU patients, is diagnosed on day 1 and carries significant morbidity and mortality risk with patients mostly admitted from home via the ED. However, most SA-AKI is stage 1 and mostly due to low UO, which carries much lower risk than diagnosis by other criteria.
Study context
- Population
- ICU admissions in 12 intensive care units (ICUs), 2015–2021; Sepsis-associated acute kidney injury (SA-AKI) per Acute Disease Quality Initiative (ADQI) definition (Sepsis-3 + Kidney Disease Improving Global Outcomes (KDIGO) AKI criteria)
- Participants
- 84,528 admissions
- Exposure
- Urinary output (UO) alone vs Creatinine alone vs UO and creatinine
- Outcome
- Incidence of SA-AKI
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
SA-AKI incidence
Admissions meeting SA-AKI criteria
13,451
Peak incidence (2021)
18%
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| Mortality by diagnostic criterionUO alone vs Creatinine alone or Both UO and creatinine | 0.34 (0.32–0.36) | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | UO alone | Creatinine alone | P value |
|---|---|---|---|
| RRT requirement by diagnostic criterionUO alone vs Creatinine alone vs Both UO and creatinine · consistent across all AKI stages | 2.8% | 18% | P < 0.001 |
- Time to SA-AKI diagnosis from ICU admission: SA-AKI median 1 (IQR 1–1) day
- Renal replacement therapy (RRT) requirement by diagnostic criterion: Both UO and creatinine 50%
- Hospital mortality in SA-AKI: SA-AKI 18%
AKI stage and criterion at diagnosis
- Stage 1 AKI at diagnosis
- 54%
- Due to low UO criterion only
- 65%
Hospital mortality in SA-AKI
- SA-AKI independently associated with increased mortality
Original publication
Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study. Intensive Care Med. Published 11 July 2023. doi:10.
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