Sepsis Plus AKI Increases Death Risk

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ICU and in-hospital mortality greater in patients with both ailments than in non-septic AKI patients.

 

Intensive care unit (ICU) patients with acute kidney injury (AKI) and sepsis are at greater risk of ICU and in-hospital mortality compared with those who have non-septic AKI.

 

Sean M. Bagshaw, MD, of the University of Alberta in Edmonton, Canada, and colleagues in Australia analyzed data from the Australian and New Zealand Intensive Care Society Adult Patient Database.

 

They examined data on 120,123 patients admitted to the ICU for 24 hours or more. Clinicians assessed for the presence of AKI within the first 24 hours after admission. Of the 120,123 patients, 33,375 had a sepsis-related diagnosis (27.8%). Among these patients, 14,039 (42.1%) had concomitant AKI (septic AKI).

 

Compared with non-septic AKI patients, septic AKI patients had greater abnormalities in acute physiology and greater acuity of illness including lower blood pressure, higher heart and respiratory rates, worse pulmonary function, and higher white cell counts, Dr. Bagshaw's team reported in Critical Care (2008;12:R47).

 

Compared with patients without sepsis and AKI, septic AKI patients had a 69% increased risk of ICU mortality and 54% increased risk of in-hospital mortality, after adjusting for potential confounders. Non-septic AKI patients had a 53% and 43% increased risk of ICU and in-hospital mortality, respectively. Moreover, septic AKI was associated with longer ICU and hospital stays.

 

Septic AKI may differ from AKI induced by other factors and from sepsis not complicated by AKI, the authors noted. “The mechanisms that account for these differences remain speculative, but they may relate to the physiological and immune consequences of either sepsis or AKI alone or of their additive and complex interplay,” they wrote.

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