Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study
Purpose The Acute Disease Quality Initiative (ADQI) Workgroup recently released a consensus definition of sepsis-associated acute kidney injury (SA-AKI), combining Sepsis-3 and Kidney Disease Improving Global Outcomes (KDIGO) AKI criteria. This study aims to describe the epidemiology of SA-AKI. Meth...
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| Veröffentlicht in: | Intensive care medicine 2023-09, Vol.49 (9), p.1079-1089 |
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| creator | White, Kyle C. Serpa-Neto, Ary Hurford, Rod Clement, Pierre Laupland, Kevin B. See, Emily McCullough, James White, Hayden Shekar, Kiran Tabah, Alexis Ramanan, Mahesh Garrett, Peter Attokaran, Antony G. Luke, Stephen Senthuran, Siva McIlroy, Philippa Bellomo, Rinaldo |
| description | Purpose
The Acute Disease Quality Initiative (ADQI) Workgroup recently released a consensus definition of sepsis-associated acute kidney injury (SA-AKI), combining Sepsis-3 and Kidney Disease Improving Global Outcomes (KDIGO) AKI criteria. This study aims to describe the epidemiology of SA-AKI.
Methods
This is a retrospective cohort study carried out in 12 intensive care units (ICUs) from 2015 to 2021. We studied the incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes of SA-AKI based on the ADQI definition.
Results
Out of 84,528 admissions, 13,451 met the SA-AKI criteria with its incidence peaking at 18% in 2021. SA-AKI patients were typically admitted from home via the emergency department (ED) with a median time to SA-AKI diagnosis of 1 day (interquartile range (IQR) 1–1) from ICU admission. At diagnosis, most SA-AKI patients (54%) had a stage 1 AKI, mostly due to the low urinary output (UO) criterion only (65%). Compared to diagnosis by creatinine alone, or by both UO and creatinine criteria, patients diagnosed by UO alone had lower renal replacement therapy (RRT) requirements (2.8% vs 18% vs 50%;
p |
| doi_str_mv | 10.1007/s00134-023-07138-0 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10499944</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A765280563</galeid><sourcerecordid>A765280563</sourcerecordid><originalsourceid>FETCH-LOGICAL-c646t-fbbfa0f8f5e5cd7b943dc9a57e2558d97f5cea5ea30407144e592d53e3d98a793</originalsourceid><addsrcrecordid>eNp9kk2P0zAQhiMEYrsLf4ADssSFQ1Mcf-SDC6pWy4e0EgfgbLnOpHVJ7GI7lfrv-GlM6NJlUYV8GMt-5p3x-M2yFwVdFJRWbyKlBRc5ZTynVcHrnD7KZoXgLC8Yrx9nM8oFy0Up2EV2GeMW8aqUxdPsgldISUZn2c8vsIs25jpGb6xO0BJtxgTku20dHIh12zFMgaQNYEjgot0DMToAGZ1Nb_HQ2BacgTnZ6WTBJWI2OmiTINiYrIlzkuxg3Rpj0FswyYfDtAedBsTnRDsse9-BH5PxA8QFWZJh7FECKQhz4lcRwh6LeKd7EtPYHp5lTzrdR3h-F6-yb-9vvl5_zG8_f_h0vbzNTSnKlHerVadpV3cSpGmrVSN4axotK2BS1m1TddKAlqA5FThMIUA2rJUceNvUumr4VfbuqLsbVwO0U0dB92oX7KDDQXlt1cMbZzdq7feqoKJpGiFQ4fWdQvA_RohJDTYa6HvtwI9RsVoiJRrGEX31D7r1Y8A3T1QpeC0kfvGJWuselHWdx8JmElVL_GhWU1lOWvkZag0OsEvvoLN4_IBfnOFxtTBYczaBHRNM8DEG6E5DKaiajKqORlVoVPXbqIpi0su_x3lK-eNMBPgRiHjl1hDuR_Af2V91ePeO</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2864384512</pqid></control><display><type>article</type><title>Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study</title><source>Springer Nature - Complete Springer Journals</source><creator>White, Kyle C. ; Serpa-Neto, Ary ; Hurford, Rod ; Clement, Pierre ; Laupland, Kevin B. ; See, Emily ; McCullough, James ; White, Hayden ; Shekar, Kiran ; Tabah, Alexis ; Ramanan, Mahesh ; Garrett, Peter ; Attokaran, Antony G. ; Luke, Stephen ; Senthuran, Siva ; McIlroy, Philippa ; Bellomo, Rinaldo</creator><creatorcontrib>White, Kyle C. ; Serpa-Neto, Ary ; Hurford, Rod ; Clement, Pierre ; Laupland, Kevin B. ; See, Emily ; McCullough, James ; White, Hayden ; Shekar, Kiran ; Tabah, Alexis ; Ramanan, Mahesh ; Garrett, Peter ; Attokaran, Antony G. ; Luke, Stephen ; Senthuran, Siva ; McIlroy, Philippa ; Bellomo, Rinaldo ; Queensland Critical Care Research Network (QCCRN) ; the Queensland Critical Care Research Network (QCCRN)</creatorcontrib><description>Purpose
The Acute Disease Quality Initiative (ADQI) Workgroup recently released a consensus definition of sepsis-associated acute kidney injury (SA-AKI), combining Sepsis-3 and Kidney Disease Improving Global Outcomes (KDIGO) AKI criteria. This study aims to describe the epidemiology of SA-AKI.
Methods
This is a retrospective cohort study carried out in 12 intensive care units (ICUs) from 2015 to 2021. We studied the incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes of SA-AKI based on the ADQI definition.
Results
Out of 84,528 admissions, 13,451 met the SA-AKI criteria with its incidence peaking at 18% in 2021. SA-AKI patients were typically admitted from home via the emergency department (ED) with a median time to SA-AKI diagnosis of 1 day (interquartile range (IQR) 1–1) from ICU admission. At diagnosis, most SA-AKI patients (54%) had a stage 1 AKI, mostly due to the low urinary output (UO) criterion only (65%). Compared to diagnosis by creatinine alone, or by both UO and creatinine criteria, patients diagnosed by UO alone had lower renal replacement therapy (RRT) requirements (2.8% vs 18% vs 50%;
p <
0.001), which was consistent across all stages of AKI. SA-AKI hospital mortality was 18% and SA-AKI was independently associated with increased mortality. In SA-AKI, diagnosis by low UO only, compared to creatinine alone or to both UO and creatinine criteria, carried an odds ratio of 0.34 (95% confidence interval (CI) 0.32–0.36) for mortality.
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.</description><identifier>ISSN: 0342-4642</identifier><identifier>ISSN: 1432-1238</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-023-07138-0</identifier><identifier>PMID: 37432520</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Anesthesiology ; Australia ; Care and treatment ; Creatinine ; Criteria ; Critical Care Medicine ; Diagnosis ; Emergency medical care ; Emergency medical services ; Emergency Medicine ; Epidemiology ; Health services ; Hospitals ; Infection ; Intensive ; Intensive care ; Intensive care units ; Kidney diseases ; Kidneys ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Morbidity ; Mortality ; Mortality risk ; Observational studies ; Original ; Pain Medicine ; Patient outcomes ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Sepsis</subject><ispartof>Intensive care medicine, 2023-09, Vol.49 (9), p.1079-1089</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>COPYRIGHT 2023 Springer</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c646t-fbbfa0f8f5e5cd7b943dc9a57e2558d97f5cea5ea30407144e592d53e3d98a793</citedby><cites>FETCH-LOGICAL-c646t-fbbfa0f8f5e5cd7b943dc9a57e2558d97f5cea5ea30407144e592d53e3d98a793</cites><orcidid>0000-0002-0129-8297</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-023-07138-0$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-023-07138-0$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37432520$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>White, Kyle C.</creatorcontrib><creatorcontrib>Serpa-Neto, Ary</creatorcontrib><creatorcontrib>Hurford, Rod</creatorcontrib><creatorcontrib>Clement, Pierre</creatorcontrib><creatorcontrib>Laupland, Kevin B.</creatorcontrib><creatorcontrib>See, Emily</creatorcontrib><creatorcontrib>McCullough, James</creatorcontrib><creatorcontrib>White, Hayden</creatorcontrib><creatorcontrib>Shekar, Kiran</creatorcontrib><creatorcontrib>Tabah, Alexis</creatorcontrib><creatorcontrib>Ramanan, Mahesh</creatorcontrib><creatorcontrib>Garrett, Peter</creatorcontrib><creatorcontrib>Attokaran, Antony G.</creatorcontrib><creatorcontrib>Luke, Stephen</creatorcontrib><creatorcontrib>Senthuran, Siva</creatorcontrib><creatorcontrib>McIlroy, Philippa</creatorcontrib><creatorcontrib>Bellomo, Rinaldo</creatorcontrib><creatorcontrib>Queensland Critical Care Research Network (QCCRN)</creatorcontrib><creatorcontrib>the Queensland Critical Care Research Network (QCCRN)</creatorcontrib><title>Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>Purpose
The Acute Disease Quality Initiative (ADQI) Workgroup recently released a consensus definition of sepsis-associated acute kidney injury (SA-AKI), combining Sepsis-3 and Kidney Disease Improving Global Outcomes (KDIGO) AKI criteria. This study aims to describe the epidemiology of SA-AKI.
Methods
This is a retrospective cohort study carried out in 12 intensive care units (ICUs) from 2015 to 2021. We studied the incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes of SA-AKI based on the ADQI definition.
Results
Out of 84,528 admissions, 13,451 met the SA-AKI criteria with its incidence peaking at 18% in 2021. SA-AKI patients were typically admitted from home via the emergency department (ED) with a median time to SA-AKI diagnosis of 1 day (interquartile range (IQR) 1–1) from ICU admission. At diagnosis, most SA-AKI patients (54%) had a stage 1 AKI, mostly due to the low urinary output (UO) criterion only (65%). Compared to diagnosis by creatinine alone, or by both UO and creatinine criteria, patients diagnosed by UO alone had lower renal replacement therapy (RRT) requirements (2.8% vs 18% vs 50%;
p <
0.001), which was consistent across all stages of AKI. SA-AKI hospital mortality was 18% and SA-AKI was independently associated with increased mortality. In SA-AKI, diagnosis by low UO only, compared to creatinine alone or to both UO and creatinine criteria, carried an odds ratio of 0.34 (95% confidence interval (CI) 0.32–0.36) for mortality.
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.</description><subject>Anesthesiology</subject><subject>Australia</subject><subject>Care and treatment</subject><subject>Creatinine</subject><subject>Criteria</subject><subject>Critical Care Medicine</subject><subject>Diagnosis</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Medicine</subject><subject>Epidemiology</subject><subject>Health services</subject><subject>Hospitals</subject><subject>Infection</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive care units</subject><subject>Kidney diseases</subject><subject>Kidneys</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Mortality risk</subject><subject>Observational studies</subject><subject>Original</subject><subject>Pain Medicine</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Sepsis</subject><issn>0342-4642</issn><issn>1432-1238</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kk2P0zAQhiMEYrsLf4ADssSFQ1Mcf-SDC6pWy4e0EgfgbLnOpHVJ7GI7lfrv-GlM6NJlUYV8GMt-5p3x-M2yFwVdFJRWbyKlBRc5ZTynVcHrnD7KZoXgLC8Yrx9nM8oFy0Up2EV2GeMW8aqUxdPsgldISUZn2c8vsIs25jpGb6xO0BJtxgTku20dHIh12zFMgaQNYEjgot0DMToAGZ1Nb_HQ2BacgTnZ6WTBJWI2OmiTINiYrIlzkuxg3Rpj0FswyYfDtAedBsTnRDsse9-BH5PxA8QFWZJh7FECKQhz4lcRwh6LeKd7EtPYHp5lTzrdR3h-F6-yb-9vvl5_zG8_f_h0vbzNTSnKlHerVadpV3cSpGmrVSN4axotK2BS1m1TddKAlqA5FThMIUA2rJUceNvUumr4VfbuqLsbVwO0U0dB92oX7KDDQXlt1cMbZzdq7feqoKJpGiFQ4fWdQvA_RohJDTYa6HvtwI9RsVoiJRrGEX31D7r1Y8A3T1QpeC0kfvGJWuselHWdx8JmElVL_GhWU1lOWvkZag0OsEvvoLN4_IBfnOFxtTBYczaBHRNM8DEG6E5DKaiajKqORlVoVPXbqIpi0su_x3lK-eNMBPgRiHjl1hDuR_Af2V91ePeO</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>White, Kyle C.</creator><creator>Serpa-Neto, Ary</creator><creator>Hurford, Rod</creator><creator>Clement, Pierre</creator><creator>Laupland, Kevin B.</creator><creator>See, Emily</creator><creator>McCullough, James</creator><creator>White, Hayden</creator><creator>Shekar, Kiran</creator><creator>Tabah, Alexis</creator><creator>Ramanan, Mahesh</creator><creator>Garrett, Peter</creator><creator>Attokaran, Antony G.</creator><creator>Luke, Stephen</creator><creator>Senthuran, Siva</creator><creator>McIlroy, Philippa</creator><creator>Bellomo, Rinaldo</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-0129-8297</orcidid></search><sort><creationdate>20230901</creationdate><title>Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study</title><author>White, Kyle C. ; Serpa-Neto, Ary ; Hurford, Rod ; Clement, Pierre ; Laupland, Kevin B. ; See, Emily ; McCullough, James ; White, Hayden ; Shekar, Kiran ; Tabah, Alexis ; Ramanan, Mahesh ; Garrett, Peter ; Attokaran, Antony G. ; Luke, Stephen ; Senthuran, Siva ; McIlroy, Philippa ; Bellomo, Rinaldo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c646t-fbbfa0f8f5e5cd7b943dc9a57e2558d97f5cea5ea30407144e592d53e3d98a793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Anesthesiology</topic><topic>Australia</topic><topic>Care and treatment</topic><topic>Creatinine</topic><topic>Criteria</topic><topic>Critical Care Medicine</topic><topic>Diagnosis</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency Medicine</topic><topic>Epidemiology</topic><topic>Health services</topic><topic>Hospitals</topic><topic>Infection</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive care units</topic><topic>Kidney diseases</topic><topic>Kidneys</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Mortality risk</topic><topic>Observational studies</topic><topic>Original</topic><topic>Pain Medicine</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Sepsis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>White, Kyle C.</creatorcontrib><creatorcontrib>Serpa-Neto, Ary</creatorcontrib><creatorcontrib>Hurford, Rod</creatorcontrib><creatorcontrib>Clement, Pierre</creatorcontrib><creatorcontrib>Laupland, Kevin B.</creatorcontrib><creatorcontrib>See, Emily</creatorcontrib><creatorcontrib>McCullough, James</creatorcontrib><creatorcontrib>White, Hayden</creatorcontrib><creatorcontrib>Shekar, Kiran</creatorcontrib><creatorcontrib>Tabah, Alexis</creatorcontrib><creatorcontrib>Ramanan, Mahesh</creatorcontrib><creatorcontrib>Garrett, Peter</creatorcontrib><creatorcontrib>Attokaran, Antony G.</creatorcontrib><creatorcontrib>Luke, Stephen</creatorcontrib><creatorcontrib>Senthuran, Siva</creatorcontrib><creatorcontrib>McIlroy, Philippa</creatorcontrib><creatorcontrib>Bellomo, Rinaldo</creatorcontrib><creatorcontrib>Queensland Critical Care Research Network (QCCRN)</creatorcontrib><creatorcontrib>the Queensland Critical Care Research Network (QCCRN)</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>White, Kyle C.</au><au>Serpa-Neto, Ary</au><au>Hurford, Rod</au><au>Clement, Pierre</au><au>Laupland, Kevin B.</au><au>See, Emily</au><au>McCullough, James</au><au>White, Hayden</au><au>Shekar, Kiran</au><au>Tabah, Alexis</au><au>Ramanan, Mahesh</au><au>Garrett, Peter</au><au>Attokaran, Antony G.</au><au>Luke, Stephen</au><au>Senthuran, Siva</au><au>McIlroy, Philippa</au><au>Bellomo, Rinaldo</au><aucorp>Queensland Critical Care Research Network (QCCRN)</aucorp><aucorp>the Queensland Critical Care Research Network (QCCRN)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2023-09-01</date><risdate>2023</risdate><volume>49</volume><issue>9</issue><spage>1079</spage><epage>1089</epage><pages>1079-1089</pages><issn>0342-4642</issn><issn>1432-1238</issn><eissn>1432-1238</eissn><abstract>Purpose
The Acute Disease Quality Initiative (ADQI) Workgroup recently released a consensus definition of sepsis-associated acute kidney injury (SA-AKI), combining Sepsis-3 and Kidney Disease Improving Global Outcomes (KDIGO) AKI criteria. This study aims to describe the epidemiology of SA-AKI.
Methods
This is a retrospective cohort study carried out in 12 intensive care units (ICUs) from 2015 to 2021. We studied the incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes of SA-AKI based on the ADQI definition.
Results
Out of 84,528 admissions, 13,451 met the SA-AKI criteria with its incidence peaking at 18% in 2021. SA-AKI patients were typically admitted from home via the emergency department (ED) with a median time to SA-AKI diagnosis of 1 day (interquartile range (IQR) 1–1) from ICU admission. At diagnosis, most SA-AKI patients (54%) had a stage 1 AKI, mostly due to the low urinary output (UO) criterion only (65%). Compared to diagnosis by creatinine alone, or by both UO and creatinine criteria, patients diagnosed by UO alone had lower renal replacement therapy (RRT) requirements (2.8% vs 18% vs 50%;
p <
0.001), which was consistent across all stages of AKI. SA-AKI hospital mortality was 18% and SA-AKI was independently associated with increased mortality. In SA-AKI, diagnosis by low UO only, compared to creatinine alone or to both UO and creatinine criteria, carried an odds ratio of 0.34 (95% confidence interval (CI) 0.32–0.36) for mortality.
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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37432520</pmid><doi>10.1007/s00134-023-07138-0</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-0129-8297</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0342-4642 |
| ispartof | Intensive care medicine, 2023-09, Vol.49 (9), p.1079-1089 |
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| language | eng |
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| source | Springer Nature - Complete Springer Journals |
| subjects | Anesthesiology Australia Care and treatment Creatinine Criteria Critical Care Medicine Diagnosis Emergency medical care Emergency medical services Emergency Medicine Epidemiology Health services Hospitals Infection Intensive Intensive care Intensive care units Kidney diseases Kidneys Medical research Medicine Medicine & Public Health Medicine, Experimental Morbidity Mortality Mortality risk Observational studies Original Pain Medicine Patient outcomes Patients Pediatrics Pneumology/Respiratory System Sepsis |
| title | Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study |
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