Septic acute kidney injury in critically ill patients: Clinical characteristics and outcomes

Sean M. Bagshaw, Shigehiko Uchino, Rinaldo Bellomo, Hiroshi Morimatsu, Stanislao Morgera, Miet Schetz, Ian Tan, Catherine Bouman, Ettiene Macedo, Noel Gibney, Ashita Tolwani, Heleen M. Oudemans-van Straaten, Claudio Ronco, John A. Kellum

Research output: Contribution to journalArticle

423 Citations (Scopus)

Abstract

Sepsis is the most common cause of acute kidney injury (AKI) in critical illness, but there is limited information on septic AKI. A prospective, observational study of critically ill patients with septic and nonseptic AKI was performed from September 2000 to December 2001 at 54 hospitals in 23 countries. A total of 1753 patients were enrolled. Sepsis was considered the cause in 833 (47.5%); the predominant sources of sepsis were chest and abdominal (54.3%). Septic AKI was associated with greater aberrations in hemodynamics and laboratory parameters, greater severity of illness, and higher need for mechanical ventilation and vasoactive therapy. There was no difference in enrollment kidney function or in the proportion who received renal replacement therapy (RRT; 72 versus 71%; P = 0.83). Oliguria was more common in septic AKI (67 versus 57%; P <0.001). Septic AKI had a higher in-hospital case-fatality rate compared with nonseptic AKI (70.2 versus 51.8%; P <0.001). After adjustment for covariates, septic AKI remained associated with higher odds for death (1.48; 95% confidence interval 1.17 to 1.89; P = 0.001). Median (IQR) duration of hospital stay for survivors (37 [19 to 59] versus 21 [12 to 42] d; P <0.0001) was longer for septic AKI. There was a trend to lower serum creatinine (106 [73 to 158] versus 121 [88 to 184] μmol /L; P = 0.01) and RRT dependence (9 versus 14%; P = 0.052) at hospital discharge for septic AKI. Patients with septic AKI were sicker and had a higher burden of illness and greater abnormalities in acute physiology. Patients with septic AKI had an increased risk for death and longer duration of hospitalization yet showed trends toward greater renal recovery and independence from RRT.

Original languageEnglish
Pages (from-to)431-439
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume2
Issue number3
DOIs
Publication statusPublished - May 2007

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Acute Kidney Injury
Critical Illness
Sepsis
Oliguria
Kidney
Cost of Illness
Renal Replacement Therapy
Artificial Respiration
Observational Studies
Survivors
Length of Stay
Creatinine
Hospitalization
Thorax
Hemodynamics
Prospective Studies
Confidence Intervals

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Septic acute kidney injury in critically ill patients : Clinical characteristics and outcomes. / Bagshaw, Sean M.; Uchino, Shigehiko; Bellomo, Rinaldo; Morimatsu, Hiroshi; Morgera, Stanislao; Schetz, Miet; Tan, Ian; Bouman, Catherine; Macedo, Ettiene; Gibney, Noel; Tolwani, Ashita; Oudemans-van Straaten, Heleen M.; Ronco, Claudio; Kellum, John A.

In: Clinical Journal of the American Society of Nephrology, Vol. 2, No. 3, 05.2007, p. 431-439.

Research output: Contribution to journalArticle

Bagshaw, SM, Uchino, S, Bellomo, R, Morimatsu, H, Morgera, S, Schetz, M, Tan, I, Bouman, C, Macedo, E, Gibney, N, Tolwani, A, Oudemans-van Straaten, HM, Ronco, C & Kellum, JA 2007, 'Septic acute kidney injury in critically ill patients: Clinical characteristics and outcomes', Clinical Journal of the American Society of Nephrology, vol. 2, no. 3, pp. 431-439. https://doi.org/10.2215/CJN.03681106
Bagshaw, Sean M. ; Uchino, Shigehiko ; Bellomo, Rinaldo ; Morimatsu, Hiroshi ; Morgera, Stanislao ; Schetz, Miet ; Tan, Ian ; Bouman, Catherine ; Macedo, Ettiene ; Gibney, Noel ; Tolwani, Ashita ; Oudemans-van Straaten, Heleen M. ; Ronco, Claudio ; Kellum, John A. / Septic acute kidney injury in critically ill patients : Clinical characteristics and outcomes. In: Clinical Journal of the American Society of Nephrology. 2007 ; Vol. 2, No. 3. pp. 431-439.
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abstract = "Sepsis is the most common cause of acute kidney injury (AKI) in critical illness, but there is limited information on septic AKI. A prospective, observational study of critically ill patients with septic and nonseptic AKI was performed from September 2000 to December 2001 at 54 hospitals in 23 countries. A total of 1753 patients were enrolled. Sepsis was considered the cause in 833 (47.5{\%}); the predominant sources of sepsis were chest and abdominal (54.3{\%}). Septic AKI was associated with greater aberrations in hemodynamics and laboratory parameters, greater severity of illness, and higher need for mechanical ventilation and vasoactive therapy. There was no difference in enrollment kidney function or in the proportion who received renal replacement therapy (RRT; 72 versus 71{\%}; P = 0.83). Oliguria was more common in septic AKI (67 versus 57{\%}; P <0.001). Septic AKI had a higher in-hospital case-fatality rate compared with nonseptic AKI (70.2 versus 51.8{\%}; P <0.001). After adjustment for covariates, septic AKI remained associated with higher odds for death (1.48; 95{\%} confidence interval 1.17 to 1.89; P = 0.001). Median (IQR) duration of hospital stay for survivors (37 [19 to 59] versus 21 [12 to 42] d; P <0.0001) was longer for septic AKI. There was a trend to lower serum creatinine (106 [73 to 158] versus 121 [88 to 184] μmol /L; P = 0.01) and RRT dependence (9 versus 14{\%}; P = 0.052) at hospital discharge for septic AKI. Patients with septic AKI were sicker and had a higher burden of illness and greater abnormalities in acute physiology. Patients with septic AKI had an increased risk for death and longer duration of hospitalization yet showed trends toward greater renal recovery and independence from RRT.",
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