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Comparative Study
. 2011 Feb;37(2):241-8.
doi: 10.1007/s00134-010-2089-9. Epub 2010 Dec 9.

Sepsis as a cause and consequence of acute kidney injury: Program to Improve Care in Acute Renal Disease

Ravindra L Mehta  1 , Josée Bouchard, Sharon B Soroko, T Alp Ikizler, Emil P Paganini, Glenn M Chertow, Jonathan Himmelfarb; Program to Improve Care in Acute Renal Disease (PICARD) Study Group
Affiliations
Comparative Study

Sepsis as a cause and consequence of acute kidney injury: Program to Improve Care in Acute Renal Disease

Ravindra L Mehta et al. Intensive Care Med. 2011 Feb.

Abstract

Purpose: Sepsis commonly contributes to acute kidney injury (AKI); however, the frequency with which sepsis develops as a complication of AKI and the clinical consequences of this sepsis are unknown. This study examined the incidence of, and outcomes associated with, sepsis developing after AKI.

Methods: We analyzed data from 618 critically ill patients enrolled in a multicenter observational study of AKI (PICARD). Patients were stratified according to their sepsis status and timing of incident sepsis relative to AKI diagnosis.

Results: We determined the associations among sepsis, clinical characteristics, provision of dialysis, in-hospital mortality, and length of stay (LOS), comparing outcomes among patients according to their sepsis status. Among the 611 patients with data on sepsis status, 174 (28%) had sepsis before AKI, 194 (32%) remained sepsis-free, and 243 (40%) developed sepsis a median of 5 days after AKI. Mortality rates for patients with sepsis developing after AKI were higher than in sepsis-free patients (44 vs. 21%; p < 0.0001) and similar to patients with sepsis preceding AKI (48 vs. 44%; p = 0.41). Compared with sepsis-free patients, those with sepsis developing after AKI were also more likely to be dialyzed (70 vs. 50%; p < 0.001) and had longer LOS (37 vs. 27 days; p < 0.001). Oliguria, higher fluid accumulation and severity of illness scores, non-surgical procedures after AKI, and provision of dialysis were predictors of sepsis after AKI.

Conclusions: Sepsis frequently develops after AKI and portends a poor prognosis, with high mortality rates and relatively long LOS. Future studies should evaluate techniques to monitor for and manage this complication to improve overall prognosis.

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Figures

Fig. 1
Fig. 1
Incidence and timing of sepsis in all patients
Fig. 2
Fig. 2
Kaplan–Meier mortality estimates, by sepsis status over hospitalization (p = 0.005 between all groups)
Fig. 3
Fig. 3
Outcomes according to sepsis status
Fig. 4
Fig. 4
In-hospital mortality rate stratified for sepsis and dialysis status
See this image and copyright information in PMC

Comment in

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