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. 2013 Oct 11;17(5):R231.
doi: 10.1186/cc13054.

Risk of developing severe sepsis after acute kidney injury: a population-based cohort study

Tai-Shuan Lai, Cheng-Yi Wang, Sung-Ching Pan, Tao-Min Huang, Meng-Chun Lin, Chun-Fu Lai, Che-Hsiung Wu, Vin-Cent Wu, Kuo-Liong Chien; National Taiwan University Hospital Study Group on Acute Renal Failure (NSARF)

Risk of developing severe sepsis after acute kidney injury: a population-based cohort study

Tai-Shuan Lai et al. Crit Care. .

Abstract

Introduction: Sepsis has been a factor of acute kidney injury (AKI); however, little is known about dialysis-requiring AKI and the risk of severe sepsis after survival to discharge.

Methods: We conducted a population-based cohort study based on the Taiwan National Health Insurance Research Database from 1999 to 2009. We identified patients with AKI requiring dialysis during hospitalization and survived for at least 90 days after discharge, and matched them with those without AKI according to age, sex, and concurrent diabetes. The primary outcome was severe sepsis, defined as sepsis with a diagnosis of acute organ dysfunction. Individuals who recovered enough to survive without acute dialysis were further analyzed.

Results: We identified 2983 individuals (mean age, 62 years; median follow-up, 3.96 years) with dialysis-requiring AKI and 11,932 matched controls. The incidence rate of severe sepsis was 6.84 and 2.32 per 100 person-years among individuals with dialysis-requiring AKI and without AKI in the index hospitalization, respectively. Dialysis-requiring AKI patients had a higher risk of developing de novo severe sepsis than the non-AKI group. In subgroup analysis, even individuals with recovery from dialysis-requiring AKI were at high risk of developing severe sepsis.

Conclusions: AKI is an independent risk factor for severe sepsis. Even patients who recovered from AKI had a high risk of long-term severe sepsis.

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Figures

Figure 1
Figure 1
Flow diaphragm of the study population. AKI: acute kidney injury.
Figure 2
Figure 2
Kaplan–Meier curve for incidence of severe sepsis after discharge for patients with or without acute kidney injury. AKI: acute kidney injury.
Figure 3
Figure 3
Risk of severe sepsis associated with acute kidney injury at index hospitalization by participant characteristics. AKI: acute kidney injury.
See this image and copyright information in PMC

Comment in

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