Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2019 May 7;14(5):e0216412.
doi: 10.1371/journal.pone.0216412. eCollection 2019.

The importance of acute kidney injury in suspected community acquired infection

James Tollitt  1   2 , Nicola Bennett  2 , Denise Darby  3 , Emma Flanagan  4 , Paul Chadwick  3 , Smeeta Sinha  1   2 , Philip A Kalra  1   2 , James Ritchie  1   2 , Dimitrios Poulikakos  1   2   5
Affiliations
Clinical Trial

The importance of acute kidney injury in suspected community acquired infection

James Tollitt et al. PLoS One. .

Abstract

Background: Most sepsis and acute kidney injury (AKI) cases are community acquired (CA). The aim of this study was to evaluate the characteristics of suspected community acquired infection (sCA-I) and CA-AKI and their impact upon patient outcomes.

Methods: All adult creatinine blood tests from non-elective, non-dialysis attendances to a single centre over a 29-month period were analysed retrospectively. We defined sCA-I and CA-AKI cases as antibiotic prescription and AKI alert within 48 hours of attendance respectively. Binary logistic regression models were created to determine associations with 30-day mortality, intensive care unit (ICU) admission and length of stay (LOS) dichotomised at median.

Results: Of 61,471 attendances 28.1% and 5.7% suffered sCA-I or CA-AKI in isolation respectively, 3.4% suffered both. sCA-I was present in 58.8% of CA-AKI cases and CA-AKI was present in 11.9% of CA-I cases. The combination of sCA-I and CA-AKI was associated with a higher risk for all outcomes compared to sCA-I or CA-AKI in isolation. The 30-day mortality was 8.1%, 11.8% and 26.2% in patients with sCA-I, CA-AKI and when sCA-I and CA-AKI occurred in combination respectively. The adjusted odds ratios (OR) and 95% confidence intervals (CI) for 30-day mortality, ICU admission and LOS for sCA-I combined with CA-AKI stage 1 were OR 6.09:CI: 5.21-7.12, OR 12.52 CI: 10.54-14.88 and OR 8.97 CI: 7.62-10.56, respectively, and for combined sCA-I and CA-AKI stage 3 were OR 9.23 CI: 6.91-12.33, OR 29.26 CI: 22.46-38.18 and OR 9.48 CI: 6.82-13.18 respectively.

Conclusion: The combination of sCA-I and CA-AKI is associated with worse outcomes.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Forrest plot displaying the adjusted odds ratios for 30-day all-cause mortality in general population.
Fig 2
Fig 2. Forrest plot displaying the adjusted odds ratios for intensive care unit admission in general population.
Fig 3
Fig 3. Forrest plot displaying the adjusted odds ratios for length of stay> 3 days in general population.
See this image and copyright information in PMC

References

    1. NCEPOD, National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! London: NCEPOD; 2015;1–130.
    1. NICE. Sepsis: recognition, diagnosis and early management Recommendations: Guidance and guidelines. NICE; 2016.
    1. Chertow GM. Acute Kidney Injury, Mortality, Length of Stay, and Costs in Hospitalized Patients. J Am Soc Nephrol. 2005. November 1;16(11):3365–70. 10.1681/ASN.2004090740 - DOI - PubMed
    1. Selby NM, Crowley L, Fluck RJ, McIntyre CW, Monaghan J, Lawson N, et al. Use of Electronic Results Reporting to Diagnose and Monitor AKI in Hospitalized Patients. Clin J Am Soc Nephrol. 2012. April 1;7(4):533–40. 10.2215/CJN.08970911 - DOI - PubMed
    1. Emmett L, Tollitt J, McCorkindale S, Sinha S, Poulikakos D. The Evidence of Acute Kidney Injury in the Community and for Primary Care Interventions. Nephron. 2017. March 25;136(3):202–10. 10.1159/000460266 - DOI - PubMed

Publication types