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. 2022 Mar 25:10:e13184.
doi: 10.7717/peerj.13184. eCollection 2022.

Acute kidney injury-attributable mortality in critically ill patients with sepsis

Zhiyi Wang #  1   2 , Jie Weng #  1 , Jinwen Yang  3 , Xiaoming Zhou  1 , Zhe Xu  4 , Ruonan Hou  1 , Zhiliang Zhou  1 , Liang Wang  5 , Chan Chen  3 , Shengwei Jin  6
Affiliations

Acute kidney injury-attributable mortality in critically ill patients with sepsis

Zhiyi Wang et al. PeerJ. .

Abstract

Background: To assess whether acute kidney injury (AKI) is independently associated with hospital mortality in ICU patients with sepsis, and estimate the excess AKI-related mortality attributable to AKI.

Methods: We analyzed adult patients from two distinct retrospective critically ill cohorts: (1) Medical Information Mart for Intensive Care IV (MIMIC IV; n = 15,610) cohort and (2) Wenzhou (n = 1,341) cohort. AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We applied multivariate logistic and linear regression models to assess the hospital and ICU mortality, hospital length-of-stay (LOS), and ICU LOS. The excess attributable mortality for AKI in ICU patients with sepsis was further evaluated.

Results: AKI occurred in 5,225 subjects in the MIMIC IV cohort (33.5%) and 494 in the Wenzhou cohort (36.8%). Each stage of AKI was an independent risk factor for hospital mortality in multivariate logistic regression after adjusting for baseline illness severity. The excess attributable mortality for AKI was 58.6% (95% CI [46.8%-70.3%]) in MIMIC IV and 44.6% (95% CI [12.7%-76.4%]) in Wenzhou. Additionally, AKI was independently associated with increased ICU mortality, hospital LOS, and ICU LOS.

Conclusion: Acute kidney injury is an independent risk factor for hospital and ICU mortality, as well as hospital and ICU LOS in critically ill patients with sepsis. Thus, AKI is associated with excess attributable mortality.

Keywords: Acute kidney injury; Attributable mortality; Mortality; Sepsis.

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Conflict of interest statement

The authors declare there are no competing interests.

Figures

Figure 1
Figure 1. Direct acyclic graph for the relationship between AKI and death.
Figure 2
Figure 2. Study flowcharts for the MIMIC IV and Wenzhou cohorts.
Figure 3
Figure 3. Odds ratios with 95% confidence intervals for in-hospital mortality stratified by severity of AKI.
In addition to severity of illness variables listed in the Figure, adjusted models for MIMIC IV include age, gender, race, and shock. Adjusted models for Wenzhou include age, gender and shock.
See this image and copyright information in PMC

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References

    1. Al-Jaghbeer M, Dealmeida D, Bilderback A, Ambrosino R, Kellum JA. Clinical decision support for in-hospital AKI. Journal of the American Society of Nephrology. 2018;29:654–660. doi: 10.1681/asn.2017070765. - DOI - PMC - PubMed
    1. Auriemma CL, Zhuo H, Delucchi K, Deiss T, Liu T, Jauregui A, Ke S, Vessel K, Lippi M, Seeley E, Kangelaris KN, Gomez A, Hendrickson C, Liu KD, Matthay MA, Ware LB, Calfee CS. Acute respiratory distress syndrome-attributable mortality in critically ill patients with sepsis. Intensive Care Medicine. 2020;46:1222–1231. doi: 10.1007/s00134-020-06010-9. - DOI - PMC - PubMed
    1. Barrantes F, Tian J, Vazquez R, Amoateng-Adjepong Y, Manthous CA. Acute kidney injury criteria predict outcomes of critically ill patients. Critical Care Medicine. 2008;36:1397–1403. doi: 10.1097/CCM.0b013e318168fbe0. - DOI - PubMed
    1. Chang JW, Jeng MJ, Yang LY, Chen TJ, Chiang SC, Soong WJ, Wu KG, Lee YS, Wang HH, Yang CF, Tsai HL. The epidemiology and prognostic factors of mortality in critically ill children with acute kidney injury in Taiwan. Kidney International. 2015;87:632–639. doi: 10.1038/ki.2014.299. - DOI - PubMed
    1. Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. American Journal of Kidney Diseases. 2009;53:961–973. doi: 10.1053/j.ajkd.2008.11.034. - DOI - PMC - PubMed

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