Observational Study

. 2023 Sep;49(9):1079-1089.

doi: 10.1007/s00134-023-07138-0. Epub 2023 Jul 11.

Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study

Kyle C White^{1

2

3}, Ary Serpa-Neto^{4

5}, Rod Hurford⁶, Pierre Clement⁷, Kevin B Laupland^{8

7}, Emily See^{9

10

11

12

13}, James McCullough¹⁴, Hayden White^{15

16}, Kiran Shekar^{17

8

18}, Alexis Tabah^{17

8

19}, Mahesh Ramanan^{17

20

21}, Peter Garrett^{5

22}, Antony G Attokaran^{17

23}, Stephen Luke^{24

25}, Siva Senthuran^{25

26}, Philippa McIlroy²⁷, Rinaldo Bellomo^{4

10

11

28}; Queensland Critical Care Research Network (QCCRN)

Collaborators, Affiliations

Collaborators

Queensland Critical Care Research Network (QCCRN):
Mahesh Ramanan, Prashanti Marella, Patrick Young, Pip McIlroy, Ben Nash, James McCullough, Mandy Tallott, Andrea Marshall, David Moore, Hayden White, Sunil Sane, Lynette Morrison, Pam Dipplesman, Stephen Luke, Anni Paasilahti, Ray Asimus, Jennifer Taylor, Kyle White, David Cook, Peter Kruger, Jason Meyer, Rod Hurford, Kevin Plumpton, Andrew Barlow, Alexis Tabah, Hamish Pollock, Patrick Young, Antony G Attokaran, Jacobus Poggenpoel, Josephine Reoch, Kevin B Laupland, Felicity Edwards, Jayesh Dhanani, Marianne Kirrane, Pierre Clement, Nermin Karamujic, Paula Lister, Vikram Masurkar, Lauren Murray, Jane Brailsford, Todd Erbacher, Kiran Shekar, Jayshree Lavana, George Cornell, Siva Senthuran, Stephen Whebell, Gail Henson, Michelle Gatton, Zephanie Tyack, Robert Andrews, Arthur Ter Hofstede, Moe Wynn, Kevin B Laupland, Felicity Edwards

Affiliations

¹ Intensive Care Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia. kyle.white@health.qld.gov.au.
² Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. kyle.white@health.qld.gov.au.
³ Queensland University of Technology (QUT), Brisbane, QLD, Australia. kyle.white@health.qld.gov.au.
⁴ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁵ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁶ Intensive Care Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.
⁷ Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
⁸ Queensland University of Technology (QUT), Brisbane, QLD, Australia.
⁹ School of Medicine, University of Melbourne, Melbourne, Australia.
¹⁰ Department of Critical Care, University of Melbourne, Melbourne, Australia.
¹¹ Department of Intensive Care, Austin Hospital, Heidelberg, Australia.
¹² Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia.
¹³ Department of Nephrology, The Royal Children's Hospital, Parkville, Australia.
¹⁴ Intensive Care Unit, Gold Coast University Hospital, Southport, QLD, Australia.
¹⁵ Intensive Care Unit, Logan Hospital, Logan, QLD, Australia.
¹⁶ School of Medicine and Dentistry, Griffith University, Mount Gravatt, QLD, Australia.
¹⁷ Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
¹⁸ Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia.
¹⁹ Intensive Care Unit, Redcliffe Hospital, Brisbane, QLD, Australia.
²⁰ Intensive Care Unit, Caboolture Hospital, Caboolture, QLD, Australia.
²¹ Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia.
²² Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, QLD, Australia.
²³ Intensive Care Unit, Rockhampton Hospital, The Range, QLD, Australia.
²⁴ Intensive Care Services, Mackay Base Hospital, Mackay, QLD, Australia.
²⁵ College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
²⁶ Intensive Care Unit, Townsville Hospital, Townsville, QLD, Australia.
²⁷ Intensive Care Unit, Cairns Hospital, Cairns, QLD, Australia.
²⁸ Department of Intensive Care,, Royal Melbourne Hospital, Melbourne, Australia.

PMID: 37432520
PMCID: PMC10499944
DOI: 10.1007/s00134-023-07138-0

Observational Study

Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study

Kyle C White et al. Intensive Care Med. 2023 Sep.

. 2023 Sep;49(9):1079-1089.

doi: 10.1007/s00134-023-07138-0. Epub 2023 Jul 11.

Authors

Collaborators

Queensland Critical Care Research Network (QCCRN):
Mahesh Ramanan, Prashanti Marella, Patrick Young, Pip McIlroy, Ben Nash, James McCullough, Mandy Tallott, Andrea Marshall, David Moore, Hayden White, Sunil Sane, Lynette Morrison, Pam Dipplesman, Stephen Luke, Anni Paasilahti, Ray Asimus, Jennifer Taylor, Kyle White, David Cook, Peter Kruger, Jason Meyer, Rod Hurford, Kevin Plumpton, Andrew Barlow, Alexis Tabah, Hamish Pollock, Patrick Young, Antony G Attokaran, Jacobus Poggenpoel, Josephine Reoch, Kevin B Laupland, Felicity Edwards, Jayesh Dhanani, Marianne Kirrane, Pierre Clement, Nermin Karamujic, Paula Lister, Vikram Masurkar, Lauren Murray, Jane Brailsford, Todd Erbacher, Kiran Shekar, Jayshree Lavana, George Cornell, Siva Senthuran, Stephen Whebell, Gail Henson, Michelle Gatton, Zephanie Tyack, Robert Andrews, Arthur Ter Hofstede, Moe Wynn, Kevin B Laupland, Felicity Edwards

Affiliations

¹ Intensive Care Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia. kyle.white@health.qld.gov.au.
² Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. kyle.white@health.qld.gov.au.
³ Queensland University of Technology (QUT), Brisbane, QLD, Australia. kyle.white@health.qld.gov.au.
⁴ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁵ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁶ Intensive Care Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.
⁷ Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
⁸ Queensland University of Technology (QUT), Brisbane, QLD, Australia.
⁹ School of Medicine, University of Melbourne, Melbourne, Australia.
¹⁰ Department of Critical Care, University of Melbourne, Melbourne, Australia.
¹¹ Department of Intensive Care, Austin Hospital, Heidelberg, Australia.
¹² Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia.
¹³ Department of Nephrology, The Royal Children's Hospital, Parkville, Australia.
¹⁴ Intensive Care Unit, Gold Coast University Hospital, Southport, QLD, Australia.
¹⁵ Intensive Care Unit, Logan Hospital, Logan, QLD, Australia.
¹⁶ School of Medicine and Dentistry, Griffith University, Mount Gravatt, QLD, Australia.
¹⁷ Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
¹⁸ Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia.
¹⁹ Intensive Care Unit, Redcliffe Hospital, Brisbane, QLD, Australia.
²⁰ Intensive Care Unit, Caboolture Hospital, Caboolture, QLD, Australia.
²¹ Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia.
²² Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, QLD, Australia.
²³ Intensive Care Unit, Rockhampton Hospital, The Range, QLD, Australia.
²⁴ Intensive Care Services, Mackay Base Hospital, Mackay, QLD, Australia.
²⁵ College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
²⁶ Intensive Care Unit, Townsville Hospital, Townsville, QLD, Australia.
²⁷ Intensive Care Unit, Cairns Hospital, Cairns, QLD, Australia.
²⁸ Department of Intensive Care,, Royal Melbourne Hospital, Melbourne, Australia.

PMID: 37432520
PMCID: PMC10499944
DOI: 10.1007/s00134-023-07138-0

Abstract

Purpose: The Acute Disease Quality Initiative (ADQI) Workgroup recently released a consensus definition of sepsis-associated acute kidney injury (SA-AKI), combining Sepsis-3 and Kidney Disease Improving Global Outcomes (KDIGO) AKI criteria. This study aims to describe the epidemiology of SA-AKI.

Methods: This is a retrospective cohort study carried out in 12 intensive care units (ICUs) from 2015 to 2021. We studied the incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes of SA-AKI based on the ADQI definition.

Results: Out of 84,528 admissions, 13,451 met the SA-AKI criteria with its incidence peaking at 18% in 2021. SA-AKI patients were typically admitted from home via the emergency department (ED) with a median time to SA-AKI diagnosis of 1 day (interquartile range (IQR) 1-1) from ICU admission. At diagnosis, most SA-AKI patients (54%) had a stage 1 AKI, mostly due to the low urinary output (UO) criterion only (65%). Compared to diagnosis by creatinine alone, or by both UO and creatinine criteria, patients diagnosed by UO alone had lower renal replacement therapy (RRT) requirements (2.8% vs 18% vs 50%; p < 0.001), which was consistent across all stages of AKI. SA-AKI hospital mortality was 18% and SA-AKI was independently associated with increased mortality. In SA-AKI, diagnosis by low UO only, compared to creatinine alone or to both UO and creatinine criteria, carried an odds ratio of 0.34 (95% confidence interval (CI) 0.32-0.36) for mortality.

Conclusion: SA-AKI occurs in 1 in 6 ICU patients, is diagnosed on day 1 and carries significant morbidity and mortality risk with patients mostly admitted from home via the ED. However, most SA-AKI is stage 1 and mostly due to low UO, which carries much lower risk than diagnosis by other criteria.

Keywords: Acute kidney injury; Critical care; Sepsis; Sepsis-associated acute kidney injury.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

**Fig. 1**
Mean Daily serum creatinine by AKI diagnostic criteria

See this image and copyright information in PMC

Comment in

Clinical implications of urine output-based sepsis-associated acute kidney injury.
Kasugai D, Nakashima T, Goto T. Kasugai D, et al. Intensive Care Med. 2023 Oct;49(10):1263-1265. doi: 10.1007/s00134-023-07190-w. Epub 2023 Aug 21. Intensive Care Med. 2023. PMID: 37604956 No abstract available.
Double the risk of death and other 'inconvenient truths' about oliguria.
Kellum JA, Murugan R. Kellum JA, et al. Intensive Care Med. 2023 Nov;49(11):1420-1421. doi: 10.1007/s00134-023-07187-5. Epub 2023 Aug 24. Intensive Care Med. 2023. PMID: 37620560 No abstract available.
Tackling sepsis-associated acute kidney injury using routinely collected data.
Claure-Del Granado R, James MT, Legrand M. Claure-Del Granado R, et al. Intensive Care Med. 2023 Sep;49(9):1100-1102. doi: 10.1007/s00134-023-07200-x. Epub 2023 Aug 28. Intensive Care Med. 2023. PMID: 37638977 No abstract available.
Details and the devil within - the case of sepsis associated acute kidney injury.
Gómez H, Zarbock A. Gómez H, et al. Intensive Care Med. 2023 Nov;49(11):1424-1425. doi: 10.1007/s00134-023-07204-7. Epub 2023 Aug 31. Intensive Care Med. 2023. PMID: 37650942 No abstract available.

References

1. Finfer S, Machado FR. The global epidemiology of sepsis. Does it matter that we know so little? Am J Resp Crit Care. 2016;193(3):228–230. doi: 10.1164/rccm.201510-1976ED. - DOI - PubMed
1. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units and colon; results of the SOAP study and ast. Crit Care Med. 2006;34(2):344–353. doi: 10.1097/01.CCM.0000194725.48928.3A. - DOI - PubMed
1. Chiu C, Legrand M. Epidemiology of sepsis and septic shock. Curr Opin Anaesthesiol. 2021;34(2):71–76. doi: 10.1097/ACO.0000000000000958. - DOI - PubMed
1. Poston JT, Koyner JL. Sepsis associated acute kidney injury. BMJ. 2019;364:k4891. doi: 10.1136/bmj.k4891. - DOI - PMC - PubMed
1. Peerapornratana S, Manrique-Caballero CL, Gómez H, Kellum JA. Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney Int. 2019;96(5):1083–1099. doi: 10.1016/j.kint.2019.05.026. - DOI - PMC - PubMed

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Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study

Collaborators

Affiliations

Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

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Comment in

References

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Medical

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