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Observational Study
. 2024 Nov 24;28(1):383.
doi: 10.1186/s13054-024-05167-9.

Epidemiology of sepsis-associated acute kidney injury in critically ill patients: a multicenter, prospective, observational cohort study in South Korea

Myung Jin Song #  1 , Yeonhoon Jang #  2 , Matthieu Legrand  3 , Sunghoon Park  4 , RyoungEun Ko  5 , Gee Young Suh  5   6 , Dong Kyu Oh  7 , Su Yeon Lee  7 , Mi Hyeon Park  7 , Chae-Man Lim  7 , Se Young Jung  8   9 , Sung Yoon Lim  10 ; Korean Sepsis Alliance (KSA) investigator
Affiliations
Observational Study

Epidemiology of sepsis-associated acute kidney injury in critically ill patients: a multicenter, prospective, observational cohort study in South Korea

Myung Jin Song et al. Crit Care. .

Abstract

Background: Despite the clinical importance of sepsis-associated acute kidney injury (SA-AKI), little is known about its epidemiology. We aimed to investigate the incidence and outcomes of SA-AKI, as well as the risk factors for mortality among patients with severe SA-AKI in critically ill patients.

Methods: This secondary multicenter, observational, prospective cohort analysis of sepsis in South Korea evaluated patients aged ≥ 19 years admitted to intensive care units with a diagnosis of sepsis. The primary outcome was the incidence of SA-AKI, defined using the new consensus definition of the Acute Disease Quality Initiative 28 Workgroup. Secondary outcomes were in-hospital mortality and risk factors for in-hospital mortality.

Results: Between September 2019 and December 2022, 5100 patients were admitted to intensive care units with a diagnosis of sepsis, and 3177 (62.3%) developed SA-AKI. A total of 613 (19.3%), 721 (22.7%), and 1843 (58.0%) patients had stage 1, 2, and 3 SA-AKI, respectively. Severe SA-AKI (stages 2 and 3 combined) was associated with an increased risk of in-hospital mortality. Adherence to the fluid resuscitation component of the one-hour sepsis bundle was associated with a decreased risk of in-hospital mortality in severe SA-AKI (adjusted odds ratio, 0.62; 95% confidence interval, 0.48-0.79; P < 0.001).

Conclusions: Of the patients admitted to the intensive care unit for sepsis, 62.3% developed SA-AKI. Severe SA-AKI was associated with an increased risk of mortality. Adherence to the fluid resuscitation component of the one-hour sepsis bundle can potentially improve outcomes in these patients.

Keywords: Acute kidney injury; Epidemiology; Intensive care unit; Kidney; Sepsis.

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Conflict of interest statement

Declarations. Availability of data and materials: No datasets were generated or analysed during the current study. The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate: This study was approved by the institutional review boards of each participating hospital, including the Seoul National University Bundang Hospital (IRB number: B-1810-500-402). The requirement for informed consent was waived because of the noninterventional, observational nature of the study. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flow CKD, chronic kidney disease; ESRD, end-stage renal disease; ICU, intensive care unit; KSA, Korean Sepsis Alliance; SA-AKI, sepsis-associated acute kidney injury; Cr, creatinine level
Fig. 2
Fig. 2
Kaplan–Meier survival curves according to the sepsis-associated acute kidney injury stage. A Kaplan–Meier survival curves for in-hospital mortality. B Kaplan–Meier survival curves for ICU mortality. ICU, intensive care unit; SA-AKI, sepsis-associated acute kidney injury
See this image and copyright information in PMC

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