[An analysis of clinical characteristics of septic acute kidney injury by using criteria of Kidney Disease: Improving Global Outcomes]

Zhi-Dong Zang, Jie Yan
Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine] 2013, 52 (4): 299-304

OBJECTIVE: To evaluate the value of Kidney Disease: Improving Global Outcomes (KDIGO) criteria in investigating clinical feature and prognosis of acute kidney injury (AKI) patients with sepsis in ICU.

METHODS: Clinical data of patients with AKI defined by KDIGO criteria in ICU of Wuxi People's Hospital from June 2007 to June 2012 were collected. Clinical characteristics, prognosis and major risk factors of death of septic AKI patients were retrospectively analyzed.

RESULTS: Of the enrolled 703 AKI patients, 395 (56.2%) were caused by sepsis (septic AKI), which indicated that sepsis mainly contributed to the causes of AKI. For septic AKI stratified by KDIGO classification, 146 (37.0%) patients belonged to AKI I, 154 (39.0%) to AKI II, and 95 (24.1%) to AKI III. Compared with the patients with non-septic AKI, septic AKI patients had greater APACHE II and SOFA score (25.1 ± 4.9 vs 20.5 ± 6.4, 12.9 ± 2.6 vs 10.4 ± 4.5; all P values < 0.05). Although there was no significant difference in baseline serum creatinine [(82.9 ± 22.2) µmol/L vs (83.1 ± 30.0) µmol/L, P > 0.05] between the two groups, patients with sepsis had higher serum creatinine [(143.5 ± 21.6) µmol/L vs (96.2 ± 15.5)µmol/L; P < 0.05], a higher proportion fulfilled KDIGO categories for both AKI II and III (63.0% vs 33.1%; P < 0.05), a higher renal replacement therapy (RRT) rate (22.3% vs 6.2%; P < 0.05) and a lower proportion of complete renal recovery (74.4% vs 82.8%) (all P values < 0.05). The 90-day mortality of septic AKI patients was higher than that of non-septic AKI patients (52.2% vs 34.1%; P < 0.05). Septic AKI, graded by KDIGO, was associated with an increased mortality. Logistic regression analysis showed that APACHEII score (OR = 5.451, 95%CI: 3.095 - 9.416), SOFA score (OR = 2.166, 95%CI: 1.964 - 4.515) and RRT (OR = 4.021, 95%CI: 2.975 - 6.324) were independent risk factors for mortality of septic AKI patients.

CONCLUSION: Septic AKI patients have a higher burden of illness, worse renal function and higher mortality. APACHEII score, SOFA score and RRT are independent risk factors to septic AKI mortality.

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