February 2011, Volume 37, Issue 2, pp 241-248,
Open Access This content is freely available online to anyone, anywhere at any time.
Date: 09 Dec 2010
Sepsis as a cause and consequence of acute kidney injury: Program to Improve Care in Acute Renal Disease
Sepsis commonly contributes to acute kidney injury (AKI); however, the frequency with which sepsis develops as a complication of AKI and the clinical consequences of this sepsis are unknown. This study examined the incidence of, and outcomes associated with, sepsis developing after AKI.
We analyzed data from 618 critically ill patients enrolled in a multicenter observational study of AKI (PICARD). Patients were stratified according to their sepsis status and timing of incident sepsis relative to AKI diagnosis.
We determined the associations among sepsis, clinical characteristics, provision of dialysis, in-hospital mortality, and length of stay (LOS), comparing outcomes among patients according to their sepsis status. Among the 611 patients with data on sepsis status, 174 (28%) had sepsis before AKI, 194 (32%) remained sepsis-free, and 243 (40%) developed sepsis a median of 5 days after AKI. Mortality rates for patients with sepsis developing after AKI were higher than in sepsis-free patients (44 vs. 21%; p < 0.0001) and similar to patients with sepsis preceding AKI (48 vs. 44%; p = 0.41). Compared with sepsis-free patients, those with sepsis developing after AKI were also more likely to be dialyzed (70 vs. 50%; p < 0.001) and had longer LOS (37 vs. 27 days; p < 0.001). Oliguria, higher fluid accumulation and severity of illness scores, non-surgical procedures after AKI, and provision of dialysis were predictors of sepsis after AKI.
Sepsis frequently develops after AKI and portends a poor prognosis, with high mortality rates and relatively long LOS. Future studies should evaluate techniques to monitor for and manage this complication to improve overall prognosis.
This article is discussed in the editorial available at: doi:10.1007/s00134-010-2097-9.
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- Sepsis as a cause and consequence of acute kidney injury: Program to Improve Care in Acute Renal Disease
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Intensive Care Medicine
Volume 37, Issue 2 , pp 241-248
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- Acute kidney injury
- Intensive care unit
- Severity of illness
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- Author Affiliations
- 1. Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, 200 W Arbor Drive, San Diego, CA, 92103, USA
- 2. Division of Nephrology, Department of Medicine, Vanderbilt University, Nashville, TN, USA
- 3. Division of Nephrology, Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
- 4. Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
- 5. Kidney Research Institute and Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA