Sepsis-associated acute kidney injury in the intensive care unit: Incidence, Patient Characteristics, Timing, Trajectory, Treatment, and Associated Outcomes. A multicenter, observational study.

Abstract

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 described the epidemiology of SA-AKI. Methods Retrospective cohort study in 12 intensive care units (ICU) from 2015 to 2021. We studied the incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes of the ADQI SA-AKI definition. Results Of 84,831 admissions, 15,549 met the SA-AKI criteria with its incidence peaking at > 20% in 2021. SA-AKI patients were typically admitted from home via the emergency department (ED) with median time to SA-AKI diagnosis of one day (IQR 1–1) from ICU admission. At diagnosis, most SA-AKI patients had a stage 1 (55%) AKI, mostly due to the low urinary output (UO) criterion only (67%). Compared to diagnosis by creatinine alone, or both UO and creatinine criteria, patients diagnosed by UO alone had lower RRT requirement (3.3% vs 19% vs 51%; p < 0.001), which was consistent across all stages of AKI. SA-AKI hospital mortality was 19% and SA-AKI was independently associated with increased mortality. However, diagnosis by low UO only carried an odds ratio of 0.37 (95% CI, 0.34–0.39) for mortality. Conclusion SA-AKI occurs in one in five ICU patients, is diagnosed on day one, 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.