Kidney Week

Abstract: FR-PO070

Incidence and Clinical Outcomes of Sepsis-Associated AKI: A Multicenter Contemporary Cohort Study

Session Information

• AKI: Epidemiology, Risk Factors, and Prevention - 2
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Takeuchi, Tomonori, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Tomonori Takeuchi, MD

• Flannery, Alexander H., University of Kentucky, Lexington, Kentucky, United States

Alexander H. Flannery, PharmD, PhD, FASN

• Liu, Lucas Jing, Fred Hutchinson Cancer Center, Seattle, Washington, United States

Lucas Jing Liu

• Cama-Olivares, Augusto, Brookwood Baptist Health, Birmingham, Alabama, United States

Augusto Cama-Olivares, MD

• Chen, Jin, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Jin Chen, PhD

• Huen, Sarah C., The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Sarah C. Huen, MD, PhD

• Tolwani, Ashita J., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Ashita J. Tolwani, MD, MS, MSc

• Neyra, Javier A., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Javier A. Neyra, MD, MS, FASN

Background

The Acute Dialysis Quality Initiative defines sepsis-associated acute kidney injury (SA-AKI) as meeting both Sepsis-3 and KDIGO criteria within 7 days of sepsis diagnosis. We aim to evaluate the epidemiology of SA-AKI based on this contemporary definition.

Methods

This multicenter retrospective cohort study used EHR data from two academic hospitals, focusing on ICU admissions for individuals aged ≥18 from 2/2010 to 6/2022. Patients with ESKD or kidney transplant were excluded. Using culture and antibiotic timestamps, we identified infection occurrence and classified sepsis if the SOFA score reached 2 or more during the same period. AKI was identified using KDIGO serum creatinine (SCr) and urine output criteria. We compared patients with SA-AKI to those who developed AKI without sepsis (AKI only) and those who developed sepsis without AKI (sepsis only). Clinical outcomes included in-hospital mortality and major adverse kidney events at discharge (MAKE), evaluated by multivariable Cox regression and logistic regression models, respectively.

Results

Among 187,888 identified ICU patients, 63,621 developed sepsis, and 70,692 developed AKI. Of these, 29,615 met the SA-AKI criteria. The median age of ICU patients was 59 [IQR: 47, 70] years, with 43.3% being women. The prevalence of diabetes, cardiovascular disease, and chronic kidney disease was 21.6, 30.4, and 13.7%, respectively. In-hospital mortality was 11.2 for sepsis only, 11.8 for AKI only, and 25.0% for SA-AKI, and the HRs were 1.18 (95% CI: 1.12-1.25) for AKI only and 1.59 (1.51-1.66) for SA-AKI, with sepsis only as the reference group (Figure). The incidence of MAKE was 12.9 for sepsis only, 18.6 for AKI only, and 37.7% for SA-AKI, and the ORs were 1.58 (1.50-1.66) for AKI only and 3.35 (3.19-3.51) for SA-AKI, with sepsis only as the reference group.

Conclusion

In critically ill adults, SA-AKI is a frequent condition that is associated with increased mortality and a higher incidence of MAKE compared to sepsis only and AKI only.

Funding

• NIDDK Support