Comparison of Epidemiology and Outcomes of Acute Kidney Injury in Critically Ill Patients with and without Sepsis

Nithyashree Nandagopal; Pavan K Reddy; Lakshmi Ranganathan; Nagarajan Ramakrishnan; Rajiv Annigeri; Ramesh Venkataraman

doi:10.5005/jp-journals-10071-23386

Comparison of Epidemiology and Outcomes of Acute Kidney Injury in Critically Ill Patients with and without Sepsis

Indian J Crit Care Med. 2020 Apr;24(4):258-262. doi: 10.5005/jp-journals-10071-23386.

Authors

Nithyashree Nandagopal¹, Pavan K Reddy², Lakshmi Ranganathan², Nagarajan Ramakrishnan², Rajiv Annigeri¹, Ramesh Venkataraman²

Affiliations

¹ Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India.
² Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India.

Abstract

Objectives: In critically ill patients, acute kidney injury (AKI) and sepsis often coexist. This confounds the assessment of outcomes of both sepsis and AKI in these patients. Hence, in this study, we compare the outcomes of AKI with sepsis, AKI without sepsis, and sepsis without AKI against a control cohort comprising patients with neither AKI nor sepsis.

Materials and methods: Prospective observational study conducted in our critical care unit (CCU) between January and July 2009. Data including demographic details, acute physiology and chronic health evaluation (APACHE) III score, presence of AKI, presence of sepsis, intensive care unit (ICU) length of stay (LOS), and outcomes were collected for all patients. Acute Kidney Injury Network (AKIN) criteria were used to define the presence of AKI and American College of Critical Care Medicine 2001 definition was used to define the presence of sepsis.

Results: A total of 250 patients were included in the study and 8 patients were excluded from analysis as they were discharged from hospital against medical advice. The remaining 242 patients (mean age 52.8 ± 17 years; 61.6% male; APACHE III score: 48.2 ± 24.1) were analyzed, and AKI was seen in 111 patients (45.8%). Among the patients with AKI, 55.8% (62/111) had sepsis and 44.2% (49/111) had nonseptic AKI. There was a higher need for renal replacement therapy (RRT) among patients with septic AKI in comparison to those with nonseptic AKI (19.3% vs 6.1%; p = 0.04), but no mortality difference was seen between the two groups (25.8% vs 20.4%, p = 0.5). Patients with sepsis and AKI had a significantly higher mortality (25.8%) compared to the patients with sepsis alone (5.6%; p < 0.01).

Conclusion: Patients with septic AKI had a higher RRT requirement compared to patients with nonseptic AKI, but no significant differences in mortality were seen between the groups. Occurrence of AKI in septic patients substantially increases their mortality.

How to cite this article: Nandagopal N, Reddy PK, Ranganathan L, Ramakrishnan N, Annigeri R, Venkataraman R. Comparison of Epidemiology and Outcomes of Acute Kidney Injury in Critically Ill Patients with and without Sepsis. Indian J Crit Care Med 2020;24(4):258-262.

Keywords: Acute kidney injury; Acute kidney injury network; Sepsis.