Long-term risk of mortality after acute kidney injury in patients with sepsis: a contemporary analysis

BMC Nephrol. 2010 Jun 2;11:9. doi: 10.1186/1471-2369-11-9.

Abstract

Background: Acute kidney injury (AKI) is associated with increased short-term mortality of septic patients; however, the exact influence of AKI on long-term mortality in such patients has not yet been determined.

Methods: We retrospectively evaluated the impact of AKI, defined by the "Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease" (RIFLE) classification based on creatinine criteria, on 2-year mortality in a cohort of 234 hospital surviving septic patients who had been hospitalized at the Infectious Disease Intensive Care Unit of our Hospital.

Results: Mean-follow-up was 21 +/- 6.4 months. During this period, 32 patients (13.7%) died. At 6 months, 1 and 2 years of follow-up, the cumulative probability of death of patients with previous AKI was 8.3, 16.9 and 34.2%, respectively, as compared with 2.2, 6 and 8.9% in patients without previous AKI (log-rank, P < 0.0001). In the univariate analysis, age (hazard ratio 1.4, 95% CI 1.2-1.7, P < 0.0001), as well as pre-existing cardiovascular disease (hazard ratio 3.6, 95% CI 1.4-9.4, P = 0.009), illness severity as evaluated by nonrenal APACHE II (hazard ratio 1.3, 95% CI 1.1-1.6, P = 0.002), and previous AKI (hazard ratio 4.2, 95% CI 2.1-8.5, P < 0.0001) were associated with increased 2-year mortality, while gender, race, pre-existing hypertension, cirrhosis, HIV infection, neoplasm, and baseline glomerular filtration rate did not. In the multivariate analysis, however, only previous AKI (hazard ratio 3.2, 95% CI 1.6-6.5, P = 0.001) and age (hazard ratio 1.4, 95% CI 1.2-1.6, P < 0.0001) emerged as independent predictors of 2-year mortality.

Conclusions: Acute kidney injury had a negative impact on long-term mortality of patients with sepsis.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Cardiovascular Diseases / complications
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Intensive Care Units
  • Kidney Diseases / complications*
  • Kidney Diseases / physiopathology
  • Male
  • Medical Records
  • Middle Aged
  • Multivariate Analysis
  • Probability
  • Retrospective Studies
  • Risk Assessment
  • Sepsis / complications*
  • Sepsis / mortality*
  • Severity of Illness Index
  • Time Factors