Clinical Profile and Outcomes of Acute Cardiorenal Syndrome type-5 in Sepsis: An Eight-Year Cohort Study

PLoS One. 2018 Jan 9;13(1):e0190965. doi: 10.1371/journal.pone.0190965. eCollection 2018.

Abstract

Background: To evaluate the clinical features and outcomes of acute cardiorenal syndrome type-5 in patients with severe sepsis and septic shock.

Methods: Historical cohort study of all adult patients with severe sepsis and septic shock admitted to the intensive care units (ICU) at Mayo Clinic Rochester from January 1, 2007 through December 31, 2014. Patients with prior renal or cardiac dysfunction were excluded. Patients were divided into groups with and without cardiorenal syndrome type-5. Acute Kidney Injury (AKI) was defined by both serum creatinine and urine output criteria of the AKI Network and the cardiac injury was determined by troponin-T levels. Outcomes included in-hospital mortality, ICU and hospital length of stay, and one-year survival.

Results: Of 602 patients meeting the study inclusion criteria, 430 (71.4%) met criteria for acute cardiorenal syndrome type-5. Patients with cardiorenal syndrome type-5 had higher severity of illness, greater vasopressor and mechanical ventilation use. Cardiorenal syndrome type-5 was associated higher unadjusted in-hospital mortality, ICU and hospital lengths of stay, and lower one-year survival. When adjusted for age, gender, severity of illness and mechanical ventilation, cardiorenal syndrome type-5 was independently associated with 1.7-times greater odds of in-hospital mortality (p = .03), but did not predict one-year survival (p = .06) compared to patients without cardiorenal syndrome.

Conclusions: In sepsis, acute cardiorenal syndrome type-5 is associated with worse in-hospital mortality compared to patients without cardiorenal syndrome.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cardio-Renal Syndrome / complications
  • Cardio-Renal Syndrome / pathology*
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Respiration, Artificial
  • Sepsis / complications*
  • Sepsis / physiopathology
  • Severity of Illness Index
  • Treatment Outcome

Grant support

This work was supported, in part, by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH) to SV. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH and also supported, in part, by intramural funding from the Critical Care Research Committee, Critical Care Independent Multidisciplinary Program, Mayo Clinic, Rochester MN, Grant Number 15-006554 to SV. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.