Acute kidney injury with sepsis

ICU patients with septic acute kidney injury (AKI) are generally sicker, have a higher burden of illness, a greater risk of mortality and longer stays in hospital than patients with non-septic AKI.

The findings, published in the open access journal Critical Care, suggest that septic AKI may represent a unique pathophysiologic condition that may require specific detection and clinical interventions.

Researchers from Melbourne, Australia, evaluated data on more than 120,000 admissions to 57 intensive care units (ICUs) across Australia. Over 33,000 patients had a diagnosis of sepsis, of which 14,000 (42%) had concomitant AKI (septic AKI). Sepsis accounted for 32.4% of all patients with AKI.

Previous research has found that AKI affects more than one third of all patients admitted to ICUs and that discriminating between the septic and non-septic forms of the condition may have implications for how patients are treated.

Compared to non-septic AKI, patients with septic AKI in this latest study had significantly higher acuity of illness, lower blood pressure, higher heart rates, worse pulmonary function, greater acidemia and higher white cell counts.

The septic condition tended to be more severe, with longer ICU and hospital stays and a higher risk of mortality in hospital.

“Septic AKI is common in the first 24 hours after ICU admission,” says Sean Bagshaw, who led the study. “Our findings suggest that septic AKI patients are clinically distinct and have distinguishing features and relevant difference in clinical outcomes when compared to those with non-septic AKI.

“Our study further supports the concept that discriminating septic and non-septic AKI may have clinical importance. We now need to investigate further whether patients may require specific interventions, for example mechanical ventilation or vasopressor support, to reduce injury and promote kidney recovery.”