Septic Acute Kidney Injury – A Unique Pathophysiologic Condition

A new study has found that intensive care unit (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.

Researchers from Austin Hospital (Heidelberg, Australia) conducted a retrospective interrogation of prospectively collected data from the Australian New Zealand intensive care society (ANZICS) adult patient database. Data were collected from 57 intensive care units (ICUs) across Australia. In total, 120,123 patients admitted to ICU for more than 24 hours from January 1, 2000, to December 31, 2005, were included in the analysis. The main outcome measures were clinical and laboratory data and outcomes.

The results showed that of total patients admitted, 33,375 had a sepsis-related diagnosis (27.8%). Among septic patients, 14,039 (42.1%) had concomitant AKI; sepsis accounted for 32.4% of all patients with AKI. For septic AKI stratified by category, 38.5% of patients belonged to the risk category, 38.8% to the injury category, and 22.7% to the failure category. Septic AKI patients had greater acuity of illness, lower blood pressure, higher heart rates, worse pulmonary function measures, greater acidaemia, and higher white cell counts compared with patients with nonseptic AKI. Septic AKI was also associated with greater severity of AKI compared with nonseptic AKI. Septic AKI was additionally associated with a significantly higher mortality in the ICU (19.8% versus 13.4%) and in hospital (29.7% versus 21.6%) compared with nonseptic AKI. Septic AKI patients had longer durations of stay in both ICU and in the hospital. The study was published on April 10, 2008, in the open access journal Critical Care, a publication of BioMed Central.

"Septic AKI is common in the first 24 hours after ICU admission,” said lead author Sean Bagshaw, M.D., of the department of intensive care. "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,” added Dr. Bagshaw. "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.”


Related Links:
Austin Hospital
BioMed Central