The effects of timing onset and progression of AKI on the clinical outcomes in AKI patients with sepsis: a prospective multicenter cohort study
AbstractBackground Limited studies are available concerning on the earlier identification of AKI with sepsis. The aim of the study was to identify the risk factors of AKI early which depended on the timing onset and progression of AKI and investigate the effects of timing onset and progression of AK...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-12-01
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| Series: | Renal Failure |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/0886022X.2022.2138433 |
| _version_ | 1797658453715451904 |
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| author | Meiping Wang Xia Wang Bo Zhu Wen Li Qi Jiang Yingting Zuo Jing Wen Yan He Xiuming Xi Li Jiang |
| author_facet | Meiping Wang Xia Wang Bo Zhu Wen Li Qi Jiang Yingting Zuo Jing Wen Yan He Xiuming Xi Li Jiang |
| author_sort | Meiping Wang |
| collection | DOAJ |
| description | AbstractBackground Limited studies are available concerning on the earlier identification of AKI with sepsis. The aim of the study was to identify the risk factors of AKI early which depended on the timing onset and progression of AKI and investigate the effects of timing onset and progression of AKI on clinical outcomes.Methods Patients who developed sepsis during their first 48-h admission to ICU were included. The primary outcome was major adverse kidney events (MAKE) consisted of all-cause mortality, RRT-dependence, or an inability to recover to 1.5 times of the baseline creatinine value up to 30 days. We determined MAKE and in-hospital mortality by multivariable logistic regression and explored the risk factors of early persistent-AKI. C statistics were used to evaluate model fit.Results 58.7% sepsis patients developed AKI. According to the timing onset and progression of AKI, Early transient-AKI, early persistent-AKI, late transient-AKI, late persistent-AKI were identified. Clinical outcomes were quite different among subgroups. Early persistent-AKI had 3.0-fold (OR 3.04, 95% CI 1.61 − 4.62) risk of MAKE and 2.6-fold (OR 2.60, 95%CI 1.72 − 3.76) risk of in-hospital mortality increased compared with the late transients-AKI. Older age, underweight, obese, faster heart rate, lower MAP, platelet, hematocrit, pH and energy intake during the first 24 h on ICU admission could well predict the early persistent-AKI in patients with sepsis.Conclusion Four AKI subphenotypes were identified based on the timing onset and progression of AKI. Early persistent-AKI showed higher risk of major adverse kidney events and in-hospital mortality.Trial registration This study was registered in the Chinese Clinical Trials Registry (www.chictr.org/cn) under registration number ChiCTR-ECH-13003934. |
| first_indexed | 2024-03-11T18:00:19Z |
| format | Article |
| id | doaj.art-ad78d86cb69a45cb8a618b31e10082cc |
| institution | Directory Open Access Journal |
| issn | 0886-022X 1525-6049 |
| language | English |
| last_indexed | 2024-03-11T18:00:19Z |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj.art-ad78d86cb69a45cb8a618b31e10082cc2023-10-17T09:23:24ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492023-12-0145110.1080/0886022X.2022.2138433The effects of timing onset and progression of AKI on the clinical outcomes in AKI patients with sepsis: a prospective multicenter cohort studyMeiping Wang0Xia Wang1Bo Zhu2Wen Li3Qi Jiang4Yingting Zuo5Jing Wen6Yan He7Xiuming Xi8Li Jiang9Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, ChinaDepartment of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, ChinaDepartment of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, ChinaDepartment of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, ChinaDepartment of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, ChinaDepartment of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, ChinaDepartment of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, ChinaDepartment of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, ChinaDepartment of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, ChinaDepartment of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, ChinaAbstractBackground Limited studies are available concerning on the earlier identification of AKI with sepsis. The aim of the study was to identify the risk factors of AKI early which depended on the timing onset and progression of AKI and investigate the effects of timing onset and progression of AKI on clinical outcomes.Methods Patients who developed sepsis during their first 48-h admission to ICU were included. The primary outcome was major adverse kidney events (MAKE) consisted of all-cause mortality, RRT-dependence, or an inability to recover to 1.5 times of the baseline creatinine value up to 30 days. We determined MAKE and in-hospital mortality by multivariable logistic regression and explored the risk factors of early persistent-AKI. C statistics were used to evaluate model fit.Results 58.7% sepsis patients developed AKI. According to the timing onset and progression of AKI, Early transient-AKI, early persistent-AKI, late transient-AKI, late persistent-AKI were identified. Clinical outcomes were quite different among subgroups. Early persistent-AKI had 3.0-fold (OR 3.04, 95% CI 1.61 − 4.62) risk of MAKE and 2.6-fold (OR 2.60, 95%CI 1.72 − 3.76) risk of in-hospital mortality increased compared with the late transients-AKI. Older age, underweight, obese, faster heart rate, lower MAP, platelet, hematocrit, pH and energy intake during the first 24 h on ICU admission could well predict the early persistent-AKI in patients with sepsis.Conclusion Four AKI subphenotypes were identified based on the timing onset and progression of AKI. Early persistent-AKI showed higher risk of major adverse kidney events and in-hospital mortality.Trial registration This study was registered in the Chinese Clinical Trials Registry (www.chictr.org/cn) under registration number ChiCTR-ECH-13003934.https://www.tandfonline.com/doi/10.1080/0886022X.2022.2138433Sepsisacute kidney injurymajor adverse kidney eventsin-hospital mortalityintensive care unit |
| spellingShingle | Meiping Wang Xia Wang Bo Zhu Wen Li Qi Jiang Yingting Zuo Jing Wen Yan He Xiuming Xi Li Jiang The effects of timing onset and progression of AKI on the clinical outcomes in AKI patients with sepsis: a prospective multicenter cohort study Renal Failure Sepsis acute kidney injury major adverse kidney events in-hospital mortality intensive care unit |
| title | The effects of timing onset and progression of AKI on the clinical outcomes in AKI patients with sepsis: a prospective multicenter cohort study |
| title_full | The effects of timing onset and progression of AKI on the clinical outcomes in AKI patients with sepsis: a prospective multicenter cohort study |
| title_fullStr | The effects of timing onset and progression of AKI on the clinical outcomes in AKI patients with sepsis: a prospective multicenter cohort study |
| title_full_unstemmed | The effects of timing onset and progression of AKI on the clinical outcomes in AKI patients with sepsis: a prospective multicenter cohort study |
| title_short | The effects of timing onset and progression of AKI on the clinical outcomes in AKI patients with sepsis: a prospective multicenter cohort study |
| title_sort | effects of timing onset and progression of aki on the clinical outcomes in aki patients with sepsis a prospective multicenter cohort study |
| topic | Sepsis acute kidney injury major adverse kidney events in-hospital mortality intensive care unit |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2022.2138433 |
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