Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study
Abstract Background Sepsis and acute kidney injury (AKI) are common severe diseases in the intensive care unit (ICU). This study aimed to estimate the attributable mortality of AKI among critically ill patients with sepsis and to assess whether AKI was an independent risk factor for 30-day mortality...
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-024-03551-9 |
| _version_ | 1797209501307240448 |
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| author | Dong-Hui Wang Jin-Chao Zhao Xiu-Ming Xi Yue Zheng Wen-Xiong Li |
| author_facet | Dong-Hui Wang Jin-Chao Zhao Xiu-Ming Xi Yue Zheng Wen-Xiong Li |
| author_sort | Dong-Hui Wang |
| collection | DOAJ |
| description | Abstract Background Sepsis and acute kidney injury (AKI) are common severe diseases in the intensive care unit (ICU). This study aimed to estimate the attributable mortality of AKI among critically ill patients with sepsis and to assess whether AKI was an independent risk factor for 30-day mortality. Methods The information we used was derived from a multicenter prospective cohort study conducted in 18 Chinese ICUs, focusing on septic patients post ICU admission. The patients were categorized into two groups: those who developed AKI (AKI group) within seven days following a sepsis diagnosis and those who did not develop AKI (non-AKI group). Using propensity score matching (PSM), patients were matched 1:1 as AKI and non-AKI groups. We then calculated the mortality rate attributable to AKI in septic patients. Furthermore, a survival analysis was conducted comparing the matched AKI and non-AKI septic patients. The primary outcome of interest was the 30-day mortality rate following the diagnosis of sepsis. Results Out of the 2175 eligible septic patients, 61.7% developed AKI. After the application of PSM, a total of 784 septic patients who developed AKI were matched in a 1:1 ratio with 784 septic patients who did not develop AKI. The overall 30-day attributable mortality of AKI was 6.6% (95% CI 2.3 ∼ 10.9%, p = 0.002). A subgroup analysis revealed that the 30-day attributable mortality rates for stage 1, stage 2, and stage 3 AKI were 0.6% (95% CI −5.9 ∼ 7.2%, p = 0.846), 4.7% (95% CI −3.1 ∼ 12.4%, p = 0.221) and 16.8% (95% CI 8.1 ∼ 25.2%, p < 0.001), respectively. Particularly noteworthy was that stage 3 AKI emerged as an independent risk factor for 30-day mortality, possessing an adjusted hazard ratio of 1.80 (95% CI 1.31 ∼ 2.47, p < 0.001). Conclusions The overall 30-day attributable mortality of AKI among critically ill patients with sepsis was 6.6%. Stage 3 AKI had the most significant contribution to 30-day mortality, while stage 1 and stage 2 AKI did not increase excess mortality. |
| first_indexed | 2024-04-24T09:55:42Z |
| format | Article |
| id | doaj.art-c28ca523206843aa9254c1b47c8f7f33 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-04-24T09:55:42Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-c28ca523206843aa9254c1b47c8f7f332024-04-14T11:09:56ZengBMCBMC Nephrology1471-23692024-04-0125111010.1186/s12882-024-03551-9Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort studyDong-Hui Wang0Jin-Chao Zhao1Xiu-Ming Xi2Yue Zheng3Wen-Xiong Li4Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical UniversityDepartment of Clinical Laboratory, Xiangyang No.1 People’ s Hospital, Hubei University of MedicineDepartment of Critical Care Medicine, Fuxing Hospital, Capital Medical UniversityDepartment of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical UniversityDepartment of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical UniversityAbstract Background Sepsis and acute kidney injury (AKI) are common severe diseases in the intensive care unit (ICU). This study aimed to estimate the attributable mortality of AKI among critically ill patients with sepsis and to assess whether AKI was an independent risk factor for 30-day mortality. Methods The information we used was derived from a multicenter prospective cohort study conducted in 18 Chinese ICUs, focusing on septic patients post ICU admission. The patients were categorized into two groups: those who developed AKI (AKI group) within seven days following a sepsis diagnosis and those who did not develop AKI (non-AKI group). Using propensity score matching (PSM), patients were matched 1:1 as AKI and non-AKI groups. We then calculated the mortality rate attributable to AKI in septic patients. Furthermore, a survival analysis was conducted comparing the matched AKI and non-AKI septic patients. The primary outcome of interest was the 30-day mortality rate following the diagnosis of sepsis. Results Out of the 2175 eligible septic patients, 61.7% developed AKI. After the application of PSM, a total of 784 septic patients who developed AKI were matched in a 1:1 ratio with 784 septic patients who did not develop AKI. The overall 30-day attributable mortality of AKI was 6.6% (95% CI 2.3 ∼ 10.9%, p = 0.002). A subgroup analysis revealed that the 30-day attributable mortality rates for stage 1, stage 2, and stage 3 AKI were 0.6% (95% CI −5.9 ∼ 7.2%, p = 0.846), 4.7% (95% CI −3.1 ∼ 12.4%, p = 0.221) and 16.8% (95% CI 8.1 ∼ 25.2%, p < 0.001), respectively. Particularly noteworthy was that stage 3 AKI emerged as an independent risk factor for 30-day mortality, possessing an adjusted hazard ratio of 1.80 (95% CI 1.31 ∼ 2.47, p < 0.001). Conclusions The overall 30-day attributable mortality of AKI among critically ill patients with sepsis was 6.6%. Stage 3 AKI had the most significant contribution to 30-day mortality, while stage 1 and stage 2 AKI did not increase excess mortality.https://doi.org/10.1186/s12882-024-03551-9SepsisAcute kidney injuryAttributable mortalityPropensity score matching |
| spellingShingle | Dong-Hui Wang Jin-Chao Zhao Xiu-Ming Xi Yue Zheng Wen-Xiong Li Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study BMC Nephrology Sepsis Acute kidney injury Attributable mortality Propensity score matching |
| title | Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study |
| title_full | Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study |
| title_fullStr | Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study |
| title_full_unstemmed | Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study |
| title_short | Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study |
| title_sort | attributable mortality of acute kidney injury among critically ill patients with sepsis a multicenter retrospective cohort study |
| topic | Sepsis Acute kidney injury Attributable mortality Propensity score matching |
| url | https://doi.org/10.1186/s12882-024-03551-9 |
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