Long-term risk of mortality after acute kidney injury in patients with sepsis: a contemporary analysis - PubMed (original) (raw)

Comparative Study

Long-term risk of mortality after acute kidney injury in patients with sepsis: a contemporary analysis

José António Lopes et al. BMC Nephrol. 2010.

Abstract

Background: Acute kidney injury (AKI) is associated with increased short-term mortality of septic patients; however, the exact influence of AKI on long-term mortality in such patients has not yet been determined.

Methods: We retrospectively evaluated the impact of AKI, defined by the "Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease" (RIFLE) classification based on creatinine criteria, on 2-year mortality in a cohort of 234 hospital surviving septic patients who had been hospitalized at the Infectious Disease Intensive Care Unit of our Hospital.

Results: Mean-follow-up was 21 +/- 6.4 months. During this period, 32 patients (13.7%) died. At 6 months, 1 and 2 years of follow-up, the cumulative probability of death of patients with previous AKI was 8.3, 16.9 and 34.2%, respectively, as compared with 2.2, 6 and 8.9% in patients without previous AKI (log-rank, P < 0.0001). In the univariate analysis, age (hazard ratio 1.4, 95% CI 1.2-1.7, P < 0.0001), as well as pre-existing cardiovascular disease (hazard ratio 3.6, 95% CI 1.4-9.4, P = 0.009), illness severity as evaluated by nonrenal APACHE II (hazard ratio 1.3, 95% CI 1.1-1.6, P = 0.002), and previous AKI (hazard ratio 4.2, 95% CI 2.1-8.5, P < 0.0001) were associated with increased 2-year mortality, while gender, race, pre-existing hypertension, cirrhosis, HIV infection, neoplasm, and baseline glomerular filtration rate did not. In the multivariate analysis, however, only previous AKI (hazard ratio 3.2, 95% CI 1.6-6.5, P = 0.001) and age (hazard ratio 1.4, 95% CI 1.2-1.6, P < 0.0001) emerged as independent predictors of 2-year mortality.

Conclusions: Acute kidney injury had a negative impact on long-term mortality of patients with sepsis.

PubMed Disclaimer

Figures

Figure 1

Figure 1

Cumulative probability of death. Cumulative probability of death in patients with (green line) and without (blue line) acute kidney injury (AKI) during previous Intensive Care Unit admission; log-rank test, P < 0.0001.

Similar articles

Cited by

References

    1. Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10:R73. doi: 10.1186/cc4915. - DOI - PMC - PubMed
    1. Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med. 2007;35:1837–1843. doi: 10.1097/01.CCM.0000277041.13090.0A. - DOI - PubMed
    1. Bagshaw SM, George C, Dinu I, Bellomo R. A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2008;23:1203–1210. doi: 10.1093/ndt/gfm744. - DOI - PubMed
    1. Lopes JA, Fernandes P, Jorge S, Gonçalves S, Alvarez A, Costae Silva Z, França C, Martins Prata M. Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Crit Care. 2008;12:R110. doi: 10.1186/cc6997. - DOI - PMC - PubMed
    1. Bagshaw SM, Laupland KB, Doig CJ, Mortis G, Fick GH, Mucenski M, Godinez-Luna T, Svenson LW, Rosenal T. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: A population based study. Crit Care. 2005;9:R700–R709. doi: 10.1186/cc3879. - DOI - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources