Acute Kidney Injury and Septic Shock-Defined by Updated Sepsis-3 Criteria in Critically Ill Patients

Vin-Cent Wu; Shih-Chieh Jeff Chueh; Jui-Ting Chang; Bang-Gee Hsu; Marlies Ostermann; Tzong-Shinn Chu

doi:10.3390/jcm8101731

Acute Kidney Injury and Septic Shock-Defined by Updated Sepsis-3 Criteria in Critically Ill Patients

J Clin Med. 2019 Oct 18;8(10):1731. doi: 10.3390/jcm8101731.

Authors

Vin-Cent Wu¹, Shih-Chieh Jeff Chueh², Jui-Ting Chang³, Bang-Gee Hsu⁴, Marlies Ostermann⁵, Tzong-Shinn Chu^{6

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Affiliations

¹ Division of Nephrology, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Zhong-Zheng District, Taipei 100, Taiwan. q91421028@ntu.edu.tw.
² Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, 9500 Euclid Ave., Cleveland, OH 44195, USA. jeffchueh@gmail.com.
³ Division of Nephrology, Department of Internal Medicine, Shin Kong Memorial Wu Ho-Su Hospital, Taipei 111, Taiwan. skhnephropgy@gmail.com.
⁴ Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; and School of Medicine, Tzu Chi University, Hualien 970, Taiwan. gee.lily@msa.hinet.net.
⁵ Department of Critical Care and Nephrology, King's College London, Guy's and St Thomas Hospital, London SE1 7EH, UK. Marlies.Ostermann@gstt.nhs.uk.
⁶ Division of Nephrology, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Zhong-Zheng District, Taipei 100, Taiwan. tschu@ntu.edu.tw.
⁷ NSARF group (National Taiwan University Hospital Study Group of ARF), Zhong-Zheng District, Taipei 100, Taiwan. tschu@ntu.edu.tw.
⁸ CAKS group (Taiwan Consortium for Acute Kidney Injury and Renal Diseases), Guishan District, Taoyuan City 333, Taiwan. tschu@ntu.edu.tw.

Abstract

Sepsis is commonly associated with acute kidney injury (AKI), particularly in those requiring dialysis (AKI-D). To date, Sepsis-3 criteria have not been applied to AKI-D patients. We investigated sepsis prevalence defined by Sepsis-3 criteria and evaluated the outcomes of septic-associated AKI-D among critically ill patients. Using the data collected from a prospective multi-center observational study, we applied the Sepsis-3 criteria to critically ill AKI-D patients treated in intensive care units (ICUs) in 30 hospitals between September 2014 and December 2015. We described the prevalence, outcomes, and characteristics of sepsis as defined by the screening Sepsis-3 criteria among AKI-D patients, and compared the outcomes of AKI-D patients with or without sepsis using the Sepsis-3 criteria. A total of 1078 patients (median 70 years; 673 (62.4%) men) with AKI-D were analyzed. The main etiology of AKI was sepsis (71.43%) and the most frequent indication for acute dialysis was oliguria (64.4%). A total of 577 (53.3% of 1078 patients) met the Sepsis-3 criteria, and 206 among the 577 patients (19.1%) had septic shock. Having sepsis and septic shock were independently associated with 90-day mortality among these ICU AKI-D patients (hazard ratio (HR) 1.23 (p = 0.027) and 1.39 (p = 0.004), respectively). Taking mortality as a competing risk factor, AKI-D patients with septic shock had a significantly reduced chance of weaning from dialysis at 90 days than those without sepsis (HR 0.65, p = 0.026). The combination of the Sepsis-3 criteria with the AKI risk score led to better performance in forecasting 90-day mortality. Sepsis affects more than 50% of ICU AKI patients requiring dialysis, and one-fifth of these patients had septic shock. In AKI-D patients, coexistent with or induced by sepsis (as screened by the Sepsis-3 criteria), there is a significantly higher mortality and reduced chance of recovering sufficient renal function, when compared to those without sepsis.

Keywords: Sepsis-3; acute dialysis; acute kidney injury; qSOFA.