SUMMARY

• Acute Kidney Injury often times accompanies sepsis.

• Sepsis Associated Acute Kidney Injury (SA-AKI) has a greater morbidity and mortality rate than sepsis or acute kidney injury alone.

• The outcome of SA-AKI has not been extensively reported due to differences in reproducibility and standard consensus definition.

• SA-AKI can be categorized  by stage or definition of AKI.

RESULTS

• Typically SA-AKI is based on the presence of the following components and definitions:

• White KC, et al. Sepsis associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study. Intensive Care Med 2023;49:1079-1089.

• 84,528 patients admitted to ICU in 12 ICU’s from Australia

• January 1, 2015 – December 31, 2021

• 13,451 sepsis patients, with most meeting sepsis and AKI definitions on day 1 to ICU

• Incidence of SA-AKI increased each year, with a higher severity of illness compared to non-sepsis ICU patients

• AKI diagnosis Criteria:

  • Urine Output Only: 5,952 (44.3%) patients
  • Creatinine Only: 4,642 (34.5%) patients
  • Both: 2,857 (21.2%) patients

• A statistically significant difference occurs in all outcome categories between AKI categories of urine output alone; creatinine alone; or both

• Using urine output alone has the clinical marker has the best outcomes, however, may be a misleading predictive indicator.

• Using both urine output and creatinine markers may provide a better predictor of eventual outcomes.

CONCLUSIONS

• The incidence of SA-AKI has increased annually from 2015 to 2021.

• SA-AKI has a higher severity of illness and a poorer outcome than sepsis alone or AKI alone.

• SA-AKI diagnosed via a low urine output alone has a shorter ICU and hospital LOS; lower mortality and less 30 day adverse event development.

• It is unknown if a low urine output is a physiologic response to sepsis or a marker of impending organ failure.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.