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.
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.
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.