Infection/SepsisEarly reversible acute kidney injury is associated with improved survival in septic shock☆,☆☆
Introduction
Acute kidney injury (AKI) is associated with adverse outcomes, universally increasing mortality, length of hospital stay and the risk of long term chronic kidney disease and kidney failure [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. In septic shock, AKI is especially common with the risk of worse outcomes increasing with the severity of injury [2], [4], [11], [12], [13], [14], [15], [16].
Current classification schemes for defining AKI, such as the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) system and the Acute Kidney Injury Network (AKIN) system define the stage and severity of AKI using criteria based on declining urine output and changes in serum creatinine compared to baseline [17], [18], [19], [20], [21]. AKI is then classified according to the most severe stage achieved at any time point, regardless of reversibility. Although this classification has been validated in large international AKI datasets, little is known regarding the impact of earl (≤ 24 hours) reversibility of AKI on outcomes [17], [18], [19]. In this retrospective analysis, we examined the effect of early reversibility of AKI on in-hospital mortality in septic shock.
Section snippets
Study population
The Cooperative Antimicrobial Therapy of Septic Shock (CATSS) database is an international, multicenter database of patients admitted with septic shock to an intensive care unit (ICU). The CATSS database, which has been described in detail previously, uses standardized case definitions and includes repeat serum creatinine measurements during the first 24 hours of admission [13], [22], [23]. The database captures information on consecutive adult (> 18 years old) patients admitted with septic
Results
During the study period, 709 (13.0%) exhibited reversible AKI, 2878 (54.9%) persistent AKI, 635 (11.7%) new AKI and 1221 (22.4%) no AKI. Improved AKI occurred in 1041 (19.1%) individuals. ICU and in-hospital morality occurred in 1851 (34.0%) and 2477 (45.5%), respectively. In hospital mortality occurred in 150 (21.2%) with reversible AKI, 1524 (53.0%) with persistent AKI, 389 (61.3%) with new AKI and 414 (33.9%) with no AKI. Table 1 outlines the study characteristics stratified by AKI status.
Discussion
In this large, international, observational cohort study of patients with septic shock admitted to the ICU, reversibility of AKI was associated with a decreased risk of mortality. Even without complete reversal of AKI, a survival benefit was noted with any improvement in AKI severity. Furthermore independent of AKI classification, individuals with the largest decline in creatinine with the first 24 hours of ICU admission demonstrated a similar survival benefit. These findings suggest that
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2022, Annals of Thoracic SurgeryCitation Excerpt :The current KDIGO definition stipulates a timeline for creatinine increase (0.3 mg/dL within 48 hours or 1.5-fold increase within 7 days).11 We used the presence of SCr elevation on POD 322-25 to differentiate transient and persistent/late CS-AKI phenotypes in this cohort. However like all CS-AKI we did not identify associations of persistent CS-AKI with clinically relevant outcomes.
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All authors approved of this manuscript.
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Conflict of Interest Statement: Anand Kumar received unrestricted grant funding from Pfizer, Lilly, Astellas, Bayer, and Merck for the initial development of the CATSS Database. Additional grant funding has been provided by the Manitoba Research Council, the Health Sciences Foundation and the Deacon Foundation. No other author has significant conflict of interest. This specific analysis has not been supported.
Manish Sood has salary support through the Jindal Research Chair for the Prevention of Kidney Disease at the University of Ottawa.