AKI occurred in approximately half of the critically ill patients admitted to ICU. The site and type of infections, as well as the use of vasopressor agents, were associated with the outcome.

Long-term use of antibiotics for septic patients leads to bacterial resistance, increased mortality, and hospital stay. In this study, we investigated an emerging biomarker presepsin-guided strategy, which can be used to evaluate the shortening of antibiotic treatment in patients with sepsis without risking a worse outcome. Methods: In this multicenter prospective cohort trial, patients were assigned to the presepsin or control groups. In the presepsin group, antibiotics were ceased based on predefined cut-off ranges of presepsin concentrations. The control group stopped antibiotics according to international guidelines. The primary endpoints were the number of days without antibiotics within 28 days and mortality at 28 and 90 days. Secondary endpoints were the percentage of patients with a recurrent infection, length of stay in ICU and hospital, hospitalization costs, days of first episode of antibiotic treatment, percentage of antibiotic administration and multidrug-resistant bacteria, and SOFA score. Results: Overall, 656 out of an initial 708 patients were eligible and assigned to the presepsin group (n ¼ 327) or the control group (n ¼ 329). Patients in the presepsin group had significantly more days without antibiotics than those in the control group (14.54 days [SD 9.01] vs. 11.01 days [SD 7.73]; P < 0.001). Mortality in the presepsin group showed no difference to that in the control group at days 28 (17.7% vs. 18.2%; P ¼ 0.868) and 90 (19.9% vs. 19.5%; P ¼ 0.891). Patients in the presepsin group had a significantly shorter mean length of stay in the hospital and lower hospitalization costs than control subjects. There were no differences in the rate of recurrent infection and multidrug-resistant bacteria and the SOFA score tendency between the two groups. Conclusions: Presepsin guidance has potential to shorten the duration of antibiotic treatment in patients with sepsis without risking worse outcomes of death, recurrent infection, and aggravation of organ failure. Trial registration: ChiCTR, ChiCTR1900024391. Registered 9 July 2019-Retrospectively registered, http://www.chictr.org.cn

Background: Septic acute kidney injury (AKI), identified when sepsis and AKI present concurrently, is a syndrome of acute function impairment and organ damage, which accounts for ~50% AKI in the intensive care unit (ICU).Methods: This study retrospectively reviewed 591 patients who were diagnosed with sepsis and admitted to the ICU of Beijing Friendship Hospital from January 2009 to December 2014. According to the concentration of serum sodium, the 591 patients were further divided into 3 groups: normal group, hyponatremia group, and hypernatremia group. Results: The arterial partial pressure of carbon dioxide (PaCO 2 , P=0.014), concentration of sodium (Na + , P<0.001), and chloride ion (Cl − , P<0.001), blood urea nitrogen (BUN, P<0.001), acute physiology and chronic health evaluation (APACHE) score (P<0.001), sequential organ failure assessment (SOFA) score (P<0.001), and Glasgow score (P<0.001) showed significant differences. The SOFA score [P=0.040; odds ratio (OR) =1.261], body mass index (BMI, P=0.041; OR =1.229), P content (P=0.032; OR =7.180) and creatine kinase myocardial band (CK-MB, P=0.006; OR =1.168) may be risk factors for occurrence of AKI in patients with hypernatremia. The AKI (P<0.001; OR =6.850) and P content (P=0.027; OR =3.676) may be risk factors for death in patients with hypernatremia. The Na + suggested a predictive ability for AKI (P<0.001; area under the curve (AUC): 0.586) but not for death (P=0.104).Conclusions: Hypernatremia is independently associated with an increased risk and has a predictive ability of AKI in patients with sepsis.