Acute Kidney Injury Requiring Dialysis in Severe Sepsis

Sakhuja, Ankit; Kumar, Gagan; Gupta, Shipra; Mittal, Tarun; Taneja, Amit; Nanchal, Rahul

doi:10.1164/rccm.201502-0329oc

Cited by 50 publications

(39 citation statements)

References 15 publications

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“…Because AT has anticoagulant as well as antiinflammatory properties (30), AT supplementation may improve organ dysfunction, which is often induced by inflammation and microcirculatory impairment resulting from sepsis-induced DIC (2,4). In patients with severe sepsis, acute kidney injury requiring renal replacement therapy is an independent predictor of mortality and poor outcomes (31). Therefore, it is an important finding that the number of renal replacement therapy-free days improved with AT supplementation.…”

Section: Figmentioning

confidence: 99%

Antithrombin Supplementation and Mortality in Sepsis-Induced Disseminated Intravascular Coagulation

Hayakawa¹,

Kudo²,

Saito

et al. 2016

Shock

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ABSTRACT-Supplemental doses of antithrombin (AT) are widely used to treat sepsis-induced disseminated intravascular coagulation (DIC) in Japan. However, evidence on the benefits of ATsupplementation for DIC is insufficient. This multicenter retrospective observational study aimed to clarify the effect of AT supplementation on sepsis-induced DIC using propensity score analyses. Data from 3,195 consecutive adult patients admitted to 42 intensive care units for severe sepsis treatment were retrospectively analyzed; 1,784 patients were diagnosed with DIC (n ¼ 715, AT group; n ¼ 1,069, control group). Inverse probability of treatment-weighted propensity score analysis indicated a statistically significant association between AT supplementation and lower in-hospital all-cause mortality (n ¼ 1,784, odds ratio [95% confidence intervals]: 0.748 [0.572-0.978], P ¼ 0.034). However, quintile-stratified propensity score analysis (n ¼ 1,784, odds ratio: 0.823 [0.646-1.050], P ¼ 0.117) and propensity score matching analysis (461 matching pairs, odds ratio: 0.855 [0.649-1.125], P ¼ 0.263) did not show this association. In the early days after intensive care unit admission, the survival rate was statistically higher in the propensity score-matched AT group than in the propensity score-matched control group (P ¼ 0.007). In DIC patients without concomitant heparin administration, similar results were observed. In conclusion, AT supplementation may be associated with reduced in-hospital all-cause mortality in patients with sepsis-induced DIC. However, the statistical robustness of this connection was not strong. In addition, although the number of transfusions needed in patients with AT supplementation increased, severe bleeding complications did not.

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Section: Figmentioning

confidence: 99%

Antithrombin Supplementation and Mortality in Sepsis-Induced Disseminated Intravascular Coagulation

Hayakawa¹,

Kudo²,

Saito

et al. 2016

Shock

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“…Despite recent medical progress, the incidence of AKI continues to rise among patients who are hospitalized or admitted to an intensive care unit (ICU) [7,8]. However, with implementation of better preventive strategies, the mortality of patients who develop AKI in the ICU appears to be on a downward trajectory [9]. Timely identification of AKI and appropriate implementation of preventive strategies are thought to be the most effective tools to improve AKI outcomes [8,10].…”

Section: Introductionmentioning

confidence: 99%

Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption

Kashani

Cheungpasitporn

Ronco

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

244

197

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Acute kidney injury (AKI) is a common complication of critical illnesses and has a significant impact on outcomes, including mortality and morbidities. Unfortunately, apart from prophylactic measures, no effective treatment for this syndrome is known. Therefore, early recognition of AKI not only can provide better opportunities for preventive interventions, but also opens many gates for research and development of effective therapeutic options. Over the last few years, several new AKI biomarkers have been discovered and validated to improve early detection, differential diagnosis, and differentiation of patients into risk groups for progressive renal failure, need for renal replacement therapy (RRT), or death. These novel AKI biomarkers complement serum creatinine (SCr) and urine output, which are the standard diagnostic tools for AKI detection. In this article, we review the available literature on characteristics of promising AKI biomarkers that are currently the focus of preclinical and clinical investigations. These biomarkers include neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein, interleukin 18 (lL-18), insulin-like growth factor-binding protein 7, tissue inhibitor of metalloproteinase 2 (TIMP-2), calprotectin, urine angiotensinogen (AGT), and urine microRNA. We then describe the clinical performance of these biomarkers for diagnosis and prognostication. We also appraise each AKI biomarker's advantages and limitations as a tool for early AKI recognition and prediction of clinical outcomes after AKI. Finally, we review the current and future states of implementation of biomarkers in the clinical practice.

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“…Severe sepsis was defined using the ICD‐9‐CM codes for severe sepsis or septic shock, septicemia, bacteremia, or fungemia with at least 1 organ dysfunction (Tables 1 and 2). 18, 19, 20, 21 This definition of severe sepsis is consistent with the 2001 American College of Chest Physicians/Society of Critical Care Medicine consensus criteria for severe sepsis: consequent organ dysfunction, hypoperfusion, or hypotension 22. Using previously validated algorithms for microbiological cultures, septic patients were classified into “culture‐positive” and “culture‐negative” sepsis 21.…”

Section: Methodsmentioning

confidence: 95%

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

Vallabhajosyula

Deshmukh

Kashani

et al. 2018

JAHA

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BackgroundThere are limited data on the presentation of Takotsubo cardiomyopathy (TTC) in severe sepsis.Methods and ResultsThis was a retrospective cohort study using the National Inpatient Sample database (2007–2013) of all adults with severe sepsis. TTC was identified in patients with severe sepsis using previously validated administrative codes. The primary outcome was in‐hospital mortality, and secondary outcomes included resource utilization and discharge disposition. Regression analysis was performed for the entire cohort and a propensity‐matched sample. An exploratory analysis was performed for predictors of TTC incidence and mortality in TTC. During this 7‐year period, in 7.1‐million hospitalizations for severe sepsis, TTC was diagnosed in 10 746 (0.15%) admissions. TTC was noted more commonly in whites, females, and among 65‐ to 79‐year‐old individuals. TTC was independently associated with lower in‐hospital mortality in severe sepsis (odds ratio, 0.58; 95% confidence interval, 0.51–0.65). This association was more prominent in females (odds ratio, 0.51; 95% confidence interval, 0.44–0.59]) compared with males (odds ratio, 0.69; 95% confidence interval, 0.55–0.85]). Presentation in later years of the study period, middle‐age, female sex, and white race were independent predictors for the diagnosis of TTC. Age ≥80 years, black race, greater comorbidity, and multiorgan dysfunction were independently associated with higher in‐hospital mortality among TTC admissions.Conclusions TTC is observed with increasing frequency in severe sepsis and was associated with a significantly lower in‐hospital mortality compared with patients without TTC. Presentation in later years of the study period, middle age, female sex, and white race were independent predictors for the diagnosis of TTC in severe sepsis.

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Acute Kidney Injury Requiring Dialysis in Severe Sepsis

Abstract: Incidence of acute kidney injury requiring dialysis in patients with severe sepsis has increased over time; conversely, associated mortality has declined. The likelihood of demise from acute kidney injury requiring dialysis in patients with severe sepsis has also declined.

Cited by 50 publications

References 15 publications

Antithrombin Supplementation and Mortality in Sepsis-Induced Disseminated Intravascular Coagulation

Antithrombin Supplementation and Mortality in Sepsis-Induced Disseminated Intravascular Coagulation

Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

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