Chronic kidney disease is associated with a higher 90-day mortality than other chronic medical conditions in patients with sepsis

Abstract

According to previous studies, the clinical course of sepsis could be affected by preexisting medical conditions, which are very common among patients with sepsis. This observational study aimed at investigating whether common chronic medical conditions affect the 90-day mortality risk in adult Caucasian patients with sepsis. A total of 482 patients with sepsis were enrolled in this study. The ninety-day mortality was the primary outcome; organ failure was the secondary outcome. Sepsis-related organ failure assessment (SOFA) scores and the requirements for organ support were evaluated to assess organ failure. A multivariate Cox regression model for the association between the 90-day mortality risk and chronic preexisting medical conditions adjusted for all relevant confounders and mortality predictors revealed the highest hazard ratio for patients with chronic kidney disease (CKD) (hazard ratio, 2.25; 95% CI, 1.46-3.46; p = 0.0002). Patients with CKD had higher SOFA scores than patients without CKD (8.9 ± 4.0 and 6.5 ± 3.4, respectively; p < 0.0001). Additionally, an analysis of organ-specific SOFA scores revealed higher scores in three organ systems (kidney, cardiovascular and coagulation). Patients with CKD have the highest 90-day mortality risk compared with patients without CKD or with other chronic medical conditions.

Vitamin D deficiency and treatment versus risk of infection in end-stage renal disease patients under dialysis: a systematic review and meta-analysis

“…Increased mortality associated with reduced renal function has also been observed in previous studies (29,34,35,37,111,(138)(139)(140)(141)(142). The Cardiovascular Health Study reported that patients with CKD had a 2-fold greater risk of infection-related mortality (138).…”

“…The association between reduced kidney function and mortality persisted in patients who had specific infections, such as bloodstream infections (35), sepsis (140) and pneumonia (29,34,142). In a cohort of patients 66 years or above, the risk of death within 30 days of onset of community-acquired bloodstream infections was 4.1 times higher in those with an eGFR less than 30 mL/min/1.73m 2 compared to those with an eGFR of 60 mL/min/1.73 m 2 or higher (35).…”

Clinical characteristics and short‐term outcomes in patients with acute cholecystitis over aged >80 years

“…In the present study, two of three patients with chronic kidney disease in the elderly group died from sepsis during the index administration. Mansur et al reported that septic patients with chronic kidney disease were associated with higher 90‐day mortality risk than patients without chronic kidney disease or other medical conditions (hazard ratio 2.25) . They suggested that the increased mortality risk among septic patients with chronic kidney disease might be attributed to leukocyte dysfunction and decreased renal clearance of inflammatory cytokines as a result of chronic kidney disease.…”

“…Mansur et al reported that septic patients with chronic kidney disease were associated with higher 90-day mortality risk than patients without chronic kidney disease or other medical conditions (hazard ratio 2.25). 18 They suggested that the increased mortality risk among septic patients with chronic kidney disease might be attributed to leukocyte dysfunction and decreased renal clearance of inflammatory cytokines as a result of chronic kidney disease. These findings indicate that more attention should be paid to AC patients with chronic renal disease when determining the treatment modality, with close monitoring continuing after treatment.…”

Functional genomics approach to understanding sepsis heterogeneity

“…In the US, 65% of sepsis cases are recorded in patients aged 65 and older, with an odds-ratio for mortality of 2.26 (Martin, Mannino & Moss, 2006). Type 2 diabetes mellitus, chronic renal disease, dementia and liver cirrhosis patients are at high risk for mortality in sepsis (Tiwari et al, 2011;Mansur et al, 2015;Bouza, Martinez-Ales & Lopez-Cuadrado, 2019). However, the impact of comorbidities on organ dysfunction has been suggested to vary according to the site of infection, with intra-abdominal infections having a worse prognosis than communityacquired pneumonia (Sinapidis et al, 2018).…”