Mortality and associated risk factors in patients with blood culture positive sepsis and acute kidney injury requiring continuous renal replacement therapy—A retrospective study

Abstract

Objectives Septic acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) carries a mortality risk nearing 50%. Risk factors associated with mortality in AKI patients undergoing CRRT with blood culture positive sepsis remain unclear as sepsis has been defined according to consensus criteria in previous studies. Methods Risk factors associated with intensive care unit (ICU), 90-day and overall mortality were studied in a retrospective cohort of 126 patients with blood culture positive sepsis and coincident severe AKI requiring CRRT. Comprehensive laboratory and clinical data were gathered at ICU admission and CRRT initiation. Results 38 different causative pathogens for sepsis and associated AKI were identified. ICU mortality was 30%, 90-day mortality 45% and one-year mortality 50%. Immunosuppression, history of heart failure, APACHE II and SAPS II scores, C-reactive protein and lactate at CRRT initiation were independently associated with mortality in multivariable Cox proportional hazards models. Blood lactate showed good predictive power for ICU mortality in receiver operating characteristic curve analyses with AUCs of 0.76 (95%CI 0.66–0.85) for lactate at ICU admission and 0.84 (95%CI 0.72–0.95) at CRRT initiation. Conclusions Our study shows for the first time that lactate measured at CRRT initiation is predictive of ICU mortality and independently associated with overall mortality in patients with blood culture positive sepsis and AKI requiring CRRT. Microbial etiology for septic AKI requiring CRRT is diverse.

The place of infectious markers in predicting culture positivity in patients with renal failure hospitalized with suspected infection

“…CRP was also identified as a predictor of mortality, together with leukocyte count and ferritin. Similar results were achieved to those of previous studies [30].…”

Renal Replacement Techniques in Septic Shock

“…Furthermore, AKI in patients with sepsis has been associated with prolonged ICU and hospital stays in survivors [ 27 , 30 ]. Risk factors for mortality in patients with septic AKI, as with sepsis alone, have included older age, comorbidities, higher disease severity and decreased urine output [ 34 , 35 ]. Nonetheless, a recovery of renal function has been observed in up to 40% of patients that survive septic AKI.…”

Unsupervised Clustering Identifies Sub-Phenotypes and Reveals Pre-Dialysis Hyperlactatemia as a Novel Outcome Predictor in Dialysis-Requiring Sepsis-Associated Acute Kidney Injury

“…Although hyperlactatemia of > 2 mmol/L is criterion of septic shock according to the Sepsis-3, it is not mandated as a criterion of sepsis [31]. It has been reported that hyperlactatemia is an independent mortality predictor in patients with SA-AKI in the emergency department [38], postoperative AKI requiring RRT [25] and SA-AKI requiring CRRT [10]. However, other studies have shown that the initial lactate level is not independently associated with death in patients with SA-AKI requiring CRRT [37] or post-cardiovascular surgery AKI [28].…”

“…Whether serum lactate levels are independently associated with mortality or kidney recovery after AKI remains controversial [10,25,28,37,38]. Thus, we applied a multivariable Cox proportional hazards model and included all variables listed in Table 1 to identify factors associated with mortality after dialysis-requiring SA-AKI.…”

“…Compared with patients who did not require dialysis, those who underwent dialysis during SA-AKI had a much higher risk of mortality [2] and lower possibility of kidney recovery [7]. Recent studies reported that 90-day mortality in patients with dialysis-requiring SA-AKI were ranged from 45.2-81.2% [8][9][10]. Therefore, this population represents the highest risk of mortality and dialysis dependence.…”