Non-pulmonary infections but not specific pathogens are associated with increased risk of AKI in septic shock

Sood, Manish M.; Mandelzweig, Keren; Rigatto, Claudio; Tangri, Navdeep; Komenda, Paul; Martinka, Gregory; Arabi, Yaseen M.; Keenan, Sean; Kumar, Aseem; Kumar, Anand

doi:10.1007/s00134-014-3361-1

Cited by 16 publications

(10 citation statements)

References 33 publications

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“…After multivariable analysis, no specific type of pathogen was associated with increased septic AKI risk compared to others. [18] On the other hand, another study did identify a higher number of positive blood cultures, especially gram-negative bacilli and fungi, in septic AKI patients compared to septic patients who did not develop AKI. [17] Additionally, several clinical characteristics differ between patients with septic AKI and those with non-septic AKI.…”

Section: Sepsis and Aki: Timing And Risk Factorsmentioning

confidence: 99%

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Clinical Approach to the Patient With AKI and Sepsis

Godin

Murray

Mehta

2015

Seminars in Nephrology

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Sepsis and AKI are frequently combined in critical care patients. They are both independently associated with increased mortality and morbidity. AKI may precede, coincide with, or follow sepsis diagnosis. Risk factors for sepsis followed by AKI differ from those associated with AKI preceding or coinciding with sepsis and the pathophysiologic mechanisms may be different. In this article, we review the available clinical, laboratory and imaging tools available for the recognition of septic AKI. Early identification of high-risk patients and targeted preventive and therapeutic measures are key in reducing mortality and morbidity of the complex syndrome of septic AKI.

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Section: Sepsis and Aki: Timing And Risk Factorsmentioning

confidence: 99%

“…[18] Additionally, a prospective observational international study of 1753 patients, showed that patients with septic AKI showed a trend towards higher chances of recovery and dialysis independence compared to non-septic AKI patients even though they had higher risk of death and longer hospital length of stay. [85]…”

Section: Rehabilitation and Follow Upmentioning

confidence: 99%

Clinical Approach to the Patient With AKI and Sepsis

Godin

Murray

Mehta

2015

Seminars in Nephrology

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“…[3] While research has attempted to determine the severity of this condition in order to treat patients appropriately, little is known about how the anatomical site of infection related with clinical outcomes in sepsis-associated (SA)-AKI patients. [4,5] The Sepsis 3.0 criteria define sepsis as a life-threatening organ dysfunction caused by dysregulation in a host's response to infection. [6] In other words, the primary driver of mortality in sepsis is the systemic infl ammatory response, and this response is triggered by uncontrolled infection arising from a specifi c anatomical source, which may infl uence the progression and clinical outcome of sepsis.…”

Section: Introductionmentioning

confidence: 99%

A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

Fan

Jiang

Chen

et al. 2020

World Journal of Emergency Medicine

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BACKGROUND: Hospital mortality rates are higher among patients with sepsis-associated acute kidney injury (SA-AKI) than among patients with sepsis. However, the pathogenesis underlying SA-AKI remains unclear. We hypothesized that the source of infection affects development of SA-AKI. We aim to explore the relationship between the anatomical source of infection and outcome in patients with SA-AKI. METHODS: Between January 2013 and January 2018, 113 patients with SA-AKI admitted to our Emergency Center were identifi ed and divided into two groups: those with pulmonary infections and those with other sources of infection. For each patient, we collected data from admission until either discharge or death. We also recorded the clinical outcome after 90 days for the discharged patients. RESULTS: The most common source of infection was the lung (52/113 cases, 46%), followed by gastrointestinal (GI) (25/113 cases, 22.1%) and urinary (22/113, 19.5%) sources. Our analysis showed that patients with SA-AKI had a significantly worse outcome (30/52 cases, P<0.001) and poorer kidney recovery (P=0.015) with pulmonary sources of infection than those infected by another source. Data also showed that patients not infected by a pulmonary source more likely experienced shock (28/61 cases, P=0.037). CONCLUSION: This study demonstrated that the source of infection infl uenced the outcome of SA-AKI patients in an independent manner. Lung injury may influence renal function in an asyet undetermined manner as the recovery of kidney function was poorer in SA-AKI patients with a pulmonary source of infection.

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“…Renal function impairment is a frequent condition during septic shock with an incidence of acute kidney injury (AKI) ranging from 55 to 73% [ 1 – 3 ]. It is independently associated with mortality [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury is associated with a decrease in cortical renal perfusion during septic shock

et al. 2018

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BackgroundRenal perfusion status remains poorly studied at the bedside during septic shock. We sought to measure cortical renal perfusion in patients with septic shock during their first 3 days of care using renal contrast enhanced ultrasound (CEUS).MethodsWe prospectively included 20 ICU patients with septic shock and 10 control patients (CL) without septic shock admitted to a surgical ICU. Cortical renal perfusion was evaluated with CEUS during continuous infusion of Sonovue (Milan, Italy) within the first 24 h (day 0), between 24 and 48 h (day 1) and after 72 h (day 3) of care. Each measurement consisted of three destruction replenishment sequences that were recorded for delayed analysis with dedicated software (Vuebox). Renal perfusion was quantified by measuring the mean transit time (mTT) and the perfusion index (PI), which is the ratio of renal blood volume (rBV) to mTT.ResultsCortical renal perfusion was decreased in septic shock as attested by a lower PI and a higher mTT in patients with septic shock than in patients of the CL group (p = 0.005 and p = 0.03). PI values had wider range in patients with septic shock (median (min-max) of 74 arbitrary units (a.u.) (3–736)) than in patients of the CL group 228 a.u. (67–440)). Renal perfusion improved over the first 3 days with a PI at day 3 higher than the PI at day 0 (74 (22–120) versus 160 (88–245) p = 0.02). mTT was significantly higher in patients with severe acute kidney injury (AKI) (n = 13) compared with patients with no AKI (n = 7) over time (p = 0.005). The PI was not different between patients with septic shock with severe AKI and those with no AKI (p = 0.29).ConclusionsAlthough hemodynamic macrovascular parameters were restored, the cortical renal perfusion can be decreased, normal or even increased during septic shock. We observed an average decrease in cortical renal perfusion during septic shock compared to patients without septic shock. The decrease in cortical renal perfusion was associated with severe AKI occurrence. The use of renal CEUS to guide renal perfusion resuscitation needs further investigation.

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Non-pulmonary infections but not specific pathogens are associated with increased risk of AKI in septic shock

Abstract: This study demonstrates that the presence of septic AKI varies significantly based on the site of infection but not the type of causative organism.

Cited by 16 publications

References 33 publications

Clinical Approach to the Patient With AKI and Sepsis

Clinical Approach to the Patient With AKI and Sepsis

A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

Acute kidney injury is associated with a decrease in cortical renal perfusion during septic shock

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