Outcome of sepsis-associated acute kidney injury in an intensive care unit: An experience from a tertiary care center of central Nepal

Abstract

Acute kidney injury (AKI) is a common and major complication of sepsis. Sepsis-induced AKI is associated with higher morbidity and mortality. A prospective study was designed to include all the patients with a provisional diagnosis of sepsis with AKI admitted in our intensive care unit from August 2009 to September 2010. Detailed demographic data including various clinical parameters, co-morbidities, investigations, complications and outcome were entered in a designated proforman and were analyzed. A total of 53 subjects with the provisional diagnosis of sepsis with AKI were included in the study. The majority of patients (60.37%) were female. The mean age of the study population was 45.84 ± 20.5 years. Forty-nine percent of the subjects were <45 years old and 26.4% patients were >65 years. Among the co-morbid conditions, 9.4% subjects had diabetes mellitus type 2. Among the primary causes of AKI, 72% of the cases were due to medical causes, in which pneumonia was the major cause, and 28% were due to surgical causes, in which cholecystitis was the major cause. 47.1% cases expired, 11.3% subjects left against medical advice and 41.5% cases had favorable outcome. Among the expired cases, 20.7% subjects expired within 24 h; for others, the median hospital stay was four days. This prospective study showed that the major causes of AKI were medical illness and pneumonia. Mortality in sepsis-induced AKI is significantly high. This highlights the importance of prevention of AKI in sepsis by early and renal-friendly aggressive treatment of sepsis and the need for improvement in the management of such AKI cases.

Incidence, characteristics and prognosis of acute kidney injury in Cameroon: a prospective study at the Douala General Hospital

“…Pneumonia was the leading cause in the study of Madav et al. in Nepal followed by gastroenteritis and urinary tract infection [ 35 ]. In contrast, gastroenteritis was the first etiology in the studies of Praskash et al.…”

Management and Outcome of Severe Sepsis and Septic Shock Patients Admitted to the Emergency Department in a Tertiary Hospital

“…15 A study carried on outcome of sepsis associated acute kidney failure injury in intensive care unit recognized pneumonia the major medical illness. 16 The use of vasopressor such as norepinephrine, epinephrine and dopamine were found significantly more in deceased group than in survivors. Empiric antibiotic administration is initiated in emergency department as early as possible so as to prevent further worsening of problem.…”

Expert consensus on the perioperative management of patients with sepsis

“…[32][33][34] Renal function Acute kidney injury (AKI) is due to inflammation reaction, endothelial injury and microcirculation disturbance, which were induced by sepsis. Studies [35,36] revealed that 50% of patients with AKI were induced by sepsis in the ICU, suggesting that sepsis is the main cause of AKI. AKI is regarded as an independent risk factor of death in septic patients.…”