"Clinical Profile and Outcomes of Acute Kidney Injury in Patients with Sepsis Admitted to Medical Wards"

Abstract

Background/ObjectiveSepsis-related acute kidney injury is common in hospitalized patients associates with poor clinical outcomes. Objectives To evaluate the clinical profile, risk factors and in-hospital outcomes of acute kidney injury among patients admitted with sepsis to medical wards.

Material and Methods:  A hospital based descriptive cross-sectional study was conducted at the Department of Medicine, Ayub Teaching Hospital Abbottabad. This was a single centered, observational study where adult patients >18 years old with sepsis were recruited in a consecutive manner. Identification of acute kidney injury was by Kidney Disease: Improving Global Outcomes criteria. Recording of data A standardised record was maintained for all patients; key clinical data included age, gender, comorbidities, clinical features including serum creatinine at initial presentation, urine output and intensity of critical care support (intensive care admission if indicated) at the onset of AKI (associated with either renal replacement therapy or not, length of stay in acute setting and in-hospital mortality. SPSS version 27.0 was used to analyze data. Continuous variables, which were normally assessed, are presented as mean ± standard deviation; non-normally distributed continuous variables were expressed as median (interquartile range); and categorical variables are expressed in frequency and percentage. Chi-square/Fisher exact test and independent-samples t-test/Mann-Whitney U test were used when appropriate. For each test, a p-value <0.05 defined statistical significance.

Results: 150 septic patients were enrolled with a mean age of 56.4 ± 14.2 years and 92 male patients. Acute renal inadequacy was found in 58 patients. ResultsPatients with AKI had increased rates of septic shock, oliguria, hypotension, elevated serum creatinine, intensive care admission and renal replacement therapy as well as prolonged hospital stay and mortality. Patients with acute kidney injury had a mortality of 31.0% compared to 9.8% in patients without acute kidney injury (p < 0.000001).

Conclusion: Acute kidney injury is commonly encountered in the septic patients admitted to the medical wards and has a strong relation with hemodynamic instability, intensive care admission, need for renal replacement therapy, prolonged hospital stay and mortality.

Keywords: Acute kidney injury, Clinical outcomes, Hospital mortality, KDIGO, Medical wards, Renal dysfunction, Sepsis, Septic shock.