Department of Anesthesiology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, United States.
J Crit Care. 2022 Dec;72:154150. doi: 10.1016/j.jcrc.2022.154150. Epub 2022 Oct 14.
Sepsis remains the most common cause of acute kidney injury (AKI) and is associated with a high mortality. This study aims to identify laboratory, clinical and demographic factors that are associated with the different stages of AKI in sepsis.
We studied patients >18 years who met Sepsis-3 criteria between July 10, 2009 and September 7, 2019 using ordinal logistic regression to determine the factors associated with different stages of AKI. Sensitivity analyses for development of any stage vs no AKI and, separately, the factors associated with receipt of kidney replacement therapy were also done.
Of 31,228 patients meeting Sepsis-3 criteria, 4684 (15%) developed AKI. Of the AKI patients, 53% were KDIGO stage 1, 9% stage 2, and 37% stage 3, with 27% of AKI patients receiving kidney replacement therapy (Stage 3b). Several comorbidities, mechanical ventilation, and pre-sepsis creatinine levels were associated with AKI occurrence and severity. Positive blood culture was associated with a higher risk (OR 1.10 [1.06, 1.15], p < 0.001), while positive respiratory, urine, and wound cultures were associated with lower risks of developing AKI and with lower severity.
Presepsis creatinine levels, mechanical ventilation, comorbidities, and positive blood cultures were associated with AKI.
脓毒症仍然是急性肾损伤（AKI）最常见的原因，与高死亡率相关。本研究旨在确定与脓毒症 AKI 不同阶段相关的实验室、临床和人口统计学因素。
我们研究了 2009 年 7 月 10 日至 2019 年 9 月 7 日符合 Sepsis-3 标准的 >18 岁患者，使用有序逻辑回归确定与 AKI 不同阶段相关的因素。还进行了发展为任何阶段 AKI 与无 AKI 的敏感性分析，以及单独确定与接受肾脏替代治疗相关的因素的敏感性分析。
在符合 Sepsis-3 标准的 31228 名患者中，有 4684 名（15%）发生 AKI。在 AKI 患者中，53%为 KDIGO 1 期，9%为 2 期，37%为 3 期，其中 27%的 AKI 患者接受了肾脏替代治疗（3b 期）。几种合并症、机械通气和脓毒症前肌酐水平与 AKI 的发生和严重程度相关。阳性血培养与更高的风险相关（OR 1.10[1.06，1.15]，p <0.001），而阳性呼吸道、尿液和伤口培养与 AKI 发生风险较低和严重程度较低相关。
脓毒症前肌酐水平、机械通气、合并症和阳性血培养与 AKI 相关。
