Takeuchi Tomonori, Flannery Alexander H, Liu Lucas J, Ghazi Lama, Cama-Olivares Augusto, Fushimi Kiyohide, Chen Jin, Huen Sarah C, Tolwani Ashita J, Neyra Javier A
Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan.
Crit Care. 2025 Mar 20;29(1):128. doi: 10.1186/s13054-025-05351-5.
The definition of sepsis-associated acute kidney injury (SA-AKI) was updated in 2023. This study aims to describe the epidemiology of SA-AKI using updated consensus definition and to evaluate clinical outcomes.
The study was a retrospective cohort analysis conducted at two academic medical centers. Adult patients admitted to intensive care units (ICU) between 2010 and 2022 were included and categorized as SA-AKI, sepsis alone, or AKI alone. SA-AKI was further classified by time of onset (early < 2 days from sepsis diagnosis vs. late 2-7 days following sepsis diagnosis) and presence of septic shock. Clinical outcomes included hospital mortality and major adverse kidney events (MAKE = death, kidney replacement therapy, or reduced kidney function from baseline) at discharge.
187,888 adult ICU patients were included, and SA-AKI was found in nearly half of sepsis patients and about 1 in 6 ICU admissions. 1 in 4 patients with SA-AKI died during hospitalization and 37.7% experienced at least one MAKE by hospital discharge. Compared to sepsis or AKI alone, SA-AKI was associated with higher mortality (adjusted HR 1.59; 95% CI 1.51-1.66) and higher odds of MAKE (adjusted OR 3.35; 95% CI 3.19-3.51). The early clinical phenotype of SA-AKI was most common, with incident AKI decreasing daily from sepsis onset. The presence of septic shock significantly worsened outcomes.
Applying updated consensus definitions highlights the high prevalence of SA-AKI in the ICU and its significant associated morbidity and mortality. Outcomes differ based on clinical phenotypes, including the timing of SA-AKI onset and the presence of shock.
脓毒症相关急性肾损伤（SA-AKI）的定义于2023年更新。本研究旨在使用更新后的共识定义描述SA-AKI的流行病学，并评估临床结局。
本研究是在两个学术医疗中心进行的回顾性队列分析。纳入2010年至2022年间入住重症监护病房（ICU）的成年患者，并分为SA-AKI组、单纯脓毒症组或单纯急性肾损伤（AKI）组。SA-AKI进一步根据发病时间（脓毒症诊断后早期＜2天与脓毒症诊断后晚期2-7天）和脓毒性休克的存在进行分类。临床结局包括住院死亡率和出院时的主要不良肾脏事件（MAKE=死亡、肾脏替代治疗或肾功能较基线下降）。
纳入了187,888例成年ICU患者，近一半的脓毒症患者存在SA-AKI，约六分之一的ICU入院患者存在SA-AKI。四分之一的SA-AKI患者在住院期间死亡，37.7%的患者在出院时经历了至少一次MAKE。与单纯脓毒症或AKI相比，SA-AKI与更高的死亡率（校正风险比1.59；95%置信区间1.51-1.66）和更高的MAKE几率（校正优势比3.35；95%置信区间3.19-3.51）相关。SA-AKI的早期临床表型最为常见，脓毒症发作后急性肾损伤的发生率每日下降。脓毒性休克的存在显著恶化了结局。
应用更新后的共识定义凸显了SA-AKI在ICU中的高患病率及其显著的相关发病率和死亡率。结局因临床表型而异，包括SA-AKI发作的时间和休克的存在。
