Akcan Arikan Ayse, Ostermann Marlies, Goldstein Stuart L, Kellum John A
Divisions of Critical Care and Nephrology, Department of Paediatrics, Baylor College of Medicine, Houston, TX, USA.
Department of Intensive Care, King's College London, Guy's & St Thomas' Hospital, London, UK.
Nat Rev Nephrol. 2025 Jun 12. doi: 10.1038/s41581-025-00973-y.
The kidney is a target organ for the dysregulated host response to infection that defines sepsis, and acute kidney injury (AKI) is often an early manifestation of this response. Current sepsis criteria for adults (Sepsis-3) continue to include outmoded measures of kidney health, such as absolute creatinine values, which are used in organ failure scoring independently of baseline kidney function or treatment with dialysis. This approach perpetuates disparities, as older female patients require much larger decreases in kidney function compared with young male patients to achieve the same 'renal domain' points, exacerbating sex- and age-based inequities in health assessment and response. Furthermore, the latest data-driven machine learning-assisted paediatric sepsis criteria (the Phoenix Sepsis Score) have excluded kidney function entirely from sepsis diagnosis. Consequently, these criteria will exclude a child with pneumonia and associated AKI, even if receiving dialysis, from a sepsis diagnosis unless other organs fail. This inconsistency, given the extensive refinement and validation of AKI diagnostic criteria over the past three decades, is unacceptable. Current criteria for diagnosis of sepsis in both adults and children fail to incorporate crucial advances in the diagnosis of kidney disease. We maintain that it is imperative that kidney injury is quantified accurately in sepsis scoring systems free of sex, race and other biases.
肾脏是宿主对定义为脓毒症的感染反应失调的靶器官，急性肾损伤（AKI）通常是这种反应的早期表现。当前的成人脓毒症标准（Sepsis-3）继续纳入过时的肾脏健康指标，如绝对肌酐值，这些指标在器官功能衰竭评分中使用，而与基线肾功能或透析治疗无关。这种方法延续了差异，因为老年女性患者与年轻男性患者相比，需要更大幅度的肾功能下降才能获得相同的“肾脏领域”分数，加剧了健康评估和应对中基于性别和年龄的不平等。此外，最新的数据驱动的机器学习辅助儿科脓毒症标准（凤凰脓毒症评分）完全将肾功能排除在脓毒症诊断之外。因此，这些标准将把一名患有肺炎和相关AKI的儿童排除在脓毒症诊断之外，即使该儿童正在接受透析，除非其他器官出现衰竭。鉴于在过去三十年中对AKI诊断标准进行了广泛的完善和验证，这种不一致是不可接受的。目前成人和儿童脓毒症的诊断标准未能纳入肾脏疾病诊断方面的关键进展。我们坚持认为，在没有性别、种族和其他偏见的脓毒症评分系统中准确量化肾损伤至关重要。
