Dynamic monitoring of kidney injury status over 3 days in the intensive care unit as a sepsis phenotype associated with hospital mortality and hyperinflammation

Chiung-Yu Lin; Yi-Hsi Wang; Yu-Mu Chen; Kai-Yin Hung; Ya-Chun Chang; Ying-Tang Fang; Ya-Ting Chang; Hung-Cheng Chen; Kuo-Tung Huang; Huang-Chih Chang; Yung-Che Chen; Chin-Chou Wang; Meng-Chih Lin; Wen-Feng Fang

doi:10.1016/j.bj.2021.08.006

Dynamic monitoring of kidney injury status over 3 days in the intensive care unit as a sepsis phenotype associated with hospital mortality and hyperinflammation

Biomed J. 2022 Aug;45(4):665-674. doi: 10.1016/j.bj.2021.08.006. Epub 2021 Sep 3.

Authors

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
² Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁴ Department of Nutritional Therapy, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan.
⁵ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁶ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: wenfengfang@yahoo.com.tw.

Abstract

Background: Sepsis-associated acute kidney injury (AKI) often worsens with the deterioration of a patient's condition. Therefore, we hypothesized that monitoring AKI dynamically from day 1 to day 3 was potential to predict hospital mortality. Specifically, we explored whether monitoring AKI dynamically in the intensive care unit (ICU) could be a sepsis phenotype predictive of mortality. A new classification was established based on the change in the AKI stage from admission day 1 and day 3. We compared the hospital mortality, cytokines, and immune response pattern between each group.

Methods: We retrospectively enrolled 523 patients with sepsis, and we calculated the AKI stages on day 1 and day 3 admission to ICUs. Among these 523 people, 388 of them were assigned to normal, improved, and deteriorated groups according to the changes in the AKI stages. 263 of which did not develop AKI on day 1 and day 3 (normal group). The AKI stage improved in 68 patients (improved group) and worsened in 57 (deteriorated group). We compared the mortality rates between the groups, and identified the relationship between the dynamic AKI status, immune response patterns, and cytokine levels.

Results: The hospital mortality rate in the deteriorated group was higher than that in the non-deteriorated group (combination of normal and improved group) (p = 0.004). Additionally, according to the Kaplan-Meier analysis, the non-deteriorated group had a distinct hospital survival curve (p = 0.004). Furthermore, both the overexpression of tumor necrosis factor-α and decreased monocyte expression of human leukocyte antigen-DR were present in the deteriorated group.

Conclusions: The deteriorated group was associated with a higher hospital mortality rate, potentially resulting from an abnormal inflammatory response. Worsening AKI in the first 3 days of ICU admission may be a sepsis phenotype predictive of hospital mortality.

Keywords: Acute kidney injury; Dynamic acute kidney injury stage; Immune response; Sepsis phenotype.

MeSH terms

Acute Kidney Injury* / complications
Acute Kidney Injury* / diagnosis
HLA Antigens
Hospital Mortality
Humans
Intensive Care Units
Kidney
Phenotype
Retrospective Studies
Sepsis* / complications
Sepsis* / diagnosis
Tumor Necrosis Factor-alpha

Substances

HLA Antigens
Tumor Necrosis Factor-alpha