Coagulative biomarkers on admission to the ICU predict acute kidney injury and mortality in patients with septic shock caused by intra-abdominal infection

Zhipeng Xu; Baoli Cheng; Shuiqiao Fu; Xu Liu; Guohao Xie; Zhongwang Li; Yun Ji; Qinghui Fu; Zhinan Xu; Xiangming Fang

doi:10.2147/IDR.S218592

Coagulative biomarkers on admission to the ICU predict acute kidney injury and mortality in patients with septic shock caused by intra-abdominal infection

Infect Drug Resist. 2019 Sep 4:12:2755-2764. doi: 10.2147/IDR.S218592. eCollection 2019.

Authors

Zhipeng Xu¹, Baoli Cheng¹, Shuiqiao Fu², Xu Liu³, Guohao Xie¹, Zhongwang Li¹, Yun Ji², Qinghui Fu², Zhinan Xu⁴, Xiangming Fang¹

Affiliations

¹ Department of Anesthesiology and Intensive Care Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China.
² Department of Surgical Intensive Care Unit, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China.
³ Department of Intensive Care Unit, The Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, People's Republic of China.
⁴ Institute of Biological Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China.

Abstract

Purpose: Sepsis-associated coagulopathy (SAC) contributes to the development of multiple organ failure (MOF) and increasing mortality. The present study was conducted to investigate whether coagulative biomarkers on admission to the intensive care unit (ICU) can predict acute kidney injury (AKI) and mortality in patients with septic shock caused by intra-abdominal infection (IAI).

Patients and methods: An observational retrospective study was conducted in the surgical ICU. We studied patients who met the criteria of septic shock (Sepsis-3) caused by IAI between January 1, 2013, and December 31, 2016. By adjusting for baseline characteristics, multivariate regression analyses were employed to identify independent risk factors for predicting AKI and mortality.

Results: Of the 138 enrolled patients, 65 patients developed AKI. The patients who developed AKI exhibited a dramatically higher Sequential Organ Failure Assessment (SOFA) score (median, 12), Acute Physiology and Chronic Health Evaluation (APACHE) II score (median, 27.5) and mortality rate. In both models, we found that activated partial thromboplastin time (APTT) (odds ratio (OR)=1.074, 95% confidence interval (CI) 1.030-1.120, p=0.001), prothrombin time (PT) (OR=1.162, 95% CI 1.037-1.302, p=0.010) and D-dimer level (OR=1.098, 95% CI 1.002-1.202, p=0.045) on admission to the ICU were significant risk factors for AKI. Moreover, Cox regression analysis showed that prolonged APTT (OR=1.065, 95% CI 1.025-1.107, p=0.001) was independently associated with high mortality.

Conclusion: In patients with septic shock caused by IAI, APTT, PT and D-dimer level on admission to the ICU were significantly associated with AKI. Furthermore, APTT was an independent predictor of 30-day mortality.

Keywords: acute kidney injury; biomarker; coagulopathy; intra-abdominal infection; mortality; septic shock.