Acute kidney injury-attributable mortality in critically ill patients with sepsis

Zhiyi Wang; Jie Weng; Jinwen Yang; Xiaoming Zhou; Zhe Xu; Ruonan Hou; Zhiliang Zhou; Liang Wang; Chan Chen; Shengwei Jin

doi:10.7717/peerj.13184

Acute kidney injury-attributable mortality in critically ill patients with sepsis

PeerJ. 2022 Mar 25:10:e13184. doi: 10.7717/peerj.13184. eCollection 2022.

Authors

Zhiyi Wang^#^{1

2}, Jie Weng^#¹, Jinwen Yang³, Xiaoming Zhou¹, Zhe Xu⁴, Ruonan Hou¹, Zhiliang Zhou¹, Liang Wang⁵, Chan Chen³, Shengwei Jin⁶

Affiliations

¹ Department of General Practice, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
² Center for Health Assessment, Wenzhou Medical University, Wenzhou, Zhejiang, China.
³ Department of Geriatric Medicine, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
⁴ Department of Emergency Intensive Care Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
⁵ Department of Public Health, Robbins College of health and Human Sciences, Baylor University, Waco, TX, United States of America.
⁶ Department of Anesthesia and Critical Care, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

^# Contributed equally.

Abstract

Background: To assess whether acute kidney injury (AKI) is independently associated with hospital mortality in ICU patients with sepsis, and estimate the excess AKI-related mortality attributable to AKI.

Methods: We analyzed adult patients from two distinct retrospective critically ill cohorts: (1) Medical Information Mart for Intensive Care IV (MIMIC IV; n = 15,610) cohort and (2) Wenzhou (n = 1,341) cohort. AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We applied multivariate logistic and linear regression models to assess the hospital and ICU mortality, hospital length-of-stay (LOS), and ICU LOS. The excess attributable mortality for AKI in ICU patients with sepsis was further evaluated.

Results: AKI occurred in 5,225 subjects in the MIMIC IV cohort (33.5%) and 494 in the Wenzhou cohort (36.8%). Each stage of AKI was an independent risk factor for hospital mortality in multivariate logistic regression after adjusting for baseline illness severity. The excess attributable mortality for AKI was 58.6% (95% CI [46.8%-70.3%]) in MIMIC IV and 44.6% (95% CI [12.7%-76.4%]) in Wenzhou. Additionally, AKI was independently associated with increased ICU mortality, hospital LOS, and ICU LOS.

Conclusion: Acute kidney injury is an independent risk factor for hospital and ICU mortality, as well as hospital and ICU LOS in critically ill patients with sepsis. Thus, AKI is associated with excess attributable mortality.

Keywords: Acute kidney injury; Attributable mortality; Mortality; Sepsis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Kidney Injury* / complications
Adult
Critical Illness
Humans
Inpatients
Intensive Care Units
Retrospective Studies
Sepsis* / complications

Grants and funding

This study was supported by National Natural Science Foundation of China, No. 81772054 and 82100074. The Key R&D Program of Zhejiang Province (2019C03011), Wenzhou Major Science and Technology Innovation Project (2018ZY006), Clinical Research Fundation of the 2nd Affiliated Hospital of Wenzhou Medical University (SAHoWMU-CR2018-11-134). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.