Epidemiology of Septic Shock Associated Acute Kidney Injury: A National Retrospective Cohort Study.

Abstract

Septic shock is the most severe and final stage of sepsis. These patients may have a higher risk for sepsis-associated acute kidney injury (AKI). The purpose of this study is to determine the frequency of AKI, major adverse kidney events at 30 days (MAKE-30), and use of renal replacement therapy (RRT) in patients with septic shock. We also aim to determine the association between stage of AKI and in-hospital mortality. Retrospective, multicenter, cohort study. This was conducted in 220 geographically diverse community and teaching hospitals across the United States. Adult patients were included if they had septic shock on hospital admission. None. Measurements include stage 1, 2, and 3 AKI, RRT, and MAKE-30. Of the 21,803 patients included in the final cohort, 92.8% had AKI during hospital admission. Patients had a mean ( sd ) age of 66.0 years (15.1 yr), 48.6% were female, 29.5% had chronic kidney disease, and mean ( sd ) estimated glomerular filtration rate was 35.8 mL/min/1.73 m 2 (24.3 mL/min/1.73 m 2 ). The maximum stage of AKI during hospitalization was none (7.2%), stage 1 (22.9%), stage 2 (27.3%), or stage 3 (42.7%). The proportion of patients who received RRT was 6.4%. MAKE-30 occurred in 42.0% and 30.9% died. There was no significant association between stage 1 (odds ratio [OR], 1.12; 95% CI, 0.97-1.29; p = 0.109), but there was a significant association between stage 2 (OR, 1.25; 95% CI, 1.09-1.43; p = 0.001), and stage 3 AKI (OR, 1.66; 95% CI, 1.46-1.89; p < 0.001) and mortality. Among hospitalized patients with septic shock, most patients have AKI, and stage 3 AKI is associated with the highest risk of mortality.