The impact of acute kidney injury on prognosis in patients with urological sepsis

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INTRODUCTION

Acute kidney injury (AKI) has negative impact on length of hospital stay and mortality in patients with sepsis. Although urinary tract infections have higher risk to develop AKI, little is known about the influence of AKI on mortality in patients with urological sepsis. We prospectively observed the impact of AKI on prognosis in patients with urological sepsis.

METHODS

We prospectively collected the data from 101 patients with urological sepsis in our hospital between September 2016 and September 2017. AKI diagnosis and stage of AKI were defined according to KDIGO criteria. Patients were divided into two groups between the patients with stage 0-1 AKI and stage 2-3 AKI. The primary end-point is 28-days mortality. The secondary end-points are hospital mortality, intensive care unit (ICU) admission rate and length of hospital stay. Multivariate logistic regression analysis was performed to identify significant risk factors of 28-days mortality.

RESULTS

Median age was 79 years old in this cohort. Of 101 patients, 66 patients (65%) were diagnosed as AKI (any stage). The number of patients with stage 0-1 and stage 2-3 AKI were 70 and 31, respectively. The number of deceased patients in the stage 0-1 and stage 2-3 AKI were 1 (1.4%) and 7 (22.6%), respectively. The 28-days survival rate was significantly lower in patients with stage 2-3 AKI than that of stage 0-1 AKI (P < 0.001). In addition, 28-days mortality, hospital mortality, ICU admission rate and length of hospital stay were significantly higher in patients with stage 2-3 AKI than that of stage 0-1 AKI. Univariate analysis showed that age, AKI and DIC status were significant risk factors for 28-days mortality. In multivariate analysis, AKI status was selected as significant independent risk factor of 28-days mortality in patients with urological sepsis.

CONCLUSION

Significant poor clinical outcomes were observed in patients with stage 2-3 AKI. Development of stage 2-3 AKI is potential prognostic factor in patients with urological sepsis.

Funding: none