Using Sepsis-3 criteria to predict prognosis of patients receiving continuous renal replacement therapy for community-acquired sepsis: a retrospective observational study

Abstract

Abstract Background The definition and guideline of sepsis and septic shock were recently updated. The aim of this study is to evaluate the ability of Third Consensus Definitions of Sepsis and Septic Shock (Sepsis-3) to predict outcomes among patients with community-acquired sepsis receiving continuous renal replacement therapy (CRRT). Methods We conducted a retrospective observational study between January 2013 and December 2015 in a single university hospital. From 368 patients receiving CRRT for various reasons, 64 patients who suffered from community-acquired sepsis and required CRRT were selected and evaluated using the current and previous sepsis criteria. We additionally assessed infection characteristics. The primary outcome was 28-day mortality, and the secondary outcome was in-hospital mortality. Results Of the 64 participants (70.3% male, median age 66.5 years), 33 (51.6%) administered antimicrobials before admission. The most common source of infections was pneumonia, and 27 participants (42.2%) had positive cultures. The Sepsis-3 criteria identified 64 cases (100%) as sepsis at the start of CRRT, while the previous criteria identified 44 cases (68.8%). According to the Sepsis-3 criteria, the 28-day mortality of sepsis and septic shock were 31.3% (20/64) and 46% (17/37), and in-hospital mortality was 43.8% (28/64) and 62.2% (23/37), respectively. Septic shock diagnosed using the Sepsis-3 criteria predicted mortality (log-rank P = 0.0001); however, using the previous criteria was not associated with mortality (log-rank P = 0.437). Among variables, lactate levels ≥ 2 mmol/L and SOFA score ≥ 14 were significantly associated with mortalities, with an optimal cutoff value for lactate of 1.8 mmol/L (AUC 0.777, sensitivity 85.7%, specificity 58.3%). Although age ≥ 65 years predicted in-hospital mortality, and pre-hospital antimicrobial therapy tended to be associated with 28-day mortality, we did not detect any association between outcomes and the CRRT regimen or general risk factors (e.g., acute kidney injury, serum creatinine levels, and comorbidities). Conclusions Our data suggests that the Sepsis-3 criteria predicted survival more accurately than the previous criteria among patients with community-acquired sepsis receiving CRRT. This is based on lactate levels and SOFA scores being strongly associated with mortality.

Keywords

• Mortality
• Septic shock
• Lactate
• SOFA