Clinical Profile and Outcome of Severe Sepsis Related Acute Kidney Injury Among Patients Admitted in Intensive Care Unit – An Observational Prospective Study

Abstract

Background: Critically ill patients in Intensive care unit (ICU) are at a high risk of developing Acute Kidney Injury (AKI) and sepsis is attributed as a cause for AKI in almost half of them. Sepsis related AKI (S-AKI) causes 6 to 8 fold increase in mortality. Aim: To study the clinical profile and outcome of patients with severe sepsis related AKI and to assess the factors associated with fatal outcome among those patients. Methods: This study was a prospective observational design done over a period of 18 months among patients admitted in ICU in a tertiary care hospital in South India. Patients above 18 years of age satisfying case definition of severe sepsis, who had AKI or developed AKI were studied. During their course of stay, timing of onset of AKI, primary source of infection, need for ventilatory support and renal replacement therapy (RRT) were noted. Outcome was categorized as survivors and non-survivors and factors associated with mortality was assessed. Results: Among the total 304 patients studied, 68.1% (n=207) were males and 31.95 (n=97) were females. Mean AKI onset was 1.62 days with 80% having onset <48 hours. Most common source of sepsis was respiratory tract source (n=97, 31.9%) followed by urinary tract source (n=62, 20.39%). Non survivors were 203 (66.8%) and survivors were 101 (33.2%). Primary source of infection significantly associated with fatal outcome in our study includes respiratory tract source (p=0.008), urinary tract source (p=0.002) and soft tissue infection (p=0.006). Need for mechanical ventilation support is significantly associated with mortality (p<0.001) and early AKI tends to have more severe acidosis ( mean serum bicarbonate of 16meq/L), higher leucocytosis (mean white cell count of 22217 cells/mm3) among non-survivors. Mortality rate observed was 66.8%. Sixty six patients (21.7%) required RRT, renal recovery was seen in 26% (n=79) and 34.6% (n=35) of survivors did not had renal recovery. Conclusion: Early AKI presentation (< 48hours) seems to be more common in severe sepsis. Primary source of infection such as respiratory tract, urinary tract, soft tissue infection and need for ventilatory support is associated with fatal outcome among patients with severe sepsis and AKI.

Keywords

• severe sepsis
• acute kidney injury
• mortality