Internal Medicine: Open Access
Open Access

Abstract

Early Outcome and Risk Factors for Death in the Sepsis-Induced Acute Kidney Injury Patients Requiring Continuous Renal Replacement Therapy: A Retrospective Study

Jing Tian, Yan Cao, Tao Zhou, Jiayue Zhang, Hongyang Xu*

Objectives: The objective of this study was to identify risk factors for death in the Sepsis-Induced Acute Kidney Injury (SI-AKI) patients requiring Continuous Renal Replacement Therapy (CRRT).

Methods: This was a single-centre, retrospective, observational study that included 108 patients who underwent CRRT between 1 January 2022 and 31 December 2022 in the Intensive Care Unit (ICU) of the affiliated Wuxi people' s Hospital of Nanjing Medical University. The patients were grouped according to the latest guidelines for sepsis and AKI and their clinical characteristics, early outcomes and risk factors for death were statistically analyzed.

Results: Compared to non-SI-AKI patients, the SI-AKI patients were mostly associated with severe cardiac insufficiency (25 (42.4%) vs. 6 (12.2%) cases, P<0.05) and hepatic impairment (34 (57.6%) vs. 13 (6.5%) cases, P<0.05), more intense inflammatory response of the organism (CRP; 119.5 (62.7-193.8) vs. 57.4 (13.3-114.4) mg/L, P<0.05) and started CRRT earlier (Cr; 242 (158-397) vs. 546 (266-823) μmol/L, P<0.05) before CRRT. During CRRT these patients had a high extubation failure rate (21 (35.6%) vs. 8 (13.6%) cases, P<0.05) and Pseudomonas aeruginosa (17 (28.8%) vs. 6 (12.2%) cases, P<0.05) and other pathogenic bacteria (14 (23.7%) vs. 3 (6.1%) cases, P<0.05) had higher rates of infection. Moreover, SI-AKI patients had a 30-day mortality rate 1.8 times higher than that of non-SIAKI patients. Multifactorial analysis suggested that sepsis (HR, 2.794; 95% CI, 1.197-6.523; P<0.05), extubation failure (HR, 4.623; 95% CI, 1.721-12.418; P<0.05) and Acinetobacter baumannii infection (HR, 2.223; 95% CI, 1.130-4.375; P<0.05) were risk factors for death in AKI patients treated with CRRT. Extubation failure (HR, 3.132; 95% CI, 1.131-8.673; P<0.05) and Pseudomonas aeruginosa infection (HR, 2.534; 95% CI, 1.032-6.219; P<0.05) were risk factors for death in patients with SI-AKI who received CRRT treatment.

Conclusions: Attention should be given in clinical practice to early prevention of infection and attempts at extubation whenever possible, which can be effective in reducing the risk and potential threat of death in SI-AKI patients treated with CRRT.

Published Date: 2025-07-18; Received Date: 2024-07-05