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

IF 6 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Medicine Pub Date : 2025-06-13 DOI:10.1097/CCM.0000000000006735

Asad E Patanwala, Brian L Erstad

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引用次数: 0

Abstract

Objectives: 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.

Design: Retrospective, multicenter, cohort study.

Setting: This was conducted in 220 geographically diverse community and teaching hospitals across the United States.

Patients: Adult patients were included if they had septic shock on hospital admission.

Interventions: None.

Measurements and main results: 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 m2 (24.3 mL/min/1.73 m2). 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.

Conclusions: Among hospitalized patients with septic shock, most patients have AKI, and stage 3 AKI is associated with the highest risk of mortality.

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感染性休克相关急性肾损伤的流行病学：一项全国性回顾性队列研究。

目的：脓毒性休克是脓毒症的最严重和最后阶段。这些患者发生败血症相关急性肾损伤（AKI）的风险较高。本研究的目的是确定感染性休克患者的AKI频率、30天内主要肾脏不良事件（MAKE-30）以及肾脏替代疗法（RRT）的使用情况。我们还旨在确定AKI分期与住院死亡率之间的关系。设计：回顾性、多中心、队列研究。环境：这是在美国220个地理位置不同的社区和教学医院进行的。患者：纳入入院时感染性休克的成年患者。干预措施:没有。测量和主要结果：测量包括1期、2期和3期AKI、RRT和MAKE-30。在最终队列纳入的21803例患者中，92.8%的患者在住院期间患有AKI。患者平均（sd）年龄为66.0岁（15.1岁），48.6%为女性，29.5%患有慢性肾脏疾病，平均（sd）估计肾小球滤过率为35.8 mL/min/1.73 m2 （24.3 mL/min/1.73 m2）。住院期间AKI的最大分期为无（7.2%）、1期（22.9%）、2期（27.3%）和3期（42.7%）。接受RRT的患者比例为6.4%。MAKE-30发生率为42.0%，死亡30.9%。第1期患者之间无显著相关性(优势比[OR]， 1.12；95% ci, 0.97-1.29；p = 0.109)，但2期间存在显著相关性(OR, 1.25；95% ci, 1.09-1.43；p = 0.001)和3期AKI (OR, 1.66；95% ci, 1.46-1.89；P < 0.001)和死亡率。结论：在感染性休克住院患者中，大多数患者有AKI， 3期AKI与死亡风险最高相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care Medicine 医学-危重病医学

CiteScore

16.30

自引率

5.70%

发文量

728

审稿时长

2 months

期刊介绍： Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.