Factors Predicting Acute Kidney Injury among Patients with Sepsis at Emergency Department
Article Sidebar
Main Article Content
Abstract
Purpose: To examine the predictive power of health literacy, perceived severity of disease, family support, prehospital time, and the incidence of acute kidney injury among patients with sepsis in the emergency department.
Design: A cross-sectional predictive research design.
Methods: A total of 151 participants, both male and female, aged 18 years or older, and diagnosed with sepsis, were selected using convenience sampling from the Emergency Department of a tertiary hospital located in Bangkok. Data were collected using Mini-Cognitive Assessment Instrument, general information form, Acute Kidney Injury Assessment form, Health Literacy in Emergency Illness Scale, the Perceived Severity of Disease Scale, and the Chinese Family Support Scale. Data analysis was performed using descriptive statistics and logistic regression.
Main findings: Health literacy, perceived severity of disease, family support, and prehospital time jointly predicted acute kidney injury (AKI) in patients with sepsis by explaining 45% of its variance (Nagelkerke R² = .45). Participants with moderate and adequate health literacy had a reduced likelihood of developing AKI by 84% (OR = .16, 95%CI [.05, .52], p = .002) and 95% (OR = .05, 95%CI [.01, .17], p < .001), respectively. Participants with high perceived severity of disease had a 62% lower likelihood of developing AKI (OR = .38, 95%CI [.15, .99], p = .05). In contrast, participants with prehospital times exceeding 72 and 120 hours after symptom recognition had approximately fourfold increased odds of developing AKI (OR = 4.09, 95%CI [1.12, 14.88], p = .033 and OR = 3.92, 95%CI [1.27, 12.15], p = .02, respectively). Although family support was associated with AKI (c2 = 10.07, p = .007), it did not predict AKI when the other study variables were controlled.
Conclusion and recommendations: Nurses and healthcare professionals should apply the findings of this study to the planning and delivery of care for patients with sepsis, focusing on the enhancement of health literacy, perceived severity of disease, and family involvement at the early stage of sepsis. Such interventions can promote timely healthcare-seeking behavior, reduce disease severity, and prevent the development of acute kidney injury.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright Notice: Nursing Science Journal of Thailand has exclusive rights to publish and distribute the manuscript and all contents therein. Without the journal’s permission, the dissemination of the manuscript in another journal or online, and the reproduction of the manuscript for non-educational purpose are prohibited.
Disclaimer: The opinion expressed and figures provided in this journal, NSJT, are the sole responsibility of the authors. The editorial board bears no responsibility in this regard.
References
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-10. doi: 10.1001/jama.2016.0287.
Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the global burden of disease study. Lancet. 2020;395(10219):200-11. doi: 10.1016/S0140-6736(19)32989-7.
Zhang CF, Wang HJ, Tong ZH, Zhang C, Wang YS, Yang HQ, et al. The diagnostic and prognostic values of serum and urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin in sepsis induced acute renal injury patients. Eur Rev Med Pharmacol Sci. 2020;24(10):5604-17. doi: 10.26355/eurrev_202005_21346.
Hsu Y-C, Hsu C-W. Septic acute kidney injury patients in emergency department: the risk factors and its correlation to serum lactate. Am J Emerg Med. 2019;37(2):204-8. doi: 10.1016/j.ajem.2018.05.012.
Parsons Leigh J, Brundin-Mather R, Moss SJ, Nickel A, Parolini A, Walsh D, et al. Public awareness and knowledge of sepsis: a cross-sectional survey of adults in Canada. Crit Care. 2022;26(1):337. doi: 10.1186/s13054-022-04215-6.
Long B, Koyfman A. Clinical mimics: an emergency medicine–focused review of sepsis mimics. J Emerg Med. 2017;52(1):34-42. doi: 10.1016/j.jemermed.2016.07.102.
Kerrigan SW, Martin-Loeches I. Public awareness of sepsis is still poor: we need to do more. Intensive Care Med. 2018;44(10):1771-3. doi: 10.1007/s00134-018-5307-5.
Olander A, Andersson H, Sundler AJ, Hagiwara MA, Bremer A. The onset of sepsis as experienced by patients and family members: a qualitative interview study. J Clin Nurs. 2023;32(19-20):7402-11. doi: 10.1111/jocn.16785.
Holmbom M, Andersson M, Berg S, Eklund D, Sobczynski P, Wilhelms D, et al. Prehospital delay is an important risk factor for mortality in community-acquired bloodstream infection (CA-BSI): a matched case–control study. BMJ Open. 2021;11(11):e052582. doi: 10.1136/bmjopen-2021-052582.
Levesque J-F, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18. doi: 10.1186/1475-9276-12-18.
Laforet K. Bridging the digital divide in wound care: health literacy and access to care. Wound Care Canada. 2020;18(3):70-4.
McCaffery KJ, Dodd RH, Cvejic E, Ayre J, Batcup C, Isautier JM, et al. Disparities in COVID-19 related knowledge, attitudes, beliefs and behaviours by health literacy. medRxiv. 2020:1-25. doi: 10.1101/2020.06.03.20121814.
Fan Z-Y, Yang Y, Yin R-Y, Tang L, Zhang F. Effect of health literacy on decision delay in patients with acute myocardial infarction. Front Cardiovasc Med. 2021;8:754321. doi: 10.3389/fcvm.2021.754321.
Phetarvut S, Watthayu N, Suwonnaroop N. Factors predicting diabetes self-management behaviors among patients with diabetes mellitus type 2. Nursing Science Journal of Thailand. 2011;29(4):18-26. (in Thai).
Reisinger MW, Moss M, Clark BJ. Is lack of social support associated with a delay in seeking medical care? A cross-sectional study of Minnesota and Tennessee residents using data from the behavioral risk factor surveillance system. BMJ Open. 2018;8(7):e018139. doi: 10.1136/bmjopen-2017-018139.
Doungsuriya P, Chanruangvanich W, Chayaput P, Thosingha O. Factors predicting severity of physiological deterioration among sepsis patients in emergency department. Journal of Thailand Nursing and Midwifery Council. 2021;36(3):134-50. (in Thai).
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373-9. doi: 10.1016/s0895-4356(96)00236-3.
Galli G, Bhatraju P, Hantrakun V, Boonsri C, Teparrukkul P, Limmathurotsakul D, et al. Incidence of and risk factors for infection-associated acute kidney injury in northeast Thailand. Am J Respir Crit Care Med. 2020;201(1):A3562. doi: 10.1164/ajrccm-conference.2020.201.1_MeetingAbstracts.A3562.
Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15(11):1021-7. doi: 10.1002/1099-1166(200011)15:11<1021::aid-gps234>3.0.co;2-6.
Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1-138.
Papukdee P, Changmai S, Torskulkao T. Health literacy in emergency illness among clients of emergency room at Vajira Hospital. Vajira Nursing Journal. 2021;23(1):1-14. (in Thai).
Chanpa M, Sanasuttipun W, Srichantaranit A. Relationships among children’s age, caregivers’ perceived severity of illness, stress, social support, and quality of life among caregivers of children with congenital heart disease. Nursing Science Journal of Thailand. 2018;36(1):73-86. (in Thai).
Li G, Hu H, Dong Z, Arao T. Development of the Chinese family support scale in a sample of Chinese patients with hypertension. PLoS One. 2013;8(12):e85682. doi: 10.1371/journal.pone.0085682.
Marx RG, Menezes A, Horovitz L, Jones EC, Warren RF. A comparison of two time intervals for test-retest reliability of health status instruments. J Clin Epidemiol. 2003;56(8):730-5. doi: 10.1016/S0895-4356(03)00084-2.
Born S, Fleischmann-Struzek C, Abels W, Piedmont S, Neugebauer E, Reinhart K, et al. Most patients with an increased risk for sepsis-related morbidity or death do not recognize sepsis as a medical emergency: results of a survey study using case vignettes. Crit Care. 2023;27(1):446. doi: 10.1186/s13054-023-04733-x.
Quiros-Roldan E, Sottini A, Natali PG, Imberti L. The impact of immune system aging on infectious diseases. Microorganisms. 2024;12(4):775. doi: 10.3390/microorganisms12040775.
