Hospital Mortality and Predicting Factors in Patients with Sepsis-associated Acute Kidney Injury Requiring Renal Replacement Therapy

Chairat Permpikul; Nattapat Wongtirawit; Surat Tongyoo; Methawoot Khemmongkon; Thummaporn Naorungroj

doi:10.33192/smj.v78i11.275788

Authors

Chairat Permpikul Division of Critical Care, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Nattapat Wongtirawit Division of Critical Care, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Surat Tongyoo Division of Critical Care, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
Methawoot Khemmongkon Division of Nephrology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
Thummaporn Naorungroj Division of Critical Care, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University

DOI:

https://doi.org/10.33192/smj.v78i11.275788

Keywords:

Acute kidney injury, Sepsis, Septic shock, Renal replacement therapy, Mortality

Abstract

Objective: to investigate the clinical predictors for hospital mortality in patients with sepsis-associated acute kidney injury who required renal replacement therapy.

Materials and Methods: A retrospective cohort study enrolling adult patients hospitalized in medical wards at Siriraj Hospital between 2018-2021, who were concurrently diagnosed with sepsis and acute kidney injury. Patients who previously received long-term renal replacement therapy were excluded. We compared clinical characteristics and treatment strategies, then analyzed the predictors of mortality according to hospital mortality.

Results: Among 189 patients with acute kidney injury requiring renal replacement therapy, 132 (69.8%) died during hospitalization. A receiver operating characteristic curve analysis for predictors of hospital mortality revealed cutoff values for age > 60 years, SOFA score > 10, APACHE II score > 20, total colloid in 72 hr > 1,500 mL, maximum vasopressor > 0.3 mcg/kg/min, white blood cell count < 12 cells/µL, serum creatinine < 4 mg/dL, and serum albumin < 2.5. Multivariate analysis identified age > 60 (OR 2.8, 1.27-6.38), APACHE II score > 20 (OR 2.57, 1.23-5.42), and maximum vasopressor dose > 0.3 mcg/kg/min (OR 4.26, 1.94-9.86) as independent mortality predictors, while creatinine > 4 mg/dL was protective (OR 0.36, 0.17-0.75).

Conclusion: Patients with sepsis-associated acute kidney injury who underwent renal replacement therapy had high hospital mortality. Age > 60 years, APACHE II score > 20, maximum vasopressor dose > 0.3 mcg/kg/min, and serum creatinine ≤ 4 mg/dL were predictors for hospital mortality.

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