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Open Access 01-08-2020 | Acute Kidney Injury | Original

Mortality and host response aberrations associated with transient and persistent acute kidney injury in critically ill patients with sepsis: a prospective cohort study

Authors: Fabrice Uhel, Hessel Peters-Sengers, Fahimeh Falahi, Brendon P. Scicluna, Lonneke A. van Vught, Marc J. Bonten, Olaf L. Cremer, Marcus J. Schultz, Tom van der Poll, the MARS consortium

Published in: Intensive Care Medicine | Issue 8/2020

Abstract

Purpose

Sepsis is the most frequent cause of acute kidney injury (AKI). The “Acute Disease Quality Initiative Workgroup” recently proposed new definitions for AKI, classifying it as transient or persistent. We investigated the incidence, mortality, and host response aberrations associated with transient and persistent AKI in sepsis patients.

Methods

A total of 1545 patients admitted with sepsis to 2 intensive care units in the Netherlands were stratified according to the presence (defined by any urine or creatinine RIFLE criterion within the first 48 h) and evolution of AKI (with persistent defined as remaining > 48 h). We determined 30-day mortality by logistic regression adjusting for confounding variables and analyzed 16 plasma biomarkers reflecting pathways involved in sepsis pathogenesis (n = 866) and blood leukocyte transcriptomes (n = 392).

Results

AKI occurred in 37.7% of patients, of which 18.4% was transient and 81.6% persistent. On admission, patients with persistent AKI had higher disease severity scores and more frequently had severe (injury or failure) RIFLE AKI stages than transient AKI patients. Persistent AKI, but not transient AKI, was associated with increased mortality by day 30 and up to 1 year. Persistent AKI was associated with enhanced and sustained inflammatory and procoagulant responses during the first 4 days, and a more severe loss of vascular integrity compared with transient AKI. Baseline blood gene expression showed minimal differences with respect to the presence or evolution of AKI.

Conclusion

Persistent AKI is independently associated with sepsis mortality, as well as with sustained inflammatory and procoagulant responses, and loss of vascular integrity as compared with transient AKI.

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Title: Mortality and host response aberrations associated with transient and persistent acute kidney injury in critically ill patients with sepsis: a prospective cohort study
Authors: Fabrice Uhel
Hessel Peters-Sengers
Fahimeh Falahi
Brendon P. Scicluna
Lonneke A. van Vught
Marc J. Bonten
Olaf L. Cremer
Marcus J. Schultz
Tom van der Poll
the MARS consortium
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Acute Kidney Injury
Septicemia
Septicemia
Acute Kidney Injury
Published in: Intensive Care Medicine / Issue 8/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06119-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Mortality and host response aberrations associated with transient and persistent acute kidney injury in critically ill patients with sepsis: a prospective cohort study

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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