The attributable mortality of sepsis for acute kidney injury: a propensity-matched analysis based on multicenter prospective cohort study

Abstract

Background

Both sepsis and AKI are diseases of major concern in intensive care unit (ICU). This study aimed to evaluate the excess mortality attributable to sepsis for acute kidney injury (AKI).

Methods

A propensity score-matched analysis on a multicenter prospective cohort study in 18 Chinese ICUs was performed. Propensity score was sequentially conducted to match AKI patients with and without sepsis on day 1, day 2, and day 3–5. The primary outcome was hospital death of AKI patients.

Results

A total of 2008 AKI patients (40.9%) were eligible for the study. Of the 1010 AKI patients with sepsis, 619 (61.3%) were matched to 619 AKI patients in whom sepsis did not develop during the screening period of the study. The hospital mortality rate of matched AKI patients with sepsis was 205 of 619 (33.1%) compared with 150 of 619 (24.0%) for their matched AKI controls without sepsis (p = 0.001). The attributable mortality of total sepsis for AKI patients was 9.1% (95% CI: 4.8–13.3%). Of the matched patients with sepsis, 328 (53.0%) diagnosed septic shock. The attributable mortality of septic shock for AKI was 16.2% (95% CI: 11.3–20.8%, p < 0.001). Further, the attributable mortality of sepsis for AKI was 1.4% (95% CI: 4.1–5.9%, p = 0.825).

Conclusions

The attributable hospital mortality of total sepsis for AKI were 9.1%. Septic shock contributes to major excess mortality rate for AKI than sepsis.

Registration for the multicenter prospective cohort study

registration number ChiCTR-ECH-13003934

Keywords:

• Sepsis
• acute kidney injury
• attributable mortality

Acknowledgements

(1) We thank the 18 trial sites of 16 hospitals in the China Critical Care Sepsis Trial (CCCST) workgroup, including Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China; Department of Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China; Department of Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China; Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong, China; Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China; Department of Surgical Intensive Care Unit, Department of Anesthesiology, ZhongShan Hospital, FuDan University, Shanghai, China; Department of Intensive Care Unit, The First Hospital of Jilin University, Changchun, China; Department of Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing China; Department of Surgical Intensive Care Unit, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Ningxia, China; Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China; Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China; Department of Surgical Intensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China; Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. In addition, we especially thank Professor Xiaoxia Peng in Centre for Clinical Epidemiology and Evidence-based medicine, Beijing Children’s Hospital, Capital Medical University, National Centre for Children Health for technical support in applying for the project.

(2) A preprint of the manuscript was online. The online platform: Research Square; Online posting’s date: 22 Jul, 2021; Internet link: https://doi.org/10.21203/rs.3.rs-699907/v1.

Ethical approval

The study was approved in all participating ICUs by their Hospital Human Ethics Committee. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 2013FXHEC-KY2018) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Geolocation information

Beijing, China.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data not available due to ethical restrictions.

Additional information

Funding

This study was supported by grants from the Beijing Municipal Science & Technology Commission [no. Z191100006619032] and National Science and Technology Support Program [no. 2012BAI11B].