Serum lactates and acute kidney injury in patients with sepsis: A cohort analysis

Abstract

Granting the association of lactates with mortality has been largely documented in critically ill patients with sepsis, its association with the development of acute kidney injury (AKI) in this setting is not well established. We aimed to analyze the association of serum lactates at intensive care unit (ICU) admission with the occurrence AKI in a cohort of critically ill septic patients. Materials and methods: This study is retrospective including 457 adult patients with sepsis admitted to the Division of Intensive Medicine of the Centro Hospitalar Lisboa Norte (Lisbon, Portugal) between January 2008 and December 2014. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to diagnose and classify patients developing AKI within the first week of hospitalization. Logistic regression analysis was employed to determine factors associated with AKI development. Data were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Statistical significance was defined as a p-value < 0.05. Results: AKI occurred in 87.5% of patients with a maximum KDIGO category (19.5% with stage 1, 22.6% with stage 2 and 45.4% with stage 3). Serum lactates were higher among patients developing AKI as compared with non-AKI patients (mmol/L 29.9 ± 25.7 vs. 18.6 ± 9.3, p = 0.001; unadjusted OR 1.04 (95% CI 1.02–1.07), p = 0.001; adjusted OR 1.03 (95% CI 1.01–1.06), p = 0.024), and they were progressively higher in accordance with AKI severity (stage 1, 24.5 ± 18.7; stage 2, 25.5 ± 16.9; stage 3, 34.6 ± 30.7; p = 0.001). Conclusions: Serum lactates at ICU admission were independently associated with the occurrence of AKI in critically ill patients with sepsis.

Keywords:

• acute kidney injury
• intensive care
• lactates
• sepsis

Public Interest Statement

Acute Kidney Injury (AKI) it’s a high prevalence problem in patients hospitalized, but especially in the intensive care unit (ICU). Serum lactate, often elevated in this context, is assumed in current knowledge as an important form of monitoring and prognostic importance in critically ill patients. Although physiologically interrelation with the kidney, its role as a risk factor for AKI has not been studied very sparingly. Therefore, we analyze the impact of serum lactates on the occurrence of AKI in a cohort of critically ill septic patients, and we find that serum lactates at ICU admission were independently associated with the occurrence of AKI. This finding may make it possible to identify these patients earlier.

Competing Interests

The authors declare no competing interest.

Additional information

Notes on contributors

José António Lopes

José António Lopes is a professor at the Faculty of Medicine of the University of Lisbon and a recognized specialist in nephrology field. Its clinical activity is focused on the approach and treatment of acute renal injury and acute in chronic kidney disease, also directs the hospitalization sector of Hospital Santa Maria, the largest hospital in Portugal. He has developed a recognized work in the area of acute renal injury, in its definition and diagnosis. Leads a research team in the field of nephrology, providing other clinicians, such as Miguel Gonçalves and colleagues, to develop interesting studies and contributing to new knowledge.