Acute Kidney Injury With Sepsis -- A Unique Pathophysiology

Main Category: Urology / Nephrology
Also Included In: Infectious Diseases / Bacteria / Viruses
Article Date: 12 Apr 2008 - 3:00 PDT

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ICU patients with septic acute kidney injury (AKI) are generally sicker, have a higher burden of illness, a greater risk of mortality and longer stays in hospital than patients with non-septic AKI. The findings, published in the open access journal Critical Care, suggest that septic AKI may represent a unique pathophysiologic condition that may require specific detection and clinical interventions.

Researchers from Melbourne, Australia, evaluated data on more than 120,000 admissions to 57 intensive care units (ICUs) across Australia. Over 33,000 patients had a diagnosis of sepsis, of which 14,000 (42%) had concomitant AKI (septic AKI). Sepsis accounted for 32.4% of all patients with AKI.

Previous research has found that AKI affects more than one third of all patients admitted to ICUs and that discriminating between the septic and non-septic forms of the condition may have implications for how patients are treated.

Compared to non-septic AKI, patients with septic AKI in this latest study had significantly higher acuity of illness, lower blood pressure, higher heart rates, worse pulmonary function, greater acidemia and higher white cell counts.

The septic condition tended to be more severe, with longer ICU and hospital stays and a higher risk of mortality in hospital.

"Septic AKI is common in the first 24 hours after ICU admission," says Sean Bagshaw, who led the study. "Our findings suggest that septic AKI patients are clinically distinct and have distinguishing features and relevant difference in clinical outcomes when compared to those with non-septic AKI.

"Our study further supports the concept that discriminating septic and non-septic AKI may have clinical importance. We now need to investigate further whether patients may require specific interventions, for example mechanical ventilation or vasopressor support, to reduce injury and promote kidney recovery."

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1. Early Acute Kidney Injury and Sepsis: A Multi-Centre Evaluation
Sean M Bagshaw, Carol George and Rinaldo Bellomo
Critical Care (in press)

Article available at the journal website:http://ccforum.com/
All articles are available free of charge, according to BioMed Central's open access policy.

2. Critical Care is a high quality, peer-reviewed, international clinical medical journal. Critical Care aims to improve the care of critically ill patients by acquiring, discussing, distributing, and promoting evidence-based information relevant to intensivists. The journal is edited by Prof Jean-Louis Vincent (Belgium) and has an Impact Factor of 3.12

3. BioMed Central (http://www.biomedcentral.com/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.

Source: Charlotte Webber
BioMed Central

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