Abstract and Introduction
Abstract
Introduction: Sepsis has been a factor of acute kidney injury (AKI); however, little is known about dialysis-requiring AKI and the risk of severe sepsis after survival to discharge.
Methods: We conducted a population-based cohort study based on the Taiwan National Health Insurance Research Database from 1999 to 2009. We identified patients with AKI requiring dialysis during hospitalization and survived for at least 90 days after discharge, and matched them with those without AKI according to age, sex, and concurrent diabetes. The primary outcome was severe sepsis, defined as sepsis with a diagnosis of acute organ dysfunction. Individuals who recovered enough to survive without acute dialysis were further analyzed.
Results: We identified 2983 individuals (mean age, 62 years; median follow-up, 3.96 years) with dialysis-requiring AKI and 11,932 matched controls. The incidence rate of severe sepsis was 6.84 and 2.32 per 100 person-years among individuals with dialysis-requiring AKI and without AKI in the index hospitalization, respectively. Dialysis-requiring AKI patients had a higher risk of developing de novo severe sepsis than the non-AKI group. In subgroup analysis, even individuals with recovery from dialysis-requiring AKI were at high risk of developing severe sepsis.
Conclusions: AKI is an independent risk factor for severe sepsis. Even patients who recovered from AKI had a high risk of long-term severe sepsis.
Introduction
Sepsis can cause multiorgan dysfunction, especially of the heart, lung and kidney, causing high morbidity and mortality in hospitalized patients.Severe sepsis, defined as sepsis with organ dysfunction, hypoperfusion or hypotension, occurs in about 11% to 27% of ICU patients, with a mortality rate of about 18% to 55%. The incidence and severity of sepsis has increased in recent years and has contributed substantially to the disease burden over time.
AKI is a common complication, especially in critically ill patients, occurring in 8% of hospitalized patients and in approximately 50% of ICU patients. Sepsis is the most common cause of AKI. Severe sepsis, including septic shock, accounts for almost half of all cases of AKI in the ICU. In humans, extrarenal organ dysfunction frequently coexists with AKI, potentiating the already high rates of AKI-associated morbidity and mortality. Unique systemic inflammatory patterns have also been observed for different mechanisms of AKI, as the deleterious interaction arises, at least in part, from systemic inflammatory changes, activation of proapoptotic pathways, increases in leukocyte trafficking and dysregulated channel expression. These in turn can lead to long-term sepsis. The aim of this study was to evaluate the incidence of severe sepsis after hospitalization in patients with or without AKI requiring dialysis in a large-scale, population-based administration database in Taiwan. We hypothesized that AKI might be an independent risk factor for developing severe sepsis, regardless of recovery of renal function recovery.