A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

doi:10.5847/wjem.j.1920-8642.2020.01.003

Abstract

Abstract:

BACKGROUND: Hospital mortality rates are higher among patients with sepsis-associated acute kidney injury (SA-AKI) than among patients with sepsis. However, the pathogenesis underlying SA-AKI remains unclear. We hypothesized that the source of infection affects development of SA-AKI. We aim to explore the relationship between the anatomical source of infection and outcome in patients with SA-AKI.

METHODS: Between January 2013 and January 2018, 113 patients with SA-AKI admitted to our Emergency Center were identified and divided into two groups: those with pulmonary infections and those with other sources of infection. For each patient, we collected data from admission until either discharge or death. We also recorded the clinical outcome after 90 days for the discharged patients.

RESULTS: The most common source of infection was the lung (52/113 cases, 46%), followed by gastrointestinal (GI) (25/113 cases, 22.1%) and urinary (22/113, 19.5%) sources. Our analysis showed that patients with SA-AKI had a significantly worse outcome (30/52 cases, P<0.001) and poorer kidney recovery (P=0.015) with pulmonary sources of infection than those infected by another source. Data also showed that patients not infected by a pulmonary source more likely experienced shock (28/61 cases, P=0.037).

CONCLUSION: This study demonstrated that the source of infection influenced the outcome of SA-AKI patients in an independent manner. Lung injury may influence renal function in an as-yet undetermined manner as the recovery of kidney function was poorer in SA-AKI patients with a pulmonary source of infection.

Key words: Sepsis, Infection source, Acute kidney injury, Lung injury, Renal function

Yi-wen Fan, Shao-wei Jiang, Jia-meng Chen, Hui-qi Wang, Dan Liu, Shu-ming Pan, Cheng-jin Gao. A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function[J]. World Journal of Emergency Medicine, 2020, 11(1): 18-26.

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Variables	Counts	Mean±SD	Median	Percentage in total patients (n=113)
Age(year)		72.49±12.25	74.00
Age group (n)
≤60	15			13.3
>60, <80	60			53.1
≥80	38			33.6
Gender (n)
Male	63			55.8
Female	50			44.2
Blood routine tests
WBC (×10⁹)		15.49±7.91	15.30
Percent of the lymphocytes (%)		6.46±5.09	5.10
Percent of the neutrophil (%)		87.60±8.22	89.80
NLR		24.07±20.57	18.00
PLT (×10⁹)		128.11±75.49	123.5
APACHE II on admission		19.96±7.10	20
SOFA on admission		7.14±3.75	6
KDIGO (n)
KDIGO 2	50			44.2
KDIGO 3	63			55.8
RRT	38			33.6
Death (n)	44			38.9
Death time (n=44)		15.11±18.03	9.5
Renal recovery at 90 days from ICU admission (n)
Full recovery	52			46
Partial recovery	35			31
Non-recovery	26			23

Variables	OG (n=61)	PG (n=52)	P
90 days death (n)	14	30	<0.001
Death time (days)	12.50±15.98 (n=14)	16.33±19.04 (n=30)	0.518
Renal recovery (n)			0.015
Full recovery	34	18
Partial recovery	19	16
Non-recovery	8	18

Variables	OG (n=61)	PG (n=52)	P
Sex (n)			0.057
Male	29	34
Female	32	18
Age(±SD)	70.75±12.85	74.52±11.28	0.104
Urea on admission (mmol/L)	22.48±13.65	20.39±10.23	0.365
Creatinine on admission (μmol/L)	341.53±227.83	271.07±155.08	0.062
APACHE II on admission	19.10±6.85	20.96±7.32	0.166
SOFA on admission	7.16±3.49	7.12±4.06	0.946
Blood routine tests
WBC (×10⁹)	16.85±8.18	13.88±7.32	0.046
Percent of the lymphocytes (%)	6.36±5.84	6.59±4.10	0.806
Percent of the neutrophil (%)	87.94±8.71	87.20±7.66	0.637
NLR	28.50±24.7	18.85±12	0.01
PLT (×10⁹)	116.72±72.73	141.25±77.16	0.086
Shock (n)			0.037
No	33	38
Yes	28	14

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