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Kidney Week

Abstract: FR-PO101

Risk of Infections Following AKI

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Bernier-Jean, Amelie, Université de Montreal , Montreal, Quebec, Canada
  • Beaubien-Souligny, William, Université de Montreal , Montreal, Quebec, Canada
  • Bouchard, Josee, Université de Montreal , Montreal, Quebec, Canada
Background

Recent studies suggest that AKI can affect distant organ function and increase non-renal complications. We aimed to determine whether AKI is independently associated with an increased risk of infectious complications in ICU patients.

Methods

We conducted a single-center retrospective cohort study of ICU patients over a year. We excluded readmission, patients on chronic dialysis, with a kidney transplant or an ICU stay less than 24 hours. The primary outcome was the development of de novo infections, analyzed with a time-dependent multivariate Cox regression model.

Results

We enrolled 1001 patients. Mean age was 64±15 years, 61% were male, 26% suffered from diabetes, 12% from CKD, 17% from COPD, and 6% were immunosuppressed. The SOFA score at ICU admission was 5 (2-8). During their stay, 51% of patients received vasopressors, 56% received mechanical ventilation (MV), and 68% underwent surgery. Twenty-six percent developed AKI and 44% had at least one infection. Patients with vs. without AKI were more likely to suffer from infections (62% vs 37%, p<0.001) (Figure 1). Pneumonia, intra-abdominal infections, and lower urinary tract infections were most common. In a time-dependent Cox-regression model, AKI (HR 1.57 95%CI 1.20-2.06) and MV (HR 1.88 95%CI 1.43-2.47) were predictors of incident infections. Patients who remained AKI and infection-free had the lowest mortality rate (2.6%), followed by those with infection alone (16.2%), infection after AKI (16.7%), AKI alone (20.4%) and infection before AKI (34.2%) (p<0.001 between groups;p=0.03 for infection after vs before AKI;p=0.03 for infection before AKI vs AKI alone;p=0.60 for infection after AKI vs AKI alone).

Conclusion

In a multivariate model, AKI was significantly associated with the development of incident infections. However, the occurrence of infection after AKI was not associated with increased mortality rate compared to infection-free AKI in our study. Patients with AKI should still be considered at higher risk for infections and targeted for infection prevention and rapid management of infections.