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Abstract: TH-PO034

AKI Predicts 30 Day Mortality in Community Acquired Infection

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Poulikakos, Dimitrios J., Salford Hospital, Manchester, United Kingdom
  • Tollitt, James, Salford Royal NHS Trust, Salford, United Kingdom
  • Ritchie, James, Salford Royal Hospital, Chorlton, MANCHESTER, United Kingdom
  • Kalra, Philip A., Salford Royal Hospital NHS Trust, Salford, United Kingdom
  • Sinha, Smeeta, Salford Royal NHS Foundation Trust, Salford, United Kingdom
Background

The National Institute for Health and Care Excellence has recently introduced new guidance for sepsis that risk stratifies patients to high, moderate and low risk based on clinical observations from the National Early Warning Score (NEWS). Laboratory assessment for Acute Kidney Injury (AKI) is mandated in patients with moderate risk, and if present warrants intravenous antibiotics within one hour. Our aim was to evaluate the association between AKI in suspected community acquired (CA) infection (I) and 30 day mortality.

Methods

Data of hospital admissions with CA-I (defined as prescription of antibiotics within 24 hours from A&E arrival) were extracted from the Electronic Patient Records from 07/2013 to 02/2018. Dialysis patients were excluded. CA-AKI was defined as AKI alerting within 24 hours. NEWS score was analysed in groups 0 (low risk), 1-4 (moderate risk) and >4 (high risk). A binary logistic model was used to assess associations with 30 day mortality. The model was tested separately in each group of NEWS. AKI 2 and 3 were analysed together as AKI2&3.

Results

There were 3764 patients aged 61 ±22 years, 2047 (54.4%) females, 292 (7.8%) CA- AKI {AKI 1, 201 (5.3%), AKI 2 60 (1.6%) and AKI 3 31 (0.8%)}. Lactate was tested in 1382 (36.7%) patients and was above 2 in 398 (10.6%) cases. NEWS was 0 in 1140 (30.3%), 1-4 in 2150 (57.1%) and >4 in 474 (12.6%) cases. 316 patients (8.4%) died within 30 days. In logistic regression analysis for the whole cohort age (OR 1.07 CI 1.06-1.08, p=<0.001), male (OR 1.48, CI 1.15-1.91, p= 0.002), lactate (OR 1.67, CI 1.19-2.34, p= 0.003), NEWS 1-4 (OR 2.23, CI 1.54-3.29, p=0<.001), NEWS>4 (OR 4.58, CI 2.99-7.01, p=0<.001), AKI 1 (OR 2.14 CI 1.44-3.20, p=<0.001) and AKI2&3 (OR 4.12 CI 2.46-6.90, p=<0.001) were associated with 30 day mortality. AKI2&3 retained a significant association in NEWS=0 group (20(1.8%) cases of AKI2&3 OR 5.41 CI 1.62-18.13, p =0.006),(Table 1)

Conclusion

CA-AKI is associated with an increased risk for mortality in CA-I even in patients with normal clinical observations. Convergence of sepsis and AKI guidance should be prospectively assessed.