Abstract：
BACKGROUND: Sepsis is often accompanied with acute kidney injury (AKI). The incidence of AKI in patients visiting the emergency department (ED) with sepsis according to the new SOFA criteria is not exactly known, because the definition of sepsis has changed and many definitions of AKI exist. Given the important consequences of early recognition of AKI in sepsis, our aim was to assess the epidemiology of sepsis-associated AKI using different AKI definitions (RIFLE, AKIN, AKIB, delta check, and KDIGO) for the different sepsis classifications (SIRS, qSOFA, and SOFA).
METHODS: We retrospectively enrolled patients with sepsis in the ED in three hospitals and applied different AKI definitions to determine the incidence of sepsis-associated AKI. In addition, the association between the different AKI definitions and persistent kidney injury, hospital length of stay, and 30-day mortality were evaluated.
RESULTS: In total, 2065 patients were included. The incidence of AKI was 17.7-51.1%, depending on sepsis and AKI definition. The highest incidence of AKI was found in qSOFA patients when the AKIN and KDIGO definitions were applied (51.1%). Applying the AKIN and KDIGO definitions in patients with sepsis according to the SOFA criteria, AKI was present in 37.3% of patients, and using the SIRS criteria, AKI was present in 25.4% of patients. Crude 30-day mortality, prolonged length of stay, and persistent kidney injury were comparable for patients diagnosed with AKI, regardless of the definition used.
CONCLUSIONS: The incidence of AKI in patients with sepsis is highly dependent on how patients with sepsis are categorised and how AKI is defined. When AKI (any definition) was already present at the ED, 30-day mortality was high (22.2%). The diagnosis of AKI in sepsis can be considered as a sign of severe disease and helps to identify patients at high risk of adverse outcome at an early stage.
METHODS: We retrospectively enrolled patients with sepsis in the ED in three hospitals and applied different AKI definitions to determine the incidence of sepsis-associated AKI. In addition, the association between the different AKI definitions and persistent kidney injury, hospital length of stay, and 30-day mortality were evaluated.
RESULTS: In total, 2065 patients were included. The incidence of AKI was 17.7-51.1%, depending on sepsis and AKI definition. The highest incidence of AKI was found in qSOFA patients when the AKIN and KDIGO definitions were applied (51.1%). Applying the AKIN and KDIGO definitions in patients with sepsis according to the SOFA criteria, AKI was present in 37.3% of patients, and using the SIRS criteria, AKI was present in 25.4% of patients. Crude 30-day mortality, prolonged length of stay, and persistent kidney injury were comparable for patients diagnosed with AKI, regardless of the definition used.
CONCLUSIONS: The incidence of AKI in patients with sepsis is highly dependent on how patients with sepsis are categorised and how AKI is defined. When AKI (any definition) was already present at the ED, 30-day mortality was high (22.2%). The diagnosis of AKI in sepsis can be considered as a sign of severe disease and helps to identify patients at high risk of adverse outcome at an early stage.
摘要：
背景：脓毒症常伴有急性肾损伤（AKI）。根据新的SOFA标准，急诊（ED）败血症患者的AKI发生率尚不清楚，因为脓毒症的定义发生了变化，并且存在许多AKI的定义。鉴于早期识别AKI在脓毒症中的重要后果，我们的目的是使用不同的AKI定义评估脓毒症相关AKI的流行病学(RIFLE，AKIN,AKIB,delta检查,和KDIGO)用于不同的脓毒症分类(SIRS，qSOFA,和沙发）。
方法：我们回顾性招募了三家医院的ED中的脓毒症患者，并应用不同的AKI定义来确定脓毒症相关AKI的发生率。此外,不同的AKI定义与持续性肾损伤之间的关联，住院时间,并评估30天死亡率。
结果：总计，纳入2065例患者。AKI发生率为17.7-51.1%,取决于脓毒症和AKI的定义。当应用AKIN和KDIGO定义时，qSOFA患者的AKI发生率最高(51.1%)。根据SOFA标准在脓毒症患者中应用AKIN和KDIGO定义，37.3%的患者出现AKI，并使用SIRS标准，25.4%的患者存在AKI。30天的粗死亡率，延长逗留时间，和持续性肾损伤与诊断为AKI的患者相当，不管使用的定义。
结论：脓毒症患者AKI的发生率高度依赖于脓毒症患者的分类和AKI的定义。当AKI(任何定义)已经出现在ED时，30天死亡率高（22.2%）。败血症中AKI的诊断可以被认为是严重疾病的征兆，并有助于在早期阶段识别出不良结局高风险的患者。
方法：我们回顾性招募了三家医院的ED中的脓毒症患者，并应用不同的AKI定义来确定脓毒症相关AKI的发生率。此外,不同的AKI定义与持续性肾损伤之间的关联，住院时间,并评估30天死亡率。
结果：总计，纳入2065例患者。AKI发生率为17.7-51.1%,取决于脓毒症和AKI的定义。当应用AKIN和KDIGO定义时，qSOFA患者的AKI发生率最高(51.1%)。根据SOFA标准在脓毒症患者中应用AKIN和KDIGO定义，37.3%的患者出现AKI，并使用SIRS标准，25.4%的患者存在AKI。30天的粗死亡率，延长逗留时间，和持续性肾损伤与诊断为AKI的患者相当，不管使用的定义。
结论：脓毒症患者AKI的发生率高度依赖于脓毒症患者的分类和AKI的定义。当AKI(任何定义)已经出现在ED时，30天死亡率高（22.2%）。败血症中AKI的诊断可以被认为是严重疾病的征兆，并有助于在早期阶段识别出不良结局高风险的患者。
