Cargando…

The importance of acute kidney injury in suspected community acquired infection

BACKGROUND: Most sepsis and acute kidney injury (AKI) cases are community acquired (CA). The aim of this study was to evaluate the characteristics of suspected community acquired infection (sCA-I) and CA-AKI and their impact upon patient outcomes. METHODS: All adult creatinine blood tests from non-e...

Descripción completa

Detalles Bibliográficos
Autores principales: Tollitt, James, Bennett, Nicola, Darby, Denise, Flanagan, Emma, Chadwick, Paul, Sinha, Smeeta, Kalra, Philip A., Ritchie, James, Poulikakos, Dimitrios
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504101/
https://www.ncbi.nlm.nih.gov/pubmed/31063508
http://dx.doi.org/10.1371/journal.pone.0216412
_version_ 1783416513750892544
author Tollitt, James
Bennett, Nicola
Darby, Denise
Flanagan, Emma
Chadwick, Paul
Sinha, Smeeta
Kalra, Philip A.
Ritchie, James
Poulikakos, Dimitrios
author_facet Tollitt, James
Bennett, Nicola
Darby, Denise
Flanagan, Emma
Chadwick, Paul
Sinha, Smeeta
Kalra, Philip A.
Ritchie, James
Poulikakos, Dimitrios
author_sort Tollitt, James
collection PubMed
description BACKGROUND: Most sepsis and acute kidney injury (AKI) cases are community acquired (CA). The aim of this study was to evaluate the characteristics of suspected community acquired infection (sCA-I) and CA-AKI and their impact upon patient outcomes. METHODS: All adult creatinine blood tests from non-elective, non-dialysis attendances to a single centre over a 29-month period were analysed retrospectively. We defined sCA-I and CA-AKI cases as antibiotic prescription and AKI alert within 48 hours of attendance respectively. Binary logistic regression models were created to determine associations with 30-day mortality, intensive care unit (ICU) admission and length of stay (LOS) dichotomised at median. RESULTS: Of 61,471 attendances 28.1% and 5.7% suffered sCA-I or CA-AKI in isolation respectively, 3.4% suffered both. sCA-I was present in 58.8% of CA-AKI cases and CA-AKI was present in 11.9% of CA-I cases. The combination of sCA-I and CA-AKI was associated with a higher risk for all outcomes compared to sCA-I or CA-AKI in isolation. The 30-day mortality was 8.1%, 11.8% and 26.2% in patients with sCA-I, CA-AKI and when sCA-I and CA-AKI occurred in combination respectively. The adjusted odds ratios (OR) and 95% confidence intervals (CI) for 30-day mortality, ICU admission and LOS for sCA-I combined with CA-AKI stage 1 were OR 6.09:CI: 5.21–7.12, OR 12.52 CI: 10.54–14.88 and OR 8.97 CI: 7.62–10.56, respectively, and for combined sCA-I and CA-AKI stage 3 were OR 9.23 CI: 6.91–12.33, OR 29.26 CI: 22.46–38.18 and OR 9.48 CI: 6.82–13.18 respectively. CONCLUSION: The combination of sCA-I and CA-AKI is associated with worse outcomes.
format Online
Article
Text
id pubmed-6504101
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-65041012019-05-09 The importance of acute kidney injury in suspected community acquired infection Tollitt, James Bennett, Nicola Darby, Denise Flanagan, Emma Chadwick, Paul Sinha, Smeeta Kalra, Philip A. Ritchie, James Poulikakos, Dimitrios PLoS One Research Article BACKGROUND: Most sepsis and acute kidney injury (AKI) cases are community acquired (CA). The aim of this study was to evaluate the characteristics of suspected community acquired infection (sCA-I) and CA-AKI and their impact upon patient outcomes. METHODS: All adult creatinine blood tests from non-elective, non-dialysis attendances to a single centre over a 29-month period were analysed retrospectively. We defined sCA-I and CA-AKI cases as antibiotic prescription and AKI alert within 48 hours of attendance respectively. Binary logistic regression models were created to determine associations with 30-day mortality, intensive care unit (ICU) admission and length of stay (LOS) dichotomised at median. RESULTS: Of 61,471 attendances 28.1% and 5.7% suffered sCA-I or CA-AKI in isolation respectively, 3.4% suffered both. sCA-I was present in 58.8% of CA-AKI cases and CA-AKI was present in 11.9% of CA-I cases. The combination of sCA-I and CA-AKI was associated with a higher risk for all outcomes compared to sCA-I or CA-AKI in isolation. The 30-day mortality was 8.1%, 11.8% and 26.2% in patients with sCA-I, CA-AKI and when sCA-I and CA-AKI occurred in combination respectively. The adjusted odds ratios (OR) and 95% confidence intervals (CI) for 30-day mortality, ICU admission and LOS for sCA-I combined with CA-AKI stage 1 were OR 6.09:CI: 5.21–7.12, OR 12.52 CI: 10.54–14.88 and OR 8.97 CI: 7.62–10.56, respectively, and for combined sCA-I and CA-AKI stage 3 were OR 9.23 CI: 6.91–12.33, OR 29.26 CI: 22.46–38.18 and OR 9.48 CI: 6.82–13.18 respectively. CONCLUSION: The combination of sCA-I and CA-AKI is associated with worse outcomes. Public Library of Science 2019-05-07 /pmc/articles/PMC6504101/ /pubmed/31063508 http://dx.doi.org/10.1371/journal.pone.0216412 Text en © 2019 Tollitt et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Tollitt, James
Bennett, Nicola
Darby, Denise
Flanagan, Emma
Chadwick, Paul
Sinha, Smeeta
Kalra, Philip A.
Ritchie, James
Poulikakos, Dimitrios
The importance of acute kidney injury in suspected community acquired infection
title The importance of acute kidney injury in suspected community acquired infection
title_full The importance of acute kidney injury in suspected community acquired infection
title_fullStr The importance of acute kidney injury in suspected community acquired infection
title_full_unstemmed The importance of acute kidney injury in suspected community acquired infection
title_short The importance of acute kidney injury in suspected community acquired infection
title_sort importance of acute kidney injury in suspected community acquired infection
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504101/
https://www.ncbi.nlm.nih.gov/pubmed/31063508
http://dx.doi.org/10.1371/journal.pone.0216412
work_keys_str_mv AT tollittjames theimportanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT bennettnicola theimportanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT darbydenise theimportanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT flanaganemma theimportanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT chadwickpaul theimportanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT sinhasmeeta theimportanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT kalraphilipa theimportanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT ritchiejames theimportanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT poulikakosdimitrios theimportanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT tollittjames importanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT bennettnicola importanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT darbydenise importanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT flanaganemma importanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT chadwickpaul importanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT sinhasmeeta importanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT kalraphilipa importanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT ritchiejames importanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection
AT poulikakosdimitrios importanceofacutekidneyinjuryinsuspectedcommunityacquiredinfection