Rates, predictors, and mortality of sepsis-associated acute kidney injury: a systematic review and meta-analysis

BACKGROUND: Due to the high incidence and mortality of sepsis-associated acute kidney injury, a significant number of studies have explored the causes of sepsis-associated acute kidney injury (AKI). However, the opinions on relevant predictive risk factors remain inconclusive. This study aimed to provide a systematic review and meta-analysis to determine the predisposing factors for sepsis-associated AKI. METHOD: A systematic literature search was performed in the Medline, Embase, Cochrane Library, PubMed, and Web of Science, databases, with an end-date of 25th May 2019. Valid data were retrieved in compliance with specific inclusion and exclusion criteria. RESULT: Forty-seven observational studies were included for analysis, achieving a cumulative patient number of 55,911. The highest incidence of AKI was caused by septic shock. Thirty-one potential risk factors were included in the meta-analysis. Analysis showed that 20 factors were statistically significant. The odds ratio (OR) and 95% confidence interval (CI), as well as the prevalence of the most frequently-seen predisposing factors for sepsis-associated AKI, were as follows: septic shock [2.88 (2.36–3.52), 60.47%], hypertension [1.43 (1.20–1.70), 38.39%], diabetes mellitus [1.59 (1.47–1.71), 27.57%], abdominal infection [1.44 (1.32–1.58), 30.87%], the administration of vasopressors [2.95 (1.67–5.22), 64.61%], the administration of vasoactive drugs [3.85 (1.89–7.87), 63.22%], mechanical ventilation [1.64 (1.24–2.16), 68.00%], positive results from blood culture [1.60 (1.35–1.89), 41.19%], and a history of smoking [1.60 (1.09–2.36), 43.09%]. Other risk factors included cardiovascular diseases, coronary artery diseases, liver diseases, unknown infections, the administration of diuretics and ACEI/ARB, the infection caused by gram-negative bacteria, and organ transplantation. CONCLUSION: Risk factors of S-AKI arise from a wide range of sources, making it difficult to predict and prevent this condition. Comorbidities, and certain drugs, are the main risk factors for S-AKI. Our review can provide guidance on the application of interventions to reduce the risks associated with sepsis-associated acute kidney injury and can also be used to tailor patient-specific treatment plans and management strategies in clinical practice.