Two subphenotypes of septic acute kidney injury are associated with different 90-day mortality and renal recovery

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Abstract

Background: The pathophysiology of septic acute kidney injury is inadequately understood. Recently, subphenotypes for sepsis and AKI have been derived. The objective of this study was to assess whether a combination of comorbidities, baseline clinical data, and biomarkers could classify meaningful subphenotypes in septic AKI with different outcomes. Methods: We performed a post hoc analysis of the prospective Finnish Acute Kidney Injury (FINNAKI) study cohort. We included patients admitted with sepsis and acute kidney injury during the first 48 h from admission to intensive care (according to Kidney Disease Improving Global Outcome criteria). Primary outcomes were 90-day mortality and renal recovery on day 5. We performed latent class analysis using 30 variables obtained on admission to classify subphenotypes. Second, we used logistic regression to assess the association of derived subphenotypes with 90-day mortality and renal recovery on day 5. Results: In total, 301 patients with septic acute kidney injury were included. Based on the latent class analysis, a two-class model was chosen. Subphenotype 1 was assigned to 133 patients (44%) and subphenotype 2 to 168 patients (56%). Increased levels of inflammatory and endothelial injury markers characterized subphenotype 2. At 90 days, 29% of patients in subphenotype 1 and 41% of patients in subphenotype 2 had died. Subphenotype 2 was associated with a lower probability of short-term renal recovery and increased 90-day mortality. Conclusions: In this post hoc analysis, we identified two subphenotypes of septic acute kidney injury with different clinical outcomes. Future studies are warranted to validate the suggested subphenotypes of septic acute kidney injury.

Details

Authors
  • Renske Wiersema
  • Sakari Jukarainen
  • Suvi T. Vaara
  • Meri Poukkanen
  • Païvi Lakkisto
  • Hector Wong
  • Adam Linder
  • Iwan C.C. Van Der Horst
  • Ville Pettilä
Organisations
External organisations
  • University Medical Center Groningen
  • University of Helsinki
  • Lapland Central Hospital
  • Maastricht University
  • University of Groningen
  • Helsinki University Central Hospital
  • University of Cincinnati
  • Cincinnati Children's Hospital Medical Center
  • Maastricht University Medical Centre
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Anesthesiology and Intensive Care
  • Urology and Nephrology

Keywords

  • Acute kidney injury, LCA, Mortality, Renal recovery, Sepsis, Subphenotypes
Original languageEnglish
Article number150
JournalCritical Care
Volume24
Issue number1
Publication statusPublished - 2020 Apr 15
Publication categoryResearch
Peer-reviewedYes