2018 Month : December Volume : 5 Issue : 49 Page : 3374-3380
Harish Chirattapurakkal Ramesh1, Jayakumar Edathedathe Krishnan2, Neeraj Manikath3
Dr. Jayakumar Edathedathe Krishnan,
Associate Professor, Department of Nephrology,
Government Medical College,
Kozhikode- 673008, Kerala.
Severe sepsis and acute kidney injury (AKI) are both common syndromes that are encountered in the emergency settings. The proportion of patients presenting with severe sepsis upon admission has been reported to be approximately 9% to 12%. An increasing trend in the presence of severe sepsis in ICU-treated patients has been observed. Discriminating between AKI of septic and non-septic origin may have clinical relevance. Evolving data suggests that septic AKI may be characterized by a distinct pathophysiology. For that reason, septic AKI may be associated with important differences in terms of patient characteristics, response to interventions and clinical outcomes when compared with non-septic precipitants of AKI.
The objective of the study is to evaluate the occurrence of Acute Kidney Injury in patients with Sepsis attending the Emergency Medicine Department at the Government Medical College, Kozhikode during the study period.
MATERIALS AND METHODS
Study Design- Single Cohort Study.
Study Setting- Department of Emergency Medicine, Govt. Medical College, Kozhikode.
Study Period- 1 year.
Study Population- Both males and females with sepsis between 30 and 70 years of age.
Sample Size- 200
Study Procedure- Patients attending emergency medicine department and satisfying inclusion criteria are enrolled in the study. Medical records will be examined for 2 days from the date of admission, including laboratory data. Glomerular filtration was calculated according to the MDRD equation. AKI was defined according to the Acute Kidney Injury Network (AKIN criteria) based on serum creatinine. Briefly, AKI was defined as an absolute difference of 50%, taking into consideration the peak and admission serum creatinine values during hospitalization.
Moreover, AKI was classified into 3 stages based on an increase of 50% to 100% in terms of admission serum creatinine (stage 1); 100% to 200% (stage 2); or greater than 300% or an increment of 0.5 mg/dL, if admission serum creatinine was higher than 4 mg/ dL (Stage 3), within 48 hours. The following parameters were collected in the ED: age, gender, temperature, respiratory rate, heart rate, mean blood pressure, leukocyte count, platelet count, vasopressor administration, urine output, serum creatinine, baseline GFR, AKIN stage and blood culture.
AKI was noticed in 27% of the patients with sepsis. There was no gender difference in the prevalence of AKI. Old age, presence of comorbidities like hypertension and diabetes mellitus were more common in the AKI group. Laboratory and clinical findings were also abnormal in the AKI group compared with non-AKI group.
Around one third of patients presenting with sepsis have features of AKI. AKI was associated with increased morbidity and mortality in patients with AKI. Multiple risk factors were noticed to have a role in the development of AKI and further studies in this regard is needed
Sepsis, Acute Kidney Injury, AKIN Criteria, Hypertension, Diabetes Mellitus.