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Published on: February 15, 2022
Early Sepsis-Associated Acute Kidney Injury and Obesity
Yoon Hae Ahn1, Si Mong Yoon2, Jinwoo Lee2
1Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea.
Insights
Obesity increases the risk of sepsis-associated acute kidney injury (SA-AKI) in intensive care units. SA-AKI presence alters how obesity affects patient recovery and survival.
Area of Science:
- Critical Care Medicine
- Nephrology
- Epidemiology
Background:
- Rising obesity rates present challenges in intensive care units (ICUs).
- Obesity is a known risk factor for chronic kidney disease.
- The link between obesity, early sepsis-associated acute kidney injury (SA-AKI), and patient outcomes requires further study.
Purpose of the Study:
- To investigate the association between obesity and the incidence of early SA-AKI in sepsis patients.
- To examine how obesity and SA-AKI interact to influence clinical outcomes, including mortality and recovery.
Main Methods:
- A nationwide prospective cohort study involving 4041 sepsis patients admitted to 20 tertiary hospital ICUs in Korea.
- Patients were categorized by body mass index (BMI); SA-AKI incidence within 48 hours of ICU admission was the primary outcome.
- Logistic regression and multivariable fractional polynomial models were used to analyze associations with mortality and clinical recovery.
Main Results:
- Obesity was linked to a higher incidence of early SA-AKI (adjusted odds ratio [AOR], 1.40).
- Obesity was associated with lower in-hospital mortality in patients without SA-AKI (AOR, 0.72), but not in those with SA-AKI (AOR, 0.85).
- Patients with obesity and SA-AKI showed reduced likelihood of clinical recovery compared to those with obesity alone.
Conclusions:
- Obesity is associated with an increased risk of developing early SA-AKI in sepsis patients.
- The impact of obesity on clinical outcomes, such as mortality and recovery, is significantly modified by the presence of SA-AKI.
Importance:
The prevalence of obesity is increasing in the intensive care unit (ICU). Although obesity is a known risk factor for chronic kidney disease, its association with early sepsis-associated acute kidney injury (SA-AKI) and their combined association with patient outcomes warrant further investigation.
Objective:
To explore the association between obesity, early SA-AKI incidence, and clinical outcomes in patients with sepsis.
Design, Setting, And Participants:
This nationwide, prospective cohort study analyzed patients aged 19 years or older who had sepsis and were admitted to 20 tertiary hospital ICUs in Korea between September 1, 2019, and December 31, 2021. Patients with preexisting stage 3A to 5 chronic kidney disease and those with missing body mass index (BMI) values were excluded.
Exposures:
Sepsis and hospitalization in the ICU.
Main Outcomes And Measures:
The primary outcome was SA-AKI incidence within 48 hours of ICU admission, and secondary outcomes were mortality and clinical recovery (survival to discharge within 30 days). Patients were categorized by BMI (calculated as weight in kilograms divided by height in meters squared), and data were analyzed by logistic regression adjusted for key characteristics and clinical factors. Multivariable fractional polynomial regression models and restricted cubic spline models were used to analyze the clinical outcomes with BMI as a continuous variable.
Results:
Of the 4041 patients (median age, 73 years [IQR, 63-81 years]; 2349 [58.1%] male) included in the study, 1367 (33.8%) developed early SA-AKI. Obesity was associated with a higher incidence of SA-AKI compared with normal weight (adjusted odds ratio [AOR], 1.40; 95% CI, 1.15-1.70), as was every increase in BMI of 10 (OR, 1.75; 95% CI, 1.47-2.08). While obesity was associated with lower in-hospital mortality in patients without SA-AKI compared with their counterparts without obesity (ie, underweight, normal weight, overweight) (AOR, 0.72; 95% CI, 0.54-0.94), no difference in mortality was observed in those with SA-AKI (AOR, 0.85; 95% CI, 0.65-1.12). Although patients with obesity without SA-AKI had a greater likelihood of clinical recovery than their counterparts without obesity, clinical recovery was less likely among those with both obesity and SA-AKI.
Conclusions And Relevance:
In this cohort study of patients with sepsis, obesity was associated with a higher risk of early SA-AKI and the presence of SA-AKI modified the association of obesity with clinical outcomes.
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