De Ritis Ratio Trajectories and Mortality Risk in Sepsis-Associated Acute Kidney Injury

Sepsis-associated acute kidney injury (SA-AKI) is a common and life-threatening complication in critically ill patients. The De Ritis ratio has been linked to adverse clinical outcomes; however, its longitudinal trajectories and prognostic value in SA-AKI patients remained unclear.

This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care database and included 4468 patients with SA-AKI who had at least four measurements of the De Ritis ratio within the first 7 d following intensive care unit (ICU) admission. Group-based trajectory modeling was used to identify distinct De Ritis ratio trajectories. Cox proportional hazards models were employed to evaluate the associations of both baseline De Ritis ratio and its trajectories with ICU mortality and 30-d mortality.

Three distinct De Ritis ratio trajectories were identified: persistently low, moderate, and high levels. SA-AKI patients in the persistently high-level group had significantly higher ICU (hazard ratio [HR] = 1.91, 95% confidence interval [CI]: 1.51-2.43) and 30-d mortality (HR = 2.05, 95% CI: 1.65-2.53) risks compared to those with persistently low trajectories. In addition, the persistently moderate De Ritis ratio trajectory was also significantly associated with ICU mortality (HR = 1.60, 95% CI: 1.36-1.88) and 30-d mortality (HR = 1.73, 95% CI: 1.51-1.99). Subgroup analysis demonstrated that these associations were more pronounced among patients admitted through the emergency department.

Persistently elevated De Ritis ratio trajectories within the first 7 d of ICU admission were independently associated with increased risks of ICU and 30-d mortality in patients with SA-AKI.