Objective To investigate the 30 day prognosis of adult patients who underwent continuous renal replacement therapy (CRRT) after cardiac surgery and developed sepsis-associated acute kidney injury (SA-AKI). Methods A retrospective cohort study was conducted, collecting clinical data from 239 adult patients who underwent CRRT at Guangdong Provincial People's Hospital from March 2023 to May 2024. Patients were divided into two groups based on whether they developed sepsis-associated acute kidney injury within 7 days after cardiac surgery: Acute kidney injury (AKI) group and SA-AKI group. Results A total of 239 adult patients who underwent cardiac surgery were included, with an average age of 57.4±13.5 years, and 157 males (65.7%). The Sequential organ failure assessment (SOFA) score was higher in the SA-AKI group compared to the AKI group, 11.0±3.63 vs. 9.45±3.89, (t=-2.534, P=0.014). The overall mortality rate was 31.4% (75/239), with an average treatment time of CRRT and the interquartile range was 8.0 (3.0,17.0) days. The mortality rate of patients in the SA-AKI group was significantly higher than that in the AKI group, 62.8% vs. 24.5%, (χ2=-4.747, P＜0.001). Kaplan-Meier survival analysis log-rank test showed that the cumulative mortality rate in the SA-AKI group was significantly higher than in the AKI group, HR (95%CI) =1.959 (1.220～3.145), (P=0.004). The repeated-measures analysis showed that there was a significant difference in SOFA scores between the SA-AKI group and the AKI group (P=0.004, F=8.135), and a significant time trend was also observed (P＜0.001, F=4.441). There was a trend towards lower blood lactate levels in both groups, with no significant inter-group differences (P=0.215，F=1.543). There was a significant difference in mean arterial pressure between the SA-AKI group and the AKI group (P=0.002, F=9.028), while the time trend was not significant (P=0.739, F=0.589). Patients in the mortality group had higher SOFA scores than those in the survival group (P＜0.001, F=61.036). The blood lactate levels were higher in the mortality group than that in the survival group (P＜0.001, F=14.853). Additionally, the mean arterial pressure was lower in the mortality group compared with the survival group (P＜0.001, F=45.056). Conclusion Patients who developed sepsis-associated acute kidney injury after cardiac surgery have a significantly increased 30-day mortality risk. During the first week of CRRT treatment, it is important to monitor changes in the condition, especially to strengthen monitoring of trends in SOFA scores, lactate levels, and hemodynamic indicators.
LIAO Jun-Jie
,
SONG Li
,
YIN Yan
,
ZHANG Yi-Ting
,
CHEN Cheng
,
QUAN Zi-Lin
,
LIANG Xin-Ling
,
FENG Zhong-Lin
,
YE Zhi-Ming
. Prognosis of patients with sepsis-associated acute kidney injury after cardiac surgery undergoing CRRT[J]. Chinese Journal of Blood Purification, 2025
, 24(07)
: 554
-558
.
DOI: 10.3969/j.issn.1671-4091.2025.07.003
[1] Poston J T, Koyner J L. Sepsis associated acute kidney injury[J]. BMJ,2019,364:k4891.
[2] Li H, Yu R, Zhou Q, et al. TRENDS AND OUTCOMES IN SEPSIS HOSPITALIZATIONS WITH AND WITHOUT ACUTE KIDNEY INJURY: A NATIONWIDE INPATIENT ANALYSIS[J]. Shock,2024,62(4):470-479.
[3] Bagshaw S M, George C, Bellomo R. Early acute kidney injury and sepsis: a multicentre evaluation[J]. Crit Care,2008,12(2):R47.
[4] Moll V, Khanna A K, Kurz A, et al. Optimization of kidney function in cardiac surgery patients with intra-abdominal hypertension: expert opinion[J]. Perioperative Medicine,2024,13(1):72.
[5] Kotani Y, Yoshida T, Kumasawa J, et al. The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study[J]. Ann Intensive Care,2021,11(1):178.
[6] Bernardi M H, Ristl R, Neugebauer T, et al. Very early changes in serum creatinine are associated with 30-day mortality after cardiac surgery: A cohort study.[Z]. 2020.37,898-907.
[7] Khwaja A. KDIGO Clinical Practice Guidelines for Acute Kidney Injury[J]. Nephron Clinical Practice,2012,120(4):c179-c184.
[8] Ozkaya P Y, Taner S, Ersayoglu I, et al. Sepsis associated acute kidney injury in pediatric intensive care unit[J]. Ther Apher Dial,2023,27(1):73-82.
[9] Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021[J]. Critical Care Medicine,2021,49(11):e1063-e1143.
[10] Zhang J, Tian J, Sun H, et al. How Does Continuous Renal Replacement Therapy Affect Septic Acute Kidney Injury?[J]. Blood Purif,2018,46(4):326-331.
[11] White K C, Serpa-Neto A, Hurford R, et al. Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study[J]. Intensive Care Med,2023,49(9):1079-1089.
[12] Hou L, Wu X, Sun Z. Risk Factors and Prognosis of Acute Kidney Injury in Hospitalised Sepsis Patients[J]. Arch Esp Urol,2024,77(3):263-269.
[13] Li L, Zhang L, Ye Y, et al. Association of acetaminophen use with mortality and renal recovery in patients with sepsis-associated acute kidney injury[J]. BMC Anesthesiol,2024,24(1):440.
[14] Sun J, Li J, Gao H, et al. Comparison of diagnostic criteria for sepsis-associated acute kidney injury in the pediatric intensive care unit: a retrospective cohort study[J]. Transl Pediatr,2024,13(3):447-458.
[15] Peerapornratana S, Manrique-Caballero C L, Gomez H, et al. Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment[J]. Kidney Int,2019,96(5):1083-1099.
[16] Rimachi R, Bruzzi De Carvahlo F, Orellano-Jimenez C, et al. Lactate/pyruvate ratio as a marker of tissue hypoxia in circulatory and septic shock[J]. Anaesth Intensive Care,2012,40(3):427-432.
[17] 龚春蕾. 血清乳酸水平与脓毒症相关急性肾损伤发生及死亡的相关性研究[D]. 广西医科大学,2021.
[18] Zhang Y, Shao D R, He Z P, et al. Efficacy of continuous renal replacement on acute renal injury developed in severe sepsis[J]. J Biol Regul Homeost Agents,2019,33(2):525-530.
[19] Lamontagne F, Richards-Belle A, Thomas K, et al. Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Older Critically Ill Patients With Vasodilatory Hypotension: A Randomized Clinical Trial[J]. JAMA,2020,323(10):938-949.
[20] Asfar P, Meziani F, Hamel J, et al. High versus low blood-pressure target in patients with septic shock[J]. N Engl J Med,2014,370(17):1583-1593.
[21] 李林，涂铭. 感染性休克致急性肾损伤的血流动力学改变及预后相关性研究[J]. 海南医学院学报,2013,19(04):496-498.
