To explore the clinical characteristics and influencing factors of 90-day outcome in patients with sepsis-associated acute kidney.

A retrospective analysis was conducted on patients with SA-AKI who were admitted to the ICU of the Chinese PLA General Hospital from January 2018 to December 2022. The patients were divided into a deceased group and a survival group based on their survival status at 90 days after the occurrence of AKI. The multi-factor Cox model regression method was used to analyze the outcome-influencing factors.

A total of 304 patients with SA-AKI were included, with a median age of 61 years (range 48-68 years), including 208 males (68.4%). According to the KDIGO staging criteria, there were 44 patients (14.5%) with AKI stage 1, 76 patients (25.0%) with AKI stage 2, and 184 patients (60.5%) with AKI stage 3. According to the recovery status of renal function within 48 hours after AKI, 44 patients (14.5%) had transient AKI, and 260 patients (85.5%) had persistent AKI. And 244 patients (80.3%) underwent continuous renal replacement therapy (CRRT). By 90 days after AKI onset, 116 patients (38.2%) had died. Compared with the deceased group, the survival group had higher levels of mean arterial pressure [(82±11) mmHg vs. (78±15) mmHg, P=0.005] and serum albumin [(29.4±6.4) g/L vs. (27.6±5.2) g/L, P=0.013], and lower levels of serum creatinine (135.5 μmol/L vs. 159.1 μmol/L, P=0.013), blood urea nitrogen (12.5 mmol/L vs. 13.8 mmol/L, P=0.009), and blood lactate (1.8 mmol/L vs. 4.1 mmol/L, P<0.01). Furthermore, the survival group exhibited lower rates of oliguria (21.3% vs. 37.9%, P=0.002), persistent AKI (79.3% vs. 89.4%, P=0.016), administration of vasopressors (68.1% vs. 86.2%, P<0.01), and receipt of CRRT (74.5% vs. 89.7%, P=0.001) compared to the deceased group. Multivariate Cox regression analysis showed that age (HR=1.034, 95%CI: 1.020-1.048, P<0.01), body mass index (HR=0.908, 95%CI: 0.860-0.958, P<0.01), mean arterial pressure (HR=0.968, 95%CI: 0.953-0.984, P<0.01), blood lactate (HR=1.158, 95%CI: 1.099-1.220, P<0.01), and CRRT (HR=2.757, 95%CI: 1.450-5.239, P=0.002) were independent factors affecting the 90-day outcome of the SA-AKI patients.

The 90-day mortality rate of the SA-AKI patients was 38% while its independent influencing factors included age, body mass index, mean arterial pressure, blood lactate, and CRRT.