, Jan C. ter Maaten1,2, Raymond J. van Wijk2, Stephan J.L. Bakker3, Hjalmar R. Bouma1,4, Marco van Londen3
Introduction
Sepsis is a leading cause of acute kidney injury (SA-AKI), associated with multiorgan failure, cardiovascular events, and increased mortality. While most research focuses on critically ill patients in intensive care units (ICU), the majority of sepsis cases are managed outside the ICU, leaving this population understudied. In this study we explore whether renal dysfunction, is an early risk marker that warrants greater recognition in patients presenting at the emergency department (ED) with severe infection at risk for development of sepsis, defined as early sepsis.
Methods
This post-hoc analysis at the Emergency Department (ED) includes patients from the Acutelines cohort (2020–2023). Kaplan-Meier curves and univariable and multivariable Cox regression analyses were used to assess the association between AKI and all-cause mortality, as well as in-hospital mortality and cardiovascular death, adjusting for potential confounders.
Results
In this study 2045 patients presented with sepsis at the ED, of which 246 (12%) had AKI. The mortality rate was 25% over a median follow-up of 346 days. AKI was associated with higher all-cause mortality (38% vs. 23%; p<0.001). After adjusting for sex, age, comorbidities, and sepsis severity, AKI remained independently associated with all-cause mortality (HR 1.44 [1.14–1.82];p=0.003), in-hospital mortality (HR 1.65 [1.16–2.34];p=0.006) and cardiovascular cause of death (HR 2.50 [1.39–4.48];p=0.002). Similar outcomes were observed in the a sub analysis excluding ICU patients.
Conclusion
SA-AKI at ED presentation is independently linked to higher all-cause, in-hospital, and cardiovascular mortality, highlighting the need for recognition across care settings and structured follow-up to improve outcomes.
