Early Sepsis-Associated Acute Kidney Injury and Obesity

Author:

Ahn Yoon Hae1,Yoon Si Mong2,Lee Jinwoo2,Lee Sang-Min12,Oh Dong Kyu3,Lee Su Yeon3,Park Mi Hyeon3,Lim Chae-Man3,Lee Hong Yeul1, ,Heo Jeongwon4,Lee Jae-myeong4,Kim Kyung Chan4,Lee Yeon Joo4,Cho Young-Jae4,Lim Sung Yoon4,Chang Youjin4,Jeon Kyeongman4,Ko Ryoung-Eun4,Suh Gee Young4,Hong Suk-Kyung4,Hong Sang-Bum4,Cho Woo Hyun4,Kwak Sang Hyun4,Lee Heung Bum4,Ahn Jong-Joon4,Seong Gil Myeong4,Lee Song-I4,Park Sunghoon4,Park Tai Sun4,Lee Su Hwan4,Choi Eun Young4,Moon Jae Young4,Kang Hyung Koo4

Affiliation:

1. Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea

2. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea

3. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Seoul, Korea

4. for the Korean Sepsis Alliance Investigators

Abstract

ImportanceThe 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.ObjectiveTo explore the association between obesity, early SA-AKI incidence, and clinical outcomes in patients with sepsis.Design, Setting, and ParticipantsThis 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.ExposuresSepsis and hospitalization in the ICU.Main Outcomes and MeasuresThe 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.ResultsOf 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 RelevanceIn 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.

Publisher

American Medical Association (AMA)

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