MO356THE INCIDENCE, MORTALITY AND RENAL OUTCOMES OF ACUTE KIDNEY INJURY IN PATIENTS WITH SUSPECTED INFECTION AT THE EMERGENCY DEPARTMENT
Authors: Khairoun Meriem , Uffen Jan Willem , Ocak Gurbey , Koopsen Romy , Haitjema Saskia , Oosterheert Jan Jelrik , Gansevoort Ronald , Kaasjager Karin 
Published: May 2021

Abstract

Background and Aims
Acute kidney injury (AKI) is a major health problem associated with considerable mortality and morbidity. The epidemiology of AKI in hospitalized and critically ill patients at the Intensive Care Unit with severe infection and sepsis has been well described, however data on mortality and clinical outcomes of AKI at the emergency department in patients with suspected infection are scarce. In this study, we investigated the incidence, mortality and renal outcomes after AKI up to one year after initial AKI-episode patients with suspected infection at the emergency department.

Method
We used data from the SPACE-cohort (SePsis in the ACutely ill patients in the Emergency department), which consisted of all consecutive patients that presented to the emergency department of the internal medicine with suspected infection in the period between 2016 and 2018 at the University Medical Center Utrecht. Clinical and laboratory data were prospectively collected of all patients. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Outcomes were 1-year all-cause mortality and renal function. Hazards ratios were assessed using Cox regression to investigate the association between AKI, 1-year mortality and renal function decline after AKI. HRs were adjusted for potential confounders including age, gender, Charlson Comorbidity Index, immune status, smoking status, medication use (diuretics, proton-pump inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs) and angiotensin converting enzyme inhibitors (ACEi)), disease severity, diagnosis in the emergency department. Decline of renal function after AKI episode at emergency department visit was defined as Serum Creatinine (SCr) level ≥30% above baseline. Survival in patients with and without AKI was assessed using Kaplan-Meier analyses.

Results
Of the 3105 patients in the SPACE-cohort with suspected infection, we included 1716, who fulfilled the inclusion criteria and had a baseline SCr measurement. Patients without SCr at baseline (401 patients), at emergence department visit (113 patients), during follow-up (33 patients), on renal replacement therapy (66 patients) or had a repeated emergency department visit (776 patients) were excluded. Of the 1716 patients presenting with suspected infection patients (median age 62y, 52.9% male), 185 patients (10.8%) had an AKI episode. Mortality was 23.8% for the AKI group and 20.4% for the non-AKI group. The adjusted HR for all-cause mortality at 1-year after presentation at the emergency department in AKI patients was 2.1 (95% CI 1.5 – 3.1). Moreover, the cumulative incidence of renal function decline was 69.8% for patients with AKI and 39.3% for patients without AKI. Patients with an episode of AKI had higher risks of developing renal function decline (adjusted HR 3.3, 95% CI 2.4-4.5) at one year after initial AKI-episode at the emergency department.

Conclusion
Acute kidney injury is common in patients with suspected infection in the emergency department and is significantly associated with mortality and renal function decline one year after AKI.