Influence of the trajectory of the urine output for 24 h on the occurrence of AKI in patients with sepsis in intensive care unit.

ABSTRACT

BACKGROUND: Sepsis-associated acute kidney injury (S-AKI) is a common and life-threatening complication in hospitalized and critically ill patients. This condition is an independent cause of death. This study was performed to investigate the correlation between the trajectory of urine output within 24 h and S-AKI. METHODS: Patients with sepsis were studied retrospectively based on the Medical Information Mart for Intensive Care IV. Latent growth mixture modeling was used to classify the trajectory of urine output changes within 24 h of sepsis diagnosis. The outcome of this study is AKI that occurs 24 h after sepsis. Cox proportional hazard model, Fine-Gray subdistribution proportional hazard model, and doubly robust estimation method were used to explore the risk of AKI in patients with different trajectory classes. RESULTS: A total of 9869 sepsis patients were included in this study, and their 24-h urine output trajectories were divided into five classes. The Cox proportional hazard model showed that compared with class 1, the HR (95% CI) values for classes 3, 4, and 5 were 1.460 (1.137-1.875), 1.532 (1.197-1.961), and 2.232 (1.795-2.774), respectively. Competing risk model and doubly robust estimation methods reached similar results. CONCLUSIONS: The trajectory of urine output within 24 h of sepsis patients has a certain impact on the occurrence of AKI. Therefore, in the early treatment of sepsis, close attention should be paid to changes in the patient's urine output to prevent the occurrence of S-AKI.