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Sepsis co-morbidity needs tailored care

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ICU patients with co-morbid sepsis and acute kidney injury (AKI) may need nursing care that is distinct from that for non-septic kidney injury, Australian researchers have said.

They said that septic AKI was a common problem in ICU, occurring in up to 12% of all admissions. The number of cases is also rising due to an increase in older patients with co-mordities and more complex interventions such as organ transplantation. But they added that few studies had looked at the condition specifically.

As a result, they evaluated five years of data on more than 120,000 admissions to 57 ICUs. More than 43,300 were diagnosed with AKI and 14,000 with septic AKI.

They found those with septic AKI were generally sicker than non-septic cases and had lower blood pressure, higher heart rates, worse pulmonary function and higher white cell counts.

Septic AKI patients were also more likely to need longer stays in hospital – an extra day on average in ICU and three days overall in hospital. Additionally, septic AKI cases had a higher risk of mortality than non-septic cases – 19.8% versus 13.4%, respectively, while in ICU and 29.7% versus 21.6% while in hospital, the researchers said.

Lead author Dr Sean Bagshaw, from Austin Hospital Melbourne, said: ‘Septic AKI is common in the first 24 hours after ICU admission. Our findings suggest that septic AKI patients are clinically distinct and have distinguishing features and relevant difference in clinical outcomes when compared to those with non-septic AKI.

‘Our study further supports the concept that discriminating septic and non-septic AKI may have clinical importance,’ he added. ‘We now need to investigate further whether patients may require specific interventions, for example mechanical ventilation or vasopressor support, to reduce injury and promote kidney recovery.’

Critical Care (2008) 12: R47

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