Prevalence, clinical features and discharge outcomes of acute kidney injury among adult patients admitted with sepsis in mulago hospital.
Background: Sepsis is a commonly encountered syndrome in both patients admitted in hospitals and patients presenting to the emergency department. Severe sepsis can be complicated by development of multiorgan damage of which the kidney is frequently among. With this study we aimed to measure the prevalence of AKI among adult patients with sepsis in Mulago hospital medical wards and to describe their clinical features and hospital discharge outcomes. Methods: We undertook a cross sectional analytical study in the Mulago hospital adult medical wards consecutively recruiting all patients who fit the American College of Chest Physicians sepsis criteria between the 1st of January and the 20th of April 2013. Demographic and clinical characteristics together with blood samples for renal function tests, a complete blood count, a malaria smear and an HIV screening test were done. A midstream urine sample examination and an abdominal ultrasound scan were also performed. Patient with AKI were followed up to determine the discharge outcome. Data collected was analyzed using proportions and odds ratios with 95% confidence intervals in the bivariate analysis. Results; Out of 387 patients recruited with sepsis, prevalence of AKI was16.3%. Fifty six percent (55.6%) of patients were male and the average age was 37 (range; 18-90) years. On bivariate analysis, factors that were significantly associated with AKI included age >59, weight between 45-64kgs, postural drop in systolic blood pressure of >9mmhg, urinary output of 0.6-2.4ml/kg/hr and WBC of > 12,000cells/mls. Among the patients with AKI mortality was 21% and 59% of patients who were discharged alive had persistent kidney injury. Stage 3 AKIN staging was significantly associated with persistence of kidney injury and average length of stay was six days. Conclusions and recommendations; The prevalence of AKI among sepsis patients in Mulago hospital is high and is associated with age >59, weight between 45-64kgs, postural drop in blood pressure of >9mmhg, urinary output of 0.6-2.4ml/kg/hr and WBC of > 12,000cells/ml. Mortality among patients who develop AKI is also high and more than half of the patients who survive till discharge have persistent kidney injury at discharge. A study to follow up these patients would be important in discovering what happens to them and the burden they contribute to chronic kidney disease which is very expensive to manage.