Two subphenotypes of septic acute kidney injury are associated with different 90-day mortality and renal recovery

• Published in: Critical care (London, England) England), 2020-04, Vol.24 (1), p.150-150, Article 150
• Main Authors: Wiersema, Renske, Jukarainen, Sakari, Vaara, Suvi T, Poukkanen, Meri, Lakkisto, Päivi, Wong, Hector, Linder, Adam, van der Horst, Iwan C C, Pettilä, Ville
• Format: Article
• Language: English
• Subjects: Acute kidney injury; Acute Kidney Injury - etiology; Acute Kidney Injury - physiopathology; Aged; Analysis; Anestesi och intensivvård; Anesthesiology and Intensive Care; Biomarkers; Biomarkers - analysis; Biomarkers - blood; Chi-Square Distribution; Clinical Medicine; Clinical outcomes; Comorbidity; Critical care; Female; Finland; Genotype & phenotype; Health aspects; Humans; Infection; Injuries; Kidney diseases; Kidneys; Klinisk medicin; LCA; Logistic Models; Male; Medical and Health Sciences; Medical research; Medicin och hälsovetenskap; Middle Aged; Mortality; Phenotype; Recovery (Medical); Recovery of Function - physiology; Renal recovery; Sensitivity analysis; Sepsis; Sepsis - blood; Sepsis - complications; Sepsis - genetics; Statistics, Nonparametric; Subphenotypes; Urologi och njurmedicin; Urology and Nephrology; Variables
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-020-02866-x

The pathophysiology of septic acute kidney injury is inadequately understood. Recently, subphenotypes for sepsis and AKI have been derived. The objective of this study was to assess whether a combination of comorbidities, baseline clinical data, and biomarkers could classify meaningful subphenotypes in septic AKI with different outcomes. We performed a post hoc analysis of the prospective Finnish Acute Kidney Injury (FINNAKI) study cohort. We included patients admitted with sepsis and acute kidney injury during the first 48 h from admission to intensive care (according to Kidney Disease Improving Global Outcome criteria). Primary outcomes were 90-day mortality and renal recovery on day 5. We performed latent class analysis using 30 variables obtained on admission to classify subphenotypes. Second, we used logistic regression to assess the association of derived subphenotypes with 90-day mortality and renal recovery on day 5. In total, 301 patients with septic acute kidney injury were included. Based on the latent class analysis, a two-class model was chosen. Subphenotype 1 was assigned to 133 patients (44%) and subphenotype 2 to 168 patients (56%). Increased levels of inflammatory and endothelial injury markers characterized subphenotype 2. At 90 days, 29% of patients in subphenotype 1 and 41% of patients in subphenotype 2 had died. Subphenotype 2 was associated with a lower probability of short-term renal recovery and increased 90-day mortality. In this post hoc analysis, we identified two subphenotypes of septic acute kidney injury with different clinical outcomes. Future studies are warranted to validate the suggested subphenotypes of septic acute kidney injury.