Presentation Authors: Naoki Fujita*, Masaki Momota, Yuki Tobisawa, Tohru Yoneyama, Hayato Yamamoto, Atsushi Imai, Shingo Hatakeyama, Hirosaki, Japan, Hiroyuki Ito, Hachinohe, Japan, Takahiro Yoneyama, Yasuhiro Hashimoto, Hirosaki, Japan, Kazuaki Yoshikawa, Mutsu, Japan, Chikara Ohyama, Hirosaki, Japan
Introduction: Although acute kidney injury (AKI) has negative impact on prognosis in patients with sepsis, the risk factors for AKI development in patients with urological sepsis remain unclear. As arterial degradation is suggested to be a risk factor for renal impairment, we hypothesized that preexisting aortic calcification may play a crucial role in development of AKI. Therefore, we prospectively evaluated the impact of aortic calcification on severe AKI development in patients with urological sepsis.
Methods: We prospectively collected the data from 181 patients with urological sepsis between September 2016 and September 2018. AKI diagnosis was defined according to KDIGO criteria. An aortic calcification was evaluated using aortic calcification index (ACI, %). The optimal cutoff value of the intensity of ACI for severe AKI prediction was calculated with the ROC curve, and then patients were divided into two groups between low ACI group and high ACI group. We investigated the influence of ACI on severe AKI development. Multivariate logistic regression analysis using inverse probability of treatment weighting (IPTW) method was performed to evaluate the impact of ACI on severe AKI development.
Results: Median age was 79 years old in this cohort. The optimal cutoff value of the intensity of ACI for severe AKI prediction was 50% (AUC = 0.631, P = 0.006). Of 181 patients, the number of patients with low ACI and high ACI were 112 and 69, respectively. The ACI value was significantly higher in patients with stage 2-3 AKI than that of stage 0-1 AKI. The hospital mortality was significantly higher in high ACI group (P=0.003). The rate of severe AKI development was significantly higher in high ACI group (P < 0.001). In multivariate analysis using IPTW model, ACI was selected as significant independent risk factor for severe AKI development in patients with urological sepsis.
Conclusions: Aortic calcification may be a potential risk factor of severe AKI development in patients with urological sepsis.