Acute Kidney Injury in Severe Sepsis and Septic Shock in Patients with and without Diabetes Mellitus: A Multicenter Study

Marion Venot, Lise Weis, Christophe Clec'h, Michael Darmon, Bernard Allaouchiche, Dany Goldgran-Tolédano, Maité Garrouste-Orgeas, Christophe Adrie, Jean-François Timsit, Elie Azoulay, Marion Venot, Lise Weis, Christophe Clec'h, Michael Darmon, Bernard Allaouchiche, Dany Goldgran-Tolédano, Maité Garrouste-Orgeas, Christophe Adrie, Jean-François Timsit, Elie Azoulay

Abstract

Introduction: Whether diabetes mellitus increases the risk of acute kidney injury (AKI) during sepsis is controversial.

Materials and methods: We used a case-control design to compare the frequency of AKI, use of renal replacement therapy (RRT), and renal recovery in patients who had severe sepsis or septic shock with or without diabetes. The data were from the Outcomerea prospective multicenter database, in which 12 French ICUs enrolled patients admitted between January 1997 and June 2009.

Results: First, we compared 451 patients with severe sepsis or septic shock and diabetes to 3,277 controls with severe sepsis or septic shock and without diabetes. Then, we compared 318 cases (with diabetes) to 746 matched controls (without diabetes). Diabetic patients did not have a higher frequency of AKI (hazard ratio [HR], 1.18; P = 0.05]) or RRT (HR, 1.09; P = 0.6). However, at discharge, diabetic patients with severe sepsis or septic shock who experienced acute kidney injury during the ICU stay and were discharged alive more often required RRT (9.5% vs. 4.8%; P = 0.02), had higher serum creatinine values (134 vs. 103 µmoL/L; P<0.001) and had less often recovered a creatinine level less than 1.25 fold the basal creatinine (41.1% vs. 60.5%; P<0.001).

Conclusions: In patients with severe sepsis or septic shock, diabetes is not associated with occurrence of AKI or need for RRT but is an independent risk factor for persistent renal dysfunction in patients who experience AKI during their ICU stay.

Conflict of interest statement

Competing Interests: Outcomerea is a nonprofit organization supported by public grants and nonexclusive grants from four pharmaceutical companies (Aventis Pharma, Wyeth, Pfizer, and MSD). Also, Outcomerea has been granted by three publicly funded French agencies (Centre National de la Recherche Scientifique [CNRS], Institut National pour la Santé et la Recherche Médicale [INSERM], and the French Ministry of Health). None of the co-authors are employed, consultants or part of any of these companies and none of their relationship with industrial companies are related to the topic covered by this manuscript. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. All of the authors provided their full disclosures: they declare no other conflicts of interest.

Figures

Fig 1. Patient flow chart.
Fig 1. Patient flow chart.

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