Avaliação de pacientes sépticos com lesão renal aguda em unidade de terapia intensiva: estudo retrospectivo sobre mortalidade e necessidade de hemodiálise

Abstract

The study evaluated the mortality of septic patients with or without acute kidney injury (AKI), emphasizing the impact of renal replacement therapy (RRT) in the intensive care unit (ICU). This was a retrospective observational study conducted at a tertiary university hospital, including 101 adult patients admitted with a diagnosis of sepsis between September 2023 and October 2024. Patients were categorized into three groups: without AKI, with AKI managed conservatively, and with AKI requiring RRT. Clinical variables, prognostic scores, need for intensive support, and outcomes (discharge or death) were analyzed. AKI was identified in 88% of patients, and 51% required dialysis. Overall hospital mortality was 81%. The presence of AKI was associated with greater clinical severity and worse prognosis in survival analysis, although it did not remain an independent predictor in regression models. The need for RRT occurred predominantly in patients with higher SAPS 3 and SOFA scores, longer mechanical ventilation, and greater clinical complexity however, in the analysis it did not remain as an independent predictor of death. In contrast, older age, comorbidities, and higher SAPS 3 score were independent predictors of death. The study concludes that AKI is highly prevalent among critically ill septic patients and is associated with worse outcomes, with dialysis serving as a marker of severity. Early recognition of renal dysfunction and accurate risk stratification are essential for guiding appropriate ICU management.