Sepsis-induced Acute Kidney Injury in Women Undergoing Pelvic and Abdominal Surgery
Juan Gustavo Vázquez-Rodríguez
*
Intensive Care Unit, High Specialty Medical Unit, Gynecology and Obstetrics Hospital No. 3, National Medical Center “La Raza”, Mexican Institute of Social Security, Mexico City, Mexico.
Juan Gustavo Vázquez-Arredondo
Department of Internal Medicine, High Specialty Medical Unit, "Dr. Antonio Fraga Mouret" Specialty Hospital, National Medical Center “La Raza”, Mexican Institute of Social Security. Mexico City, Mexico.
*Author to whom correspondence should be addressed.
Abstract
Background: Reports of morbidity and mortality from surgical sepsis-induced acute kidney injury (AKI) in women are scarce.
Aims: Determine the incidence, clinical course, management, and outcome of sepsis-induced AKI in women undergoing pelvic and abdominal surgery.
Study Design: Observational, longitudinal, retrospective, descriptive, and analytical study.
Place and Duration of Study: Intensive Care Unit (ICU) of the High Specialty Medical Unit, Gynecology and Obstetrics Hospital No. 3 of National Medical Center “La Raza” belonging to the Mexican Institute of Social Security, Mexico City between January 1, 2023, to December 31, 2024.
Methodology: A retrospective cohort of 31 women with surgical sepsis admitted to the ICU was studied. The records were consulted to obtain general data and clinical characteristics of sepsis. The frequency of AKI was determined at three times: admission, stay in ICU and at discharge. It was not possible to determine serum creatinine values or uresis ml/K/hour before admission to the ICU. Therefore, a serum creatinine concentration ≥1.1 mg/dL at ICU admission was considered representative of AKI (baseline data). To define AKI during the stay and discharge from the ICU, the criteria and classification of the Clinical Practice Guideline for AKI issued by Kidney Disease Improving Global Guidelines (KDIGO) in 2012 were considered. The incidence, clinical course, management, and outcome of surgical sepsis-induced AKI (hemodialysis, mortality) were studied.
Results: Age 48.22±15.14 years. Sepsis associated with cancer surgery 48.39% (n=15), internal genital organ surgery 29.03% (n=9) and surgery during pregnancy or postpartum 22.58% (n=7). Infectious focus: internal genital organs 87.10% (n=27), large intestine 9.68% (n=3) and lungs 3.22% (n=1). Positive cultures 48.39% (n=15) with predominance of E. coli.
Incidence of AKI in the ICU: admission 51.61% (n=16, creatinine 1.35±1.65 mg/dL), ICU stay 35.48% (n=11, creatinine 2.32±2.27 mg/dL) and discharge of ICU 25.80% (n=8, creatinine 1.8±0.57 mg/dL). Hemodialysis was performed in 31.25% (n=5/16). Stay in the ICU: without AKI 4.69±2.20 days and with AKI 7.75±1.34 days (P=.016). Mortality was 9.68% (n=3).
Conclusion: The incidence of surgical sepsis-induced AKI was found to be very high. The main characteristic was the recovery of renal function, but the complication did not resolve in all cases. A considerable percentage of patients required hemodialysis after discharge from the ICU. AKI increased the length of stay in the ICU, but not overall mortality.
Keywords: Acute kidney injury, sepsis, gynecological cancer, sepsis and pregnancy, gynecological surgery, obstetric intensive care