Prevalence & risk factors of multi-morbidity in critically ill patients with sepsis-associated acute kidney injury (SA-AKI)

Abstract

Background & Objectives: Multi-morbidity, characterised by the coexistence of two or more chronic conditions, significantly impacts critically ill patients. Among sepsis-associated acute kidney injury (SA-AKI) patients, multi-morbidity contributes to poor clinical outcomes, yet its prevalence and associated risk factors remain under-explored. This study examines the prevalence of multi-morbidity among SA-AKI patients in the intensive care unit (ICU) setting and identifies significant risk factors that influence outcomes. Methods: A cross-sectional study was conducted on 185 adult ICU patients with SA-AKI in a tertiary intensive care unit between January 2023 and January 2024. Risk factors, biochemical profiles, and clinical outcomes were analysed. Logistic regression was employed to identify predictors of multi-morbidity. Results: Among 185 SA-AKI patients, the prevalence of multi-morbidity was 38.9 per cent, with older age [≥60 yr, adjusted odds ratio (AOR): 22.11, P<0.0001), chloride imbalance (AOR: 0.42, P=0.023), and albumin imbalance (AOR: 0.10, P=0.018) identified as significant risk factors. The most common comorbidities were hypertension (52.4%) and diabetes mellitus (46.5%). Electrolyte imbalances such as hyponatremia (34.1%) and hypoalbuminemia (77.8%) were prevalent. Patients with multimorbidity had higher mechanical ventilation rates (62.5% vs. 28.3%) and hospital mortality rates (60.6% vs. 23.5%, P<0.001). Renal replacement therapy use was not significantly different between groups. Interpretation & conclusions: The study highlights the high burden of multi-morbidity in SA-AKI patients, with significant implications for clinical management and outcomes. Comprehensive strategies are needed to address the associated risk factors and improve care in this population.