Health insurance status and risk factors of mortality in patients with septic acute kidney injury in Ningbo, China

Abstract

Objective: To investigate the relationship between health insurance status and outcomes of septic acute kidney injury (AKI) related hospitalizations in an intensive care unit (ICU) in Ningbo, China. Methods: For this retrospective study, information was extracted from patients notes and billing records for patients >18 years of age with a diagnosis of AKI admitted to the ICU department, Ningbo First Hospital from April 2013 to March 2018. Results: Of the 368 patients with sepsis admitted to ICU, 167 (45%) developed AKI; 95 patients were insured and 72 were uninsured. Compared with insured patients, uninsured patients were younger, had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, but had less catheter interventions and received less renal replacement therapy (RRT). Results from a multivariate analysis showed that independent predictors of ICU mortality were age, APACHE II scores, MODS scores, use of RRT and lack of insurance. Conclusions: Uninsured patients with septic AKI were younger, stayed a shorter time in ICU, had higher illness severity scores and a higher ICU mortality than insured patients. Importantly a major risk factor for ICU mortality in this group was lack of insurance.