• Renske Wiersema, Sakari Jukarainen, Suvi T Vaara, Meri Poukkanen, Päivi Lakkisto, Hector Wong, Adam Linder, van der HorstIwan C CICCDepartment of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Intensive Care, Maastricht University Medical Centre+, University Maastricht, Maastricht, The Nethe, and Ville Pettilä.
• Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
• Crit Care. 2020 Apr 15; 24 (1): 150150.

BackgroundThe pathophysiology of septic acute kidney injury is inadequately understood. Recently, subphenotypes for sepsis and AKI have been derived. The objective of this study was to assess whether a combination of comorbidities, baseline clinical data, and biomarkers could classify meaningful subphenotypes in septic AKI with different outcomes.MethodsWe performed a post hoc analysis of the prospective Finnish Acute Kidney Injury (FINNAKI) study cohort. We included patients admitted with sepsis and acute kidney injury during the first 48 h from admission to intensive care (according to Kidney Disease Improving Global Outcome criteria). Primary outcomes were 90-day mortality and renal recovery on day 5. We performed latent class analysis using 30 variables obtained on admission to classify subphenotypes. Second, we used logistic regression to assess the association of derived subphenotypes with 90-day mortality and renal recovery on day 5.ResultsIn total, 301 patients with septic acute kidney injury were included. Based on the latent class analysis, a two-class model was chosen. Subphenotype 1 was assigned to 133 patients (44%) and subphenotype 2 to 168 patients (56%). Increased levels of inflammatory and endothelial injury markers characterized subphenotype 2. At 90 days, 29% of patients in subphenotype 1 and 41% of patients in subphenotype 2 had died. Subphenotype 2 was associated with a lower probability of short-term renal recovery and increased 90-day mortality.ConclusionsIn this post hoc analysis, we identified two subphenotypes of septic acute kidney injury with different clinical outcomes. Future studies are warranted to validate the suggested subphenotypes of septic acute kidney injury.

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