Sex and mortality in septic severe acute kidney injury

Zachary O'Brien, Alan Cass, Louise Cole, Simon Finfer, Martin Gallagher, Colin McArthur, Shay McGuiness, John Myburgh, Rinaldo Bellomo, Johan Mårtensson, on behalf of the RENAL Study Investigators, on behalf of the Australian and New Zealand Intensive Care Clinical Trials Group

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Purpose
To investigate the relationship between sex and mortality and whether menopause or the intensity of renal replacement therapy (RRT) modify this relationship in patients with severe septic acute kidney injury (AKI).

Materials and methods
Post-hoc analysis of patients with sepsis included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial.

Results
Of 724 patients, 458 (63.3%) were male and 266 (36.7%) were female. The mean delivered effluent flow rate was 25.6 ± 7.4 ml/kg/h (80 ± 15% of prescribed dose) in males and 27.4 ± 7.6 ml/kg/h (83 ± 15% of prescribed dose) in females (p = .01). A total of 237 (51.7%) males and 118 (44.5%) females died within 90 days of randomization (p = .06). The adjusted hazard ratio (HR) for 90-day mortality was significantly decreased in females as compared with males (HR 0.74, 95% CI 0.57 to 0.96, p = .02). The relationship between sex and mortality was not significantly altered by menopausal status (adjusted P value for interaction 0.99) or by RRT intensity allocation (adjusted P value for interaction 0.27).

Conclusions
In a cohort of patients with sepsis and severe AKI, female sex was associated with improved survival. The relationship between sex and survival was not altered by menopausal status or RRT intensity.
Original languageEnglish
Pages (from-to)70-76
Number of pages7
JournalJournal of Critical Care
Volume49
DOIs
Publication statusPublished - Feb 2019

Keywords

  • sepsis
  • acute kidney injury
  • sex
  • mortality
  • renal replacement therapy

Cite this

O'Brien, Z., Cass, A., Cole, L., Finfer, S., Gallagher, M., McArthur, C., ... on behalf of the Australian and New Zealand Intensive Care Clinical Trials Group (2019). Sex and mortality in septic severe acute kidney injury. Journal of Critical Care, 49, 70-76. https://doi.org/10.1016/j.jcrc.2018.10.017
O'Brien, Zachary ; Cass, Alan ; Cole, Louise ; Finfer, Simon ; Gallagher, Martin ; McArthur, Colin ; McGuiness, Shay ; Myburgh, John ; Bellomo, Rinaldo ; Mårtensson, Johan ; on behalf of the RENAL Study Investigators ; on behalf of the Australian and New Zealand Intensive Care Clinical Trials Group. / Sex and mortality in septic severe acute kidney injury. In: Journal of Critical Care. 2019 ; Vol. 49. pp. 70-76.
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abstract = "PurposeTo investigate the relationship between sex and mortality and whether menopause or the intensity of renal replacement therapy (RRT) modify this relationship in patients with severe septic acute kidney injury (AKI).Materials and methodsPost-hoc analysis of patients with sepsis included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial.ResultsOf 724 patients, 458 (63.3{\%}) were male and 266 (36.7{\%}) were female. The mean delivered effluent flow rate was 25.6 ± 7.4 ml/kg/h (80 ± 15{\%} of prescribed dose) in males and 27.4 ± 7.6 ml/kg/h (83 ± 15{\%} of prescribed dose) in females (p = .01). A total of 237 (51.7{\%}) males and 118 (44.5{\%}) females died within 90 days of randomization (p = .06). The adjusted hazard ratio (HR) for 90-day mortality was significantly decreased in females as compared with males (HR 0.74, 95{\%} CI 0.57 to 0.96, p = .02). The relationship between sex and mortality was not significantly altered by menopausal status (adjusted P value for interaction 0.99) or by RRT intensity allocation (adjusted P value for interaction 0.27).ConclusionsIn a cohort of patients with sepsis and severe AKI, female sex was associated with improved survival. The relationship between sex and survival was not altered by menopausal status or RRT intensity.",
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O'Brien, Z, Cass, A, Cole, L, Finfer, S, Gallagher, M, McArthur, C, McGuiness, S, Myburgh, J, Bellomo, R, Mårtensson, J, on behalf of the RENAL Study Investigators & on behalf of the Australian and New Zealand Intensive Care Clinical Trials Group 2019, 'Sex and mortality in septic severe acute kidney injury', Journal of Critical Care, vol. 49, pp. 70-76. https://doi.org/10.1016/j.jcrc.2018.10.017

Sex and mortality in septic severe acute kidney injury. / O'Brien, Zachary; Cass, Alan; Cole, Louise; Finfer, Simon; Gallagher, Martin; McArthur, Colin; McGuiness, Shay; Myburgh, John; Bellomo, Rinaldo; Mårtensson, Johan; on behalf of the RENAL Study Investigators; on behalf of the Australian and New Zealand Intensive Care Clinical Trials Group.

In: Journal of Critical Care, Vol. 49, 02.2019, p. 70-76.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Sex and mortality in septic severe acute kidney injury

AU - O'Brien, Zachary

AU - Cass, Alan

AU - Cole, Louise

AU - Finfer, Simon

AU - Gallagher, Martin

AU - McArthur, Colin

AU - McGuiness, Shay

AU - Myburgh, John

AU - Bellomo, Rinaldo

AU - Mårtensson, Johan

AU - on behalf of the RENAL Study Investigators

AU - on behalf of the Australian and New Zealand Intensive Care Clinical Trials Group

PY - 2019/2

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N2 - PurposeTo investigate the relationship between sex and mortality and whether menopause or the intensity of renal replacement therapy (RRT) modify this relationship in patients with severe septic acute kidney injury (AKI).Materials and methodsPost-hoc analysis of patients with sepsis included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial.ResultsOf 724 patients, 458 (63.3%) were male and 266 (36.7%) were female. The mean delivered effluent flow rate was 25.6 ± 7.4 ml/kg/h (80 ± 15% of prescribed dose) in males and 27.4 ± 7.6 ml/kg/h (83 ± 15% of prescribed dose) in females (p = .01). A total of 237 (51.7%) males and 118 (44.5%) females died within 90 days of randomization (p = .06). The adjusted hazard ratio (HR) for 90-day mortality was significantly decreased in females as compared with males (HR 0.74, 95% CI 0.57 to 0.96, p = .02). The relationship between sex and mortality was not significantly altered by menopausal status (adjusted P value for interaction 0.99) or by RRT intensity allocation (adjusted P value for interaction 0.27).ConclusionsIn a cohort of patients with sepsis and severe AKI, female sex was associated with improved survival. The relationship between sex and survival was not altered by menopausal status or RRT intensity.

AB - PurposeTo investigate the relationship between sex and mortality and whether menopause or the intensity of renal replacement therapy (RRT) modify this relationship in patients with severe septic acute kidney injury (AKI).Materials and methodsPost-hoc analysis of patients with sepsis included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial.ResultsOf 724 patients, 458 (63.3%) were male and 266 (36.7%) were female. The mean delivered effluent flow rate was 25.6 ± 7.4 ml/kg/h (80 ± 15% of prescribed dose) in males and 27.4 ± 7.6 ml/kg/h (83 ± 15% of prescribed dose) in females (p = .01). A total of 237 (51.7%) males and 118 (44.5%) females died within 90 days of randomization (p = .06). The adjusted hazard ratio (HR) for 90-day mortality was significantly decreased in females as compared with males (HR 0.74, 95% CI 0.57 to 0.96, p = .02). The relationship between sex and mortality was not significantly altered by menopausal status (adjusted P value for interaction 0.99) or by RRT intensity allocation (adjusted P value for interaction 0.27).ConclusionsIn a cohort of patients with sepsis and severe AKI, female sex was associated with improved survival. The relationship between sex and survival was not altered by menopausal status or RRT intensity.

KW - sepsis

KW - acute kidney injury

KW - sex

KW - mortality

KW - renal replacement therapy

U2 - 10.1016/j.jcrc.2018.10.017

DO - 10.1016/j.jcrc.2018.10.017

M3 - Article

VL - 49

SP - 70

EP - 76

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

ER -