Trajectory of early creatinine change is associated with the prognosis of sepsis patients

BACKGROUND: Numerous studies have investigated the creatinine in patients with sepsis, and many meaningful results have been obtained. However, few studies have measured the creatinine multiple times and established trajectory models for patients with sepsis. Thus, we explored the influence of 72-h creatinine trajectory in patients with sepsis through latent class trajectory models. METHODS: Data from patients with sepsis were extracted from the Medical Information Mart for Intensive Care-IV database for inclusion in a retrospective cohort study. Three creatinine values within 72 h after hospitalization were extracted, and the interval between each creatinine value was 24 h. The creatinine measured three times after admission was analyzed using latent class trajectory models to construct a trajectory model. The outcome was 28-day mortality. The survival probability of different trajectory groups was investigated using Kaplan-Meier (K-M) analysis, and the relationship between different creatinine trajectories and 28-day mortality risk was investigated using Cox proportional-hazards regression model. RESULTS: This study included 8663 patients with sepsis. Five different creatinine trajectories were identified based on model-fit criteria. Class 1 started at a low level and remained stable at that low level; Class 2 showed a gradual upward trend; Class 3 stabilized at a high level; Class 4 exhibited a trend of initially decreasing and then increasing; Class 5 presented an inverted U-shape. The K-M analysis indicated that patients in class 2 had the lowest probability of survival. Univariate and multivariate Cox regression analysis indicated that, with class 1 as a reference, patients in class 2 had the highest 28-day mortality risk (P < 0.001). Subgroup analysis indicated that a nominal interaction occurred between CRRT group and creatinine trajectory in the 28-day mortality (P < 0.05). CONCLUSION: Trajectory of early creatinine change is associated with the prognosis of sepsis patients, patients with persistently elevated creatinine in the first three days had a higher mortality risk. CLINICAL TRIAL: Non-applicable