Clinical and Resource Burden of Acute Kidney Injury Among Adults Hospitalized with Sepsis: A Retrospective Cross-Sectional study

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We used a large national database to characterize the burden of AKI among adults hospitalized with sepsis in the United States. Methods: We conducted a cross-sectional study of adult sepsis hospitalizations in the 2022 NIS. AKI was identified using ICD-10-CM codes. Clinical outcomes included in-hospital mortality, mechanical ventilation, vasopressor use, and in-hospital dialysis. Resource outcomes included length of stay, total hospital charges, and discharge disposition. Survey-weighted logistic and gamma regression models were used to estimate adjusted odds ratios (aORs) and adjusted ratios of geometric means (aROMs) after adjusting for demographic, socioeconomic, and comorbidity factors. Results: Among 2.96 million weighted sepsis hospitalizations, 1.32 million (44.5%) involved AKI. Patients with AKI were older and had higher comorbidity burden than those without AKI. Unadjusted mortality (19.8% vs 7.5%), mechanical ventilation (22.3% vs 9.3%), and vasopressor use (10.1% vs 5.8%) were substantially higher in the AKI group, and these differences persisted in adjusted analyses (mortality aOR 2.44; mechanical ventilation aOR 2.66; vasopressor use aOR 1.70). AKI was also associated with longer length of stay (aROM 1.33), higher hospital charges (aROM 1.50), and worse discharge outcomes, including lower home discharge (26.0% vs 43.8%) and greater transfer to post-acute care facilities (40.4% vs 30.8%). Conclusions: Sepsis-associated AKI remains a widespread and highly consequential complication, independently associated with higher mortality, greater organ support needs, prolonged hospitalization, increased financial burden, and poorer post-acute recovery. These findings underscore the need for early identification and prevention of AKI in sepsis and highlight the urgent need for early AKI mitigation strategies to improve clinical and recovery outcomes in sepsis. sepsis acute kidney injury discharge disposition hospital charges length of stay ICD-10-CM-codes in-hospital mortality mechanical ventilation vasopressor use Figures Figure 1 Figure 2 Figure 3 Background Sepsis remains one of the leading causes of hospitalization, critical illness, and mortality worldwide, contributing to substantial health‐care utilization and long-term morbidity [16, 19]. Acute kidney injury (AKI) is among the most frequent and severe organ dysfunctions occurring during sepsis, reporting up to 40–50% of hospitalized patients in prior studies and significantly worsening prognosis [12]. The development of AKI in sepsis has been consistently associated with higher mortality, greater need for organ support, prolonged hospitalization, and increased risk of long-term kidney dysfunction [1,5,14]. Despite advances in sepsis recognition and management, the burden of sepsis-associated AKI continues to rise and remains a major clinical challenge. Most prior epidemiologic studies evaluating sepsis-associated AKI have focused on single-center cohorts, ICU-based populations, or older administrative datasets predating current ICD-10 coding practices. These limitations restrict contemporary generalizability and may underestimate the evolving severity and complexity of sepsis-associated AKI. Although the relationship between AKI and mortality or organ-support needs is well established, relatively few studies have evaluated downstream functional outcomes such as discharge disposition—an increasingly important marker of survivorship and recovery. Many landmark analyses, including large multicenter critical care cohorts, reported mortality and organ failure trajectories but did not characterize post-acute disposition patterns [8,10]. Understanding these broader outcomes is essential to fully quantify the impact of AKI across the entire trajectory of sepsis care. Using the most recent nationally representative data from the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS), this study aimed to provide an updated and comprehensive assessment of the burden of AKI among adults hospitalized with sepsis in the United States. Specifically, we aimed to (1) describe the national epidemiology of sepsis-associated AKI, (2) quantify clinical and resource outcomes among sepsis hospitalizations with and without AKI, and (3) evaluate whether AKI remains independently associated with adverse outcomes after adjustment for demographic, socioeconomic, and clinical factors. Methods Study Design and Data Source We conducted a retrospective cross-sectional study using the 2022 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS), a nationally representative, all-payer inpatient database [3]. The NIS is discharge-based; therefore, each record reflects a single hospitalization. Adult hospitalizations (≥18 years) with complete age and survey design information were included. Inter-hospital transfers were retained per HCUP methodology. No human subjects were involved in this study. IRB requirement was waived by Baycare Institutional Review Board. Identification of Sepsis and Acute Kidney Injury Sepsis hospitalizations were identified using ICD-10-CM codes A40.x–A41.x (sepsis), R65.20 (severe sepsis), and R65.21 (septic shock). Acute kidney injury (AKI) was defined using ICD-10-CM codes N17.x in any diagnosis field. Because the NIS lacks present-on-admission indicators, sepsis and AKI may represent either pre-existing conditions or complications arising during hospitalization. Baseline Characteristics Baseline demographic, socioeconomic, and comorbidity variables were extracted to compare sepsis hospitalizations with and without AKI. Covariates included age, sex, race/ethnicity, primary payer, ZIP-code income quartile, and Elixhauser comorbidities. Age was summarized as mean (SD), and categorical variables as survey-weighted percentages. Standardized mean differences (SMDs) were used to quantify between-group differences (SMD ≥0.10 indicating meaningful imbalance). These variables correspond to the cohort characteristics presented in Table 1. Unadjusted Clinical and Resource Outcomes Unadjusted outcomes included in-hospital mortality, mechanical ventilation, vasopressor use, in-hospital dialysis, length of stay, total hospital charges, and discharge disposition. Mechanical ventilation and dialysis were identified using ICD-10-PCS procedure codes. Vasopressor use was approximated using central venous catheter placement ICD-10-PCS codes, which has been validated as a surrogate in administrative datasets [4]. Discharge disposition was categorized as home, transfer to another acute-care facility, skilled nursing/long-term care, or in-hospital death. Because mortality (DIED) and discharge disposition derive from different NIS fields, the proportion “died in hospital” differs from the in-hospital mortality variable. Unadjusted clinical outcomes presented in Table 2. They are visually summarized in Figure 1, and discharge disposition patterns are displayed in Figure 2. Adjusted Analyses The independent association between AKI and each outcome was evaluated using multivariable survey-weighted regression. Binary outcomes—mortality, mechanical ventilation, vasopressor use, and dialysis—were analyzed using logistic regression and reported as adjusted odds ratios (aORs) with 95% confidence intervals. Length of stay and total hospital charges, which were right-skewed, were analyzed using gamma regression with a log link and reported as adjusted ratios of geometric means (aROMs). All models adjusted for demographic, socioeconomic, and comorbidity variables listed in Table 1. The adjusted associations are presented in Table 3 and visually depicted in Figure 3. Statistical Analysis All analyses applied NIS sampling weights, strata, and clusters to produce nationally representative estimates. Continuous variables were summarized using weighted means or medians as appropriate; categorical variables using weighted percentages. Analyses were performed using R version 4.3 or later (survey, srvyr, tidyverse, broom, ggplot2). Results Among an estimated 2.96 million adult sepsis hospitalizations in 2022, 1.32 million (44.5%) were complicated by acute kidney injury (AKI). Patients with AKI were older (mean age 67.9 vs 62.6 years) and had substantially higher prevalence of chronic kidney disease, heart failure, diabetes with complications, and coagulopathy (all SMD ≥0.20). They were also more frequently insured through Medicare (64.4% vs 55.5%). Differences in race distribution were modest (SMD = 0.10), and ZIP-code income quartiles were similar between groups. Baseline characteristics are shown in Table 1. Table 1. Baseline Characteristics of Adult Sepsis Hospitalizations. Characteristic Sepsis without AKI Sepsis + AKI SMD Unweighted count 327,836 264,940 Weighted count 1,639,180 1,321,700 Demographics Age, years 62.6 (17.9) 67.9 (15.3) 0.32 Female, % 50.1 44.9 0.11 Comorbidities Chronic kidney disease / renal failure, % 17.6 38.0 0.47 Chronic pulmonary disease, % 27.6 25.5 0.047 Coagulopathy, % 11.6 21.0 0.26 Diabetes with chronic complications, % 24.3 33.8 0.21 Diabetes without chronic complications, % 10.6 8.6 0.066 Heart failure, % 22.9 34.8 0.27 Hypertension, complicated, % 27.2 46.6 0.41 Hypertension, uncomplicated, % 34.4 25.0 0.21 Liver disease, % 9.3 16.0 0.20 Solid tumor (no metastasis), % 4.7 4.9 0.008 Metastatic cancer, % 5.5 5.7 0.012 Obesity, % 19.8 20.9 0.027 Peripheral vascular disease, % 7.7 9.5 0.067 Payer type 0.19 Medicaid 17.5 13.4 Medicare 55.5 64.4 Missing 0.1 0.1 No charge 0.4 0.2 Other 2.9 2.9 Private insurance 19.5 16.1 Self-pay 4.1 2.9 Race 0.10 Asian 3.2 3.0 Black 13.2 15.1 Hispanic 13.4 10.6 Missing 2.1 2.3 Native American 0.9 0.8 Other 2.8 2.8 White 64.4 65.4 ZIP income, percentile 0.021 0–25th 30.0 30.7 26–50th 25.7 25.5 51–75th 23.4 23.3 76–100th 19.3 19.0 Missing 1.7 1.5 Table 1 summarizes the baseline demographic, socioeconomic, and comorbidity characteristics of adults hospitalized with sepsis, comparing those with and without acute kidney injury. Age is expressed as mean (standard deviation). All other variables are presented as weighted percentages. Unweighted counts represent the raw NIS sample size, whereas weighted counts represent national estimates. Standardized mean differences (SMD) quantify the magnitude of differences between groups, with values ≥0.10 generally indicating meaningful imbalance. Patients with AKI experienced substantially worse clinical outcomes than those without AKI. Compared with non-AKI hospitalizations, those with AKI demonstrated higher in-hospital mortality (19.8% vs 7.5%), mechanical ventilation use (22.3% vs 9.3%), vasopressor use (10.1% vs 5.8%), and dialysis use (7.7% vs 5.8%). Unadjusted outcomes are presented in Table 2. These differences are visually depicted in Figure 1, which highlights the substantially greater organ-support needs associated with AKI. Table 2. Clinical Outcomes of Adult Sepsis Hospitalizations Outcome Sepsis without AKI Sepsis + AKI SMD Clinical Outcomes In-hospital mortality, % 7.5 19.8 0.36 Mechanical ventilation, % 9.3 22.3 0.35 Vasopressor use (central line proxy), % 5.8 10.1 0.16 In-hospital dialysis, % 5.8 7.7 0.076 Resource Utilization Length of stay, median (IQR), days 5.0 (3.0–9.0) 7.0 (4.0–13.0) 0.25 Total hospital charges, median (IQR), $ $55,757 ($30,756–$108,313) $84,698 ($43,633–$178,705) Discharge Disposition, % 0.38 Died in hospital 22.6 30.2 Home 43.8 26.0 Other transfer/acute facility 30.8 40.4 Skilled nursing/long-term care 2.8 3.3 Table 2 summarizes unadjusted clinical outcomes, resource utilization, and discharge disposition among adults hospitalized with sepsis, stratified by AKI status. Continuous measures reported as median (IQR); categorical variables as weighted percentages. SMD ≥0.10 indicates meaningful imbalance Figure 1 displays the unadjusted clinical outcomes of sepsis hospitalizations stratified by AKI status, illustrating higher mortality and greater organ-support needs among patients with AKI. Shapes represent AKI status. AKI hospitalizations had significantly greater resource use: length of stay (7.0 vs 5.0 days) and hospital charges ($84,698 vs $55,757). Discharge outcomes also differed markedly. Home discharge was less common (26.0% vs 43.8%), whereas transfer to post-acute care was more frequent (40.4% vs 30.8%). The proportion categorized as “died in hospital” differs from in-hospital mortality due to separate NIS coding fields. Figure 2 illustrates these disposition patterns, demonstrating a clear shift toward higher post-acute care needs among patients with AKI. Figure 2 illustrates the distribution of discharge dispositions among sepsis hospitalizations, showing that patients with AKI were less likely to be discharged home and more likely to transfer to acute or post-acute facilities. Discharge disposition categories include home (A), other acute care transfer (B), died in hospital (C), and skilled nursing/long-term care (D). Bars represent percentages; shapes denote AKI status. After adjustment for demographics, socioeconomic factors, and comorbidities, AKI remained strongly and independently associated with in-hospital mortality, mechanical ventilation, vasopressor use, and in-hospital dialysis. Adjusted results are shown in Table 3 and Figure 3. AKI was also associated with substantially higher resource utilization, including length of stay and hospital charges. Table 3. Adjusted Association of Acute Kidney Injury with Clinical and Resource Outcomes Among Adults Hospitalized with Sepsis Outcome aOR / aROM (95% CI) p-value Clinical Outcomes In-hospital mortality 2.44 (2.38–2.50) <0.001 Mechanical ventilation 2.66 (2.60–2.72) <0.001 Vasopressor use (central line proxy) 1.70 (1.65–1.74) <0.001 In-hospital dialysis 0.73 (0.70–0.76) <0.001 Resource Utilization Length of stay 1.33 (1.32–1.34) <0.001 Total hospital charges 1.50 (1.48–1.52) <0.001 Table 3 presents the adjusted associations between AKI and key clinical and resource outcomes among adults hospitalized with sepsis. Binary outcomes were reported as adjusted odds ratios (aORs). Length of stay and total hospital charges were reported as adjusted ratios of geometric means (aROM). All models adjust for demographics, payer and income factors, and comorbidities. Figure 3 displays the adjusted associations between AKI and key clinical outcomes, showing higher odds of mortality, mechanical ventilation, and vasopressor use among patients with AKI after multivariable adjustment. Adjusted odds ratios estimated from survey-weighted logistic regression models adjusting for age, sex, race/ethnicity, primary payer, ZIP-code income quartile, and Elixhauser comorbidities (heart failure, chronic pulmonary disease, diabetes with complications, chronic kidney disease, liver disease, obesity, coagulopathy, peripheral vascular disease, solid tumor, metastatic cancer, and hypertension). Horizontal bars show 95% confidence intervals. Discussion In this nationally representative analysis of nearly three million adult sepsis hospitalizations in the United States, acute kidney injury (AKI) emerged as a common and clinically consequential complication. Almost half of all sepsis admissions experienced AKI, and these hospitalizations demonstrated substantially worse outcomes across multiple domains. Patients with sepsis-associated AKI had markedly higher in-hospital mortality, greater need for mechanical ventilation and vasopressor support, and increased use of in-hospital dialysis compared with those without AKI. These adverse clinical differences were accompanied by significantly longer hospital stays, higher total charges, and a greater likelihood of discharge to post-acute or long-term care facilities. Together, these findings highlight the substantial clinical and recovery burden associated with AKI in sepsis. Our findings align closely with prior observational studies demonstrating that AKI substantially worsens outcomes in sepsis. Prior analyses from large administrative datasets similarly report two- to threefold higher mortality and greater organ support needs among patients with sepsis-associated AKI [ 1 , 6 , 20 ]. The strong adjusted associations demonstrated in Fig. 3 reinforce that AKI remains independently associated with adverse outcomes even after extensive adjustment for demographic, socioeconomic, and comorbid conditions. Prospective cohorts have shown that the development of AKI in sepsis reflects underlying illness severity and contributes to progression of multiorgan failure [ 9 , 14 ]. Studies using earlier versions of the HCUP NIS have documented increased hospitalization costs and prolonged length of stay in sepsis hospitalizations complicated by AKI [ 17 ]. However, few prior investigations have examined post-acute discharge disposition in detail. By incorporating these trajectories, our study broadens the understanding of the recovery burden associated with AKI, demonstrating that its impact extends well beyond the index hospitalization. Collectively, our findings reinforce AKI as a critical inflection point in the clinical course of sepsis and highlight the need for early recognition and mitigation strategies in this high-risk population. Several mechanisms likely underlie the strong association between AKI and adverse outcomes in sepsis observed in this study. Sepsis triggers a cascade of systemic inflammation, endothelial injury, microvascular dysfunction, and hemodynamic instability, all of which predispose the kidney to ischemic and toxic insults [ 13 ]. Conversely, AKI may amplify systemic inflammation, impair metabolic and acid–base homeostasis, and contribute to fluid overload, thereby worsening pulmonary and cardiovascular function [ 5 ]. These bidirectional mechanisms likely account for the substantially higher absolute rates of ventilation and vasopressor therapy observed in Fig. 1 , which visually illustrates the clinical burden of AKI among patients with sepsis. The increased reliance on post-acute or long-term care services among survivors with AKI likely reflects the broader impact of prolonged critical illness, impaired functional recovery, and persistent organ dysfunction. Together, these mechanisms underscore how AKI serves not only as a marker of severity but may also contribute to poor outcomes in sepsis. The finding that AKI was associated with lower adjusted odds of dialysis warrants clarification. This pattern has been noted in other administrative-dataset studies and likely reflects coding behavior rather than a biological paradox [ 7 ]. First, dialysis in sepsis is frequently initiated for indications such as fluid overload or metabolic derangements in patients who never receive an N17.x code, inflating dialysis rates in the “non-AKI” group. Second, ICD-10 coding for AKI has limited sensitivity, and many cases of clinically recognized AKI—especially early or moderate stages—remain uncoded. Taken together, these factors explain why the adjusted dialysis association should be interpreted cautiously as a coding artifact rather than a true inverse clinical relationship. The clinical and health-system implications of these findings are substantial. Because AKI in sepsis is both common and strongly linked to a broad spectrum of adverse outcomes, early identification and mitigation of kidney injury should be a central priority in sepsis management. Evidence-based strategies—such as careful fluid stewardship, avoidance of nephrotoxins, and timely hemodynamic optimization—have shown potential to reduce the incidence or severity of AKI in critically ill populations [ 11 ]. The greater lengths of stay, hospital charges, and post-acute care needs associated with AKI are clearly reflected in Fig. 2 , highlighting the system-level burden imposed by this complication. Interventions aimed at mitigating AKI may therefore yield meaningful clinical, functional, and economic benefit across the spectrum of sepsis care. This study has several notable strengths. It uses the most recent iteration of the HCUP National Inpatient Sample, providing a large, nationally representative cohort of adults hospitalized with sepsis and enabling robust estimation of both clinical and resource outcomes. The use of survey-weighted methods ensures proper accounting for the complex sampling design, enhancing generalizability to U.S. inpatient care. We applied standardized approaches to identifying sepsis, AKI, comorbidities, and organ-support interventions, and adjusted for a comprehensive set of demographics, socioeconomic, and clinical covariates. Importantly, this analysis extends prior work by incorporating discharge disposition as an outcome, offering additional insights into the functional and recovery burden associated with sepsis-associated AKI. Several limitations should be considered when interpreting these findings. First, this study relied on administrative claims data, and identification of sepsis, AKI, mechanical ventilation, vasopressor use, and dialysis was based on ICD-10-CM/PCS coding rather than clinical measurements. Although these codes have been used extensively in prior epidemiologic research [ 15 ], they may be subject to misclassification and cannot distinguish between conditions present on admission and those acquired in the hospital. The absence of laboratory data precluded staging of AKI using serum creatinine or urine output criteria, limiting granular assessment of kidney injury severity [ 18 ]. Second, as with all observational studies, residual confounding is possible despite adjustment for key demographic, socioeconomic, and comorbidity variables. The NIS lacks detailed information on illness severity, medication exposures, and clinical management decisions, all of which may influence the development of AKI and downstream outcomes. Furthermore, discharge disposition does not capture post-discharge functional recovery or long-term survival. Finally, because the NIS is discharge-based rather than patient-based, repeated admissions cannot be linked, and results reflect hospitalizations rather than individuals. These limitations notwithstanding, the consistency and magnitude of the observed associations support the robustness of our conclusions. Conclusion In summary, acute kidney injury is a frequent and highly consequential complication of sepsis, associated with substantially increased mortality, greater need for organ support, prolonged hospitalization, higher financial burden, and significantly worse post-acute discharge outcomes. Using a contemporary, nationally representative cohort, this study highlights the persistent clinical and health-system impact of AKI across the full trajectory of sepsis care. These findings underscore the importance of early identification of kidney injury, implementation of renal-protective strategies, and development of targeted interventions to improve outcomes for patients with sepsis-associated AKI. Future work integrating administrative data with laboratory and physiological measures may further refine risk stratification for sepsis-associated AKI. Declarations Ethics approval and consent to participate This project was reviewed by the BayCare Institutional Review Board (IRB) and determined not to constitute human subjects research as defined by DHHS and FDA regulations (Inquiry determination dated October 22, 2025). IRB approval and oversight were therefore not required. The analysis used fully de-identified data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, and no identifiable private information or intervention involving human participants occurred. All study procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki. Because no human subjects were involved, informed consent was not required. Consent for publication Not applicable Availability of data and materials The data that support the findings of this study are available from the Agency for Healthcare Research and Quality, Department of Health and Human Services of the United States. However, restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the author upon reasonable request and with permission of the Agency for Healthcare Research and Quality. Competing interests The authors declare that they have no competing interests. Funding The authors declare that they received no funding. Authors' contributions BT was responsible for the implementation, collection, analyzing, and interpretation of data. BT is also responsible for writing the methods and discussion sections. CO conducted literature reviews and was partly involved in revising and writing other sections. Acknowledgements We wanted to acknowledge all the HCUP Data Partners that contribute to HCUP. A link to the HCUP-US web page that contains the list of State organizations is here. (hcup-us.ahrq.gov/db/hcupdatapartners.jsp). References Bagshaw SM, Lapinsky S, Dial S, et al. Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy. Intensive Care Med. 2009;35(5):871–881. Bagshaw SM, George C, Bellomo R. Early acute kidney injury and sepsis: A multicenter evaluation. Crit Care. 2008;12(2):R47. 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The attributable mortality of sepsis for acute kidney injury: a propensity-matched analysis based on multicenter prospective cohort study. Renal Failure. 2023;45(1):2162415. Kellum JA, Lameire N; KDIGO AKI Guideline Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (part 1). Crit Care. 2013;4(17):204 Lai TS, Wang CY, Pan SC, Huang TM, Lin MC, Lai CF, Wu CH, Wu VC, Chien KL; National Taiwan University Hospital Study Group on Acute Renal Failure (NSARF). Risk of developing severe sepsis after acute kidney injury: a population-based cohort study. Crit Care. 2013 Oct 11;17(5):R231. Lameire N, Van Biesen W, Hoste E, Vanholder R. The prevention of acute kidney injury: an in-depth narrative review Part 1: volume resuscitation and avoidance of drug- and nephrotoxin-induced AKI. NDT Plus. 2008;1(6):392-402. Liu, J., Xie, H., Ye, Z. et al. Rates, predictors, and mortality of sepsis-associated acute kidney injury: a systematic review and meta-analysis. 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The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–810. Waikar SS, Curhan GC, Wald R, et al. Declining mortality in patients with acute renal failure, 1988 to 2002. J Am Soc Nephrol. 2006;17(4):1143–1150. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Mar, 2026 Read the published version in BMC Nephrology → Version 1 posted Editorial decision: Revision requested 10 Feb, 2026 Reviews received at journal 10 Feb, 2026 Reviews received at journal 09 Feb, 2026 Reviewers agreed at journal 01 Feb, 2026 Reviewers agreed at journal 31 Jan, 2026 Reviewers agreed at journal 29 Jan, 2026 Reviewers agreed at journal 29 Jan, 2026 Reviewers invited by journal 18 Dec, 2025 Editor assigned by journal 18 Dec, 2025 Editor invited by journal 08 Dec, 2025 Submission checks completed at journal 05 Dec, 2025 First submitted to journal 05 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":157136,"visible":true,"origin":"","legend":"\u003cp\u003eClinical ouClinical outcomes among sepsis hospitalizations with and without acute kidney injurytcomes among sepsis hospitalizations with and without acute kidney injuryClinical outcomes among sepsis hospitalizations with and without acute kidney injury\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8264698/v1/74e2da07a08e86034bec5c03.png"},{"id":98820477,"identity":"57a3bc2b-88c8-4341-bd38-cfece8d1a558","added_by":"auto","created_at":"2025-12-22 17:16:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":204114,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of discharge disposition by acute kidney injury status among adults hospitalized with sepsis.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8264698/v1/9b55304ceb221361b931c441.png"},{"id":99307413,"identity":"d2ff1132-e373-4862-a47c-14b202194f2f","added_by":"auto","created_at":"2025-12-31 16:06:14","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":237813,"visible":true,"origin":"","legend":"\u003cp\u003eAdjusted Odds of Clinical Outcomes Associated with Acute Kidney Injury.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8264698/v1/3e706fb3db732f9fbe419c69.png"},{"id":105755965,"identity":"28bc973e-ec04-451a-8843-dad5c4e34608","added_by":"auto","created_at":"2026-03-30 16:33:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1306861,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8264698/v1/1695e2f5-f9e1-4d74-bceb-1fef9da4544e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical and Resource Burden of Acute Kidney Injury Among Adults Hospitalized with Sepsis: A Retrospective Cross-Sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eSepsis remains one of the leading causes of hospitalization, critical illness, and mortality worldwide, contributing to substantial health‐care utilization and long-term morbidity [16, 19]. Acute kidney injury (AKI) is among the most frequent and severe organ dysfunctions occurring during sepsis, reporting up to 40\u0026ndash;50% of hospitalized patients in prior studies and significantly worsening prognosis [12]. The development of AKI in sepsis has been consistently associated with higher mortality, greater need for organ support, prolonged hospitalization, and increased risk of long-term kidney dysfunction [1,5,14]. Despite advances in sepsis recognition and management, the burden of sepsis-associated AKI continues to rise and remains a major clinical challenge.\u003c/p\u003e\n\u003cp\u003eMost prior epidemiologic studies evaluating sepsis-associated AKI have focused on single-center cohorts, ICU-based populations, or older administrative datasets predating current ICD-10 coding practices. These limitations restrict contemporary generalizability and may underestimate the evolving severity and complexity of sepsis-associated AKI. Although the relationship between AKI and mortality or organ-support needs is well established, relatively few studies have evaluated downstream functional outcomes such as discharge disposition\u0026mdash;an increasingly important marker of survivorship and recovery. Many landmark analyses, including large multicenter critical care cohorts, reported mortality and organ failure trajectories but did not characterize post-acute disposition patterns [8,10]. Understanding these broader outcomes is essential to fully quantify the impact of AKI across the entire trajectory of sepsis care.\u003c/p\u003e\n\u003cp\u003eUsing the most recent nationally representative data from the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS), this study aimed to provide an updated and comprehensive assessment of the burden of AKI among adults hospitalized with sepsis in the United States. Specifically, we aimed to (1) describe the national epidemiology of sepsis-associated AKI, (2) quantify clinical and resource outcomes among sepsis hospitalizations with and without AKI, and (3) evaluate whether AKI remains independently associated with adverse outcomes after adjustment for demographic, socioeconomic, and clinical factors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design and Data Source\u003c/p\u003e\n\u003cp\u003eWe conducted a retrospective cross-sectional study using the 2022 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS), a nationally representative, all-payer inpatient database [3]. The NIS is discharge-based; therefore, each record reflects a single hospitalization. Adult hospitalizations (\u0026ge;18 years) with complete age and survey design information were included. Inter-hospital transfers were retained per HCUP methodology. No human subjects were involved in this study. IRB requirement was waived by Baycare Institutional Review Board.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIdentification of Sepsis and Acute Kidney Injury\u003c/p\u003e\n\u003cp\u003eSepsis hospitalizations were identified using ICD-10-CM codes A40.x\u0026ndash;A41.x (sepsis), R65.20 (severe sepsis), and R65.21 (septic shock). Acute kidney injury (AKI) was defined using ICD-10-CM codes N17.x in any diagnosis field. Because the NIS lacks present-on-admission indicators, sepsis and AKI may represent either pre-existing conditions or complications arising during hospitalization.\u003c/p\u003e\n\u003cp\u003eBaseline Characteristics\u003c/p\u003e\n\u003cp\u003eBaseline demographic, socioeconomic, and comorbidity variables were extracted to compare sepsis hospitalizations with and without AKI. Covariates included age, sex, race/ethnicity, primary payer, ZIP-code income quartile, and Elixhauser comorbidities. Age was summarized as mean (SD), and categorical variables as survey-weighted percentages. Standardized mean differences (SMDs) were used to quantify between-group differences (SMD \u0026ge;0.10 indicating meaningful imbalance). These variables correspond to the cohort characteristics presented in Table 1.\u003c/p\u003e\n\u003cp\u003eUnadjusted Clinical and Resource Outcomes\u003c/p\u003e\n\u003cp\u003eUnadjusted outcomes included in-hospital mortality, mechanical ventilation, vasopressor use, in-hospital dialysis, length of stay, total hospital charges, and discharge disposition. Mechanical ventilation and dialysis were identified using ICD-10-PCS procedure codes. Vasopressor use was approximated using central venous catheter placement ICD-10-PCS codes, which has been validated as a surrogate in administrative datasets [4].\u003c/p\u003e\n\u003cp\u003eDischarge disposition was categorized as home, transfer to another acute-care facility, skilled nursing/long-term care, or in-hospital death. Because mortality (DIED) and discharge disposition derive from different NIS fields, the proportion \u0026ldquo;died in hospital\u0026rdquo; differs from the in-hospital mortality variable. Unadjusted clinical outcomes presented in Table 2. They are visually summarized in Figure 1, and discharge disposition patterns are displayed in Figure 2.\u003c/p\u003e\n\u003cp\u003eAdjusted Analyses\u003c/p\u003e\n\u003cp\u003eThe independent association between AKI and each outcome was evaluated using multivariable survey-weighted regression. Binary outcomes\u0026mdash;mortality, mechanical ventilation, vasopressor use, and dialysis\u0026mdash;were analyzed using logistic regression and reported as adjusted odds ratios (aORs) with 95% confidence intervals. Length of stay and total hospital charges, which were right-skewed, were analyzed using gamma regression with a log link and reported as adjusted ratios of geometric means (aROMs). All models adjusted for demographic, socioeconomic, and comorbidity variables listed in Table 1. The adjusted associations are presented in Table 3 and visually depicted in Figure 3.\u003c/p\u003e\n\u003cp\u003eStatistical Analysis\u003c/p\u003e\n\u003cp\u003eAll analyses applied NIS sampling weights, strata, and clusters to produce nationally representative estimates. Continuous variables were summarized using weighted means or medians as appropriate; categorical variables using weighted percentages. Analyses were performed using R version 4.3 or later (survey, srvyr, tidyverse, broom, ggplot2).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong an estimated 2.96 million adult sepsis hospitalizations in 2022, 1.32 million (44.5%) were complicated by acute kidney injury (AKI). Patients with AKI were older (mean age 67.9 vs 62.6 years) and had substantially higher prevalence of chronic kidney disease, heart failure, diabetes with complications, and coagulopathy (all SMD \u0026ge;0.20). They were also more frequently insured through Medicare (64.4% vs 55.5%). Differences in race distribution were modest (SMD = 0.10), and ZIP-code income quartiles were similar between groups. Baseline characteristics are shown in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1. Baseline Characteristics of Adult Sepsis Hospitalizations.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"103%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSepsis without AKI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSepsis + AKI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eUnweighted count\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e327,836\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e264,940\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eWeighted count\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e1,639,180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e1,321,700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003eDemographics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e62.6 (17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e67.9 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Female, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e50.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e44.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eChronic kidney disease / renal failure, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e38.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eChronic pulmonary disease, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e27.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eCoagulopathy, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eDiabetes with chronic complications, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e24.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e33.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eDiabetes without chronic complications, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eHeart failure, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e22.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e34.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eHypertension, complicated, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e27.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e46.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eHypertension, uncomplicated, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e34.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eLiver disease, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Solid tumor (no \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; metastasis), %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eMetastatic cancer, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eObesity, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e20.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003ePeripheral vascular disease, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePayer type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eMedicaid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e17.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eMedicare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e55.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e64.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eNo charge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003ePrivate insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eSelf-pay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e15.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eHispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eNative American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e64.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e65.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZIP income, percentile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e0\u0026ndash;25th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e26\u0026ndash;50th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e25.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e51\u0026ndash;75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e76\u0026ndash;100th\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e19.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 1 summarizes the baseline demographic, socioeconomic, and comorbidity characteristics of adults hospitalized with sepsis, comparing those with and without acute kidney injury. Age is expressed as mean (standard deviation). All other variables are presented as weighted percentages. Unweighted counts represent the raw NIS sample size, whereas weighted counts represent national estimates. Standardized mean differences (SMD) quantify the magnitude of differences between groups, with values \u0026ge;0.10 generally indicating meaningful imbalance.\u003c/p\u003e\n\u003cp\u003ePatients with AKI experienced substantially worse clinical outcomes than those without AKI. Compared with non-AKI hospitalizations, those with AKI demonstrated higher in-hospital mortality (19.8% vs 7.5%), mechanical ventilation use (22.3% vs 9.3%), vasopressor use (10.1% vs 5.8%), and dialysis use (7.7% vs 5.8%). Unadjusted outcomes are presented in Table 2. These differences are visually depicted in Figure 1, which highlights the substantially greater organ-support needs associated with AKI.\u003c/p\u003e\n\u003cp\u003eTable 2. Clinical Outcomes of Adult Sepsis Hospitalizations\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSepsis without AKI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSepsis + AKI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eIn-hospital mortality, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eMechanical ventilation, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eVasopressor use (central line proxy), %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eIn-hospital dialysis, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResource Utilization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eLength of stay, median (IQR), days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e5.0 (3.0\u0026ndash;9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e7.0 (4.0\u0026ndash;13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eTotal hospital charges, median (IQR), $\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e$55,757 ($30,756\u0026ndash;$108,313)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e$84,698 ($43,633\u0026ndash;$178,705)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDischarge\u003c/strong\u003e \u003cstrong\u003eDisposition, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eDied in hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e30.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eOther transfer/acute facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e30.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e40.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eSkilled nursing/long-term care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 2 summarizes unadjusted clinical outcomes, resource utilization, and discharge disposition among adults hospitalized with sepsis, stratified by AKI status. Continuous measures reported as median (IQR); categorical variables as weighted percentages. SMD \u0026ge;0.10 indicates meaningful imbalance\u003c/p\u003e\n\u003cp\u003eFigure 1 displays the unadjusted clinical outcomes of sepsis hospitalizations stratified by AKI status, illustrating higher mortality and greater organ-support needs among patients with AKI. Shapes represent AKI status.\u003c/p\u003e\n\u003cp\u003eAKI hospitalizations had significantly greater resource use: length of stay (7.0 vs 5.0 days) and hospital charges ($84,698 vs $55,757). Discharge outcomes also differed markedly. Home discharge was less common (26.0% vs 43.8%), whereas transfer to post-acute care was more frequent (40.4% vs 30.8%). The proportion categorized as \u0026ldquo;died in hospital\u0026rdquo; differs from in-hospital mortality due to separate NIS coding fields. Figure 2 illustrates these disposition patterns, demonstrating a clear shift toward higher post-acute care needs among patients with AKI.\u003c/p\u003e\n\u003cp\u003eFigure 2 illustrates the distribution of discharge dispositions among sepsis hospitalizations, showing that patients with AKI were less likely to be discharged home and more likely to transfer to acute or post-acute facilities. Discharge disposition categories include home (A), other acute care transfer (B), died in hospital (C), and skilled nursing/long-term care (D). Bars represent percentages; shapes denote AKI status.\u003c/p\u003e\n\u003cp\u003eAfter adjustment for demographics, socioeconomic factors, and comorbidities, AKI remained strongly and independently associated with in-hospital mortality, mechanical ventilation, vasopressor use, and in-hospital dialysis. Adjusted results are shown in Table 3 and Figure 3. AKI was also associated with substantially higher resource utilization, including length of stay and hospital charges.\u003c/p\u003e\n\u003cp\u003eTable 3. Adjusted Association of Acute Kidney Injury with Clinical and Resource Outcomes Among Adults Hospitalized with Sepsis\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 262px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR / aROM (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 262px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 262px;\"\u003e\n \u003cp\u003eIn-hospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003e2.44 (2.38\u0026ndash;2.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 262px;\"\u003e\n \u003cp\u003eMechanical ventilation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003e2.66 (2.60\u0026ndash;2.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 262px;\"\u003e\n \u003cp\u003eVasopressor use (central line proxy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003e1.70 (1.65\u0026ndash;1.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 262px;\"\u003e\n \u003cp\u003eIn-hospital dialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003e0.73 (0.70\u0026ndash;0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 262px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResource Utilization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 262px;\"\u003e\n \u003cp\u003eLength of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003e1.33 (1.32\u0026ndash;1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 262px;\"\u003e\n \u003cp\u003eTotal hospital charges\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003e1.50 (1.48\u0026ndash;1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 3 presents the adjusted associations between AKI and key clinical and resource outcomes among adults hospitalized with sepsis. Binary outcomes were reported as adjusted odds ratios (aORs). Length of stay and total hospital charges were reported as adjusted ratios of geometric means (aROM). All models adjust for demographics, payer and income factors, and comorbidities.\u003c/p\u003e\n\u003cp\u003eFigure 3 displays the adjusted associations between AKI and key clinical outcomes, showing higher odds of mortality, mechanical ventilation, and vasopressor use among patients with AKI after multivariable adjustment. Adjusted odds ratios estimated from survey-weighted logistic regression models adjusting for age, sex, race/ethnicity, primary payer, ZIP-code income quartile, and Elixhauser comorbidities (heart failure, chronic pulmonary disease, diabetes with complications, chronic kidney disease, liver disease, obesity, coagulopathy, peripheral vascular disease, solid tumor, metastatic cancer, and hypertension). Horizontal bars show 95% confidence intervals.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this nationally representative analysis of nearly three million adult sepsis hospitalizations in the United States, acute kidney injury (AKI) emerged as a common and clinically consequential complication. Almost half of all sepsis admissions experienced AKI, and these hospitalizations demonstrated substantially worse outcomes across multiple domains. Patients with sepsis-associated AKI had markedly higher in-hospital mortality, greater need for mechanical ventilation and vasopressor support, and increased use of in-hospital dialysis compared with those without AKI. These adverse clinical differences were accompanied by significantly longer hospital stays, higher total charges, and a greater likelihood of discharge to post-acute or long-term care facilities. Together, these findings highlight the substantial clinical and recovery burden associated with AKI in sepsis.\u003c/p\u003e \u003cp\u003eOur findings align closely with prior observational studies demonstrating that AKI substantially worsens outcomes in sepsis. Prior analyses from large administrative datasets similarly report two- to threefold higher mortality and greater organ support needs among patients with sepsis-associated AKI [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The strong adjusted associations demonstrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e reinforce that AKI remains independently associated with adverse outcomes even after extensive adjustment for demographic, socioeconomic, and comorbid conditions.\u003c/p\u003e \u003cp\u003eProspective cohorts have shown that the development of AKI in sepsis reflects underlying illness severity and contributes to progression of multiorgan failure [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Studies using earlier versions of the HCUP NIS have documented increased hospitalization costs and prolonged length of stay in sepsis hospitalizations complicated by AKI [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, few prior investigations have examined post-acute discharge disposition in detail. By incorporating these trajectories, our study broadens the understanding of the recovery burden associated with AKI, demonstrating that its impact extends well beyond the index hospitalization. Collectively, our findings reinforce AKI as a critical inflection point in the clinical course of sepsis and highlight the need for early recognition and mitigation strategies in this high-risk population.\u003c/p\u003e \u003cp\u003eSeveral mechanisms likely underlie the strong association between AKI and adverse outcomes in sepsis observed in this study. Sepsis triggers a cascade of systemic inflammation, endothelial injury, microvascular dysfunction, and hemodynamic instability, all of which predispose the kidney to ischemic and toxic insults [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Conversely, AKI may amplify systemic inflammation, impair metabolic and acid\u0026ndash;base homeostasis, and contribute to fluid overload, thereby worsening pulmonary and cardiovascular function [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese bidirectional mechanisms likely account for the substantially higher absolute rates of ventilation and vasopressor therapy observed in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which visually illustrates the clinical burden of AKI among patients with sepsis. The increased reliance on post-acute or long-term care services among survivors with AKI likely reflects the broader impact of prolonged critical illness, impaired functional recovery, and persistent organ dysfunction. Together, these mechanisms underscore how AKI serves not only as a marker of severity but may also contribute to poor outcomes in sepsis.\u003c/p\u003e \u003cp\u003eThe finding that AKI was associated with lower adjusted odds of dialysis warrants clarification. This pattern has been noted in other administrative-dataset studies and likely reflects coding behavior rather than a biological paradox [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. First, dialysis in sepsis is frequently initiated for indications such as fluid overload or metabolic derangements in patients who never receive an N17.x code, inflating dialysis rates in the \u0026ldquo;non-AKI\u0026rdquo; group. Second, ICD-10 coding for AKI has limited sensitivity, and many cases of clinically recognized AKI\u0026mdash;especially early or moderate stages\u0026mdash;remain uncoded. Taken together, these factors explain why the adjusted dialysis association should be interpreted cautiously as a coding artifact rather than a true inverse clinical relationship.\u003c/p\u003e \u003cp\u003eThe clinical and health-system implications of these findings are substantial. Because AKI in sepsis is both common and strongly linked to a broad spectrum of adverse outcomes, early identification and mitigation of kidney injury should be a central priority in sepsis management. Evidence-based strategies\u0026mdash;such as careful fluid stewardship, avoidance of nephrotoxins, and timely hemodynamic optimization\u0026mdash;have shown potential to reduce the incidence or severity of AKI in critically ill populations [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The greater lengths of stay, hospital charges, and post-acute care needs associated with AKI are clearly reflected in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, highlighting the system-level burden imposed by this complication. Interventions aimed at mitigating AKI may therefore yield meaningful clinical, functional, and economic benefit across the spectrum of sepsis care.\u003c/p\u003e \u003cp\u003eThis study has several notable strengths. It uses the most recent iteration of the HCUP National Inpatient Sample, providing a large, nationally representative cohort of adults hospitalized with sepsis and enabling robust estimation of both clinical and resource outcomes. The use of survey-weighted methods ensures proper accounting for the complex sampling design, enhancing generalizability to U.S. inpatient care. We applied standardized approaches to identifying sepsis, AKI, comorbidities, and organ-support interventions, and adjusted for a comprehensive set of demographics, socioeconomic, and clinical covariates. Importantly, this analysis extends prior work by incorporating discharge disposition as an outcome, offering additional insights into the functional and recovery burden associated with sepsis-associated AKI.\u003c/p\u003e \u003cp\u003eSeveral limitations should be considered when interpreting these findings. First, this study relied on administrative claims data, and identification of sepsis, AKI, mechanical ventilation, vasopressor use, and dialysis was based on ICD-10-CM/PCS coding rather than clinical measurements. Although these codes have been used extensively in prior epidemiologic research [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], they may be subject to misclassification and cannot distinguish between conditions present on admission and those acquired in the hospital. The absence of laboratory data precluded staging of AKI using serum creatinine or urine output criteria, limiting granular assessment of kidney injury severity [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSecond, as with all observational studies, residual confounding is possible despite adjustment for key demographic, socioeconomic, and comorbidity variables. The NIS lacks detailed information on illness severity, medication exposures, and clinical management decisions, all of which may influence the development of AKI and downstream outcomes. Furthermore, discharge disposition does not capture post-discharge functional recovery or long-term survival. Finally, because the NIS is discharge-based rather than patient-based, repeated admissions cannot be linked, and results reflect hospitalizations rather than individuals. These limitations notwithstanding, the consistency and magnitude of the observed associations support the robustness of our conclusions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, acute kidney injury is a frequent and highly consequential complication of sepsis, associated with substantially increased mortality, greater need for organ support, prolonged hospitalization, higher financial burden, and significantly worse post-acute discharge outcomes. Using a contemporary, nationally representative cohort, this study highlights the persistent clinical and health-system impact of AKI across the full trajectory of sepsis care. These findings underscore the importance of early identification of kidney injury, implementation of renal-protective strategies, and development of targeted interventions to improve outcomes for patients with sepsis-associated AKI. Future work integrating administrative data with laboratory and physiological measures may further refine risk stratification for sepsis-associated AKI.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was reviewed by the BayCare Institutional Review Board (IRB) and determined not to constitute human subjects research as defined by DHHS and FDA regulations (Inquiry determination dated October 22, 2025). IRB approval and oversight were therefore not required. The analysis used fully de-identified data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, and no identifiable private information or intervention involving human participants occurred. All study procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki. Because no human subjects were involved, informed consent was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the Agency for Healthcare Research and Quality, Department of Health and Human Services of the United States. However, restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the author upon reasonable request and with permission of the Agency for Healthcare Research and Quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they received no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBT was responsible for the implementation, collection, analyzing, and interpretation of data. BT is also responsible for writing the methods and discussion sections. CO conducted literature reviews and was partly involved in revising and writing other sections. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe wanted to acknowledge all the HCUP Data Partners that contribute to HCUP. A link to the HCUP-US web page that contains the list of State organizations is here. (hcup-us.ahrq.gov/db/hcupdatapartners.jsp).\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eBagshaw SM, Lapinsky S, Dial S, et al. Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy. Intensive Care Med. 2009;35(5):871\u0026ndash;881.\u003c/li\u003e\n \u003cli\u003eBagshaw SM, George C, Bellomo R. Early acute kidney injury and sepsis: A multicenter evaluation. Crit Care. 2008;12(2):R47.\u003c/li\u003e\n \u003cli\u003eHCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2022. Agency for Healthcare Research and Quality, Rockville, MD. hcup-us.ahrq.gov/nisoverview.jsp\u003c/li\u003e\n \u003cli\u003eHaimovich AD, Jiang R, Taylor RA, Belsky JB. Risk factor identification and predictive models for central line requirements for patients on vasopressors.\u0026nbsp;Anaesthesia and Intensive Care. 2021;49(4):275-283.\u003c/li\u003e\n \u003cli\u003eHofer DM, Ruzzante L, Waskowski J,\u0026nbsp;et al.\u0026nbsp;Influence of fluid accumulation on major adverse kidney events in critically ill patients \u0026ndash; an observational cohort study.\u0026nbsp;Ann Intensive Care. 2024;52(14).\u003c/li\u003e\n \u003cli\u003eHoste EAJ, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411\u0026ndash;1423.\u003c/li\u003e\n \u003cli\u003eHsu RK, McCulloch CE, Dudley RA, et al. Temporal changes in incidence of dialysis-requiring AKI. J Am Soc Nephrol. 2013;24(1):37\u0026ndash;42.\u003c/li\u003e\n \u003cli\u003eJia HM, Jiang YJ, Zheng X, Li W, Wang MP, Xi XM, Li WX. The attributable mortality of sepsis for acute kidney injury: a propensity-matched analysis based on multicenter prospective cohort study. Renal Failure. 2023;45(1):2162415.\u003c/li\u003e\n \u003cli\u003eKellum JA, Lameire N; KDIGO AKI Guideline Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (part 1). Crit Care. 2013;4(17):204\u003c/li\u003e\n \u003cli\u003eLai TS, Wang CY, Pan SC, Huang TM, Lin MC, Lai CF, Wu CH, Wu VC, Chien KL; National Taiwan University Hospital Study Group on Acute Renal Failure (NSARF). Risk of developing severe sepsis after acute kidney injury: a population-based cohort study. Crit Care. 2013 Oct 11;17(5):R231.\u003c/li\u003e\n \u003cli\u003eLameire N, Van Biesen W, Hoste E, Vanholder R. The prevention of acute kidney injury: an in-depth narrative review Part 1: volume resuscitation and avoidance of drug- and nephrotoxin-induced AKI. NDT Plus. 2008;1(6):392-402.\u003c/li\u003e\n \u003cli\u003eLiu, J., Xie, H., Ye, Z. et al. Rates, predictors, and mortality of sepsis-associated acute kidney injury: a systematic review and meta-analysis. BMC Nephrol. 2020;21 (318).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eManrique-Caballero CL, Del Rio-Pertuz G, Gomez H. Sepsis-Associated Acute Kidney Injury. Crit Care Clin. 2021;37(2):279-301.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePeerapornratana S, Manrique-Caballero CL, G\u0026oacute;mez H, Kellum JA. Acute kidney injury from sepsis: Current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney Int. 2019;96 (5):1083\u0026ndash;1099.\u003c/li\u003e\n \u003cli\u003eRhee C, Dantes R, Epstein L, et al. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. JAMA. 2017;318(13):1241\u0026ndash;1249.\u003c/li\u003e\n \u003cli\u003eRudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990\u0026ndash;2017. Lancet. 2020;395(10219):200\u0026ndash;211.\u003c/li\u003e\n \u003cli\u003eSakhuja A, Kumar G, Gupta S, et al. Acute kidney injury requiring dialysis in severe sepsis. Am J Respir Crit Care Med. 2015;192(8):951-957.\u003c/li\u003e\n \u003cli\u003eSiew ED, Davenport A. The growth of acute kidney injury: a rising tide or just closer attention to detail? Kidney Int. 2015;87(1):46\u0026ndash;61.\u003c/li\u003e\n \u003cli\u003eSinger M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801\u0026ndash;810.\u003c/li\u003e\n \u003cli\u003eWaikar SS, Curhan GC, Wald R, et al. Declining mortality in patients with acute renal failure, 1988 to 2002. J Am Soc Nephrol. 2006;17(4):1143\u0026ndash;1150.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"sepsis, acute kidney injury, discharge disposition, hospital charges, length of stay, ICD-10-CM-codes, in-hospital mortality, mechanical ventilation, vasopressor use","lastPublishedDoi":"10.21203/rs.3.rs-8264698/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8264698/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eAcute kidney injury (AKI) is a frequent and serious complication of sepsis, yet contemporary national estimates of its clinical and health-system impact remain limited. We used a large national database to characterize the burden of AKI among adults hospitalized with sepsis in the United States.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional study of adult sepsis hospitalizations in the 2022 NIS. AKI was identified using ICD-10-CM codes. Clinical outcomes included in-hospital mortality, mechanical ventilation, vasopressor use, and in-hospital dialysis. Resource outcomes included length of stay, total hospital charges, and discharge disposition. Survey-weighted logistic and gamma regression models were used to estimate adjusted odds ratios (aORs) and adjusted ratios of geometric means (aROMs) after adjusting for demographic, socioeconomic, and comorbidity factors.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eAmong 2.96\u0026nbsp;million weighted sepsis hospitalizations, 1.32\u0026nbsp;million (44.5%) involved AKI. Patients with AKI were older and had higher comorbidity burden than those without AKI. Unadjusted mortality (19.8% vs 7.5%), mechanical ventilation (22.3% vs 9.3%), and vasopressor use (10.1% vs 5.8%) were substantially higher in the AKI group, and these differences persisted in adjusted analyses (mortality aOR 2.44; mechanical ventilation aOR 2.66; vasopressor use aOR 1.70). AKI was also associated with longer length of stay (aROM 1.33), higher hospital charges (aROM 1.50), and worse discharge outcomes, including lower home discharge (26.0% vs 43.8%) and greater transfer to post-acute care facilities (40.4% vs 30.8%).\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eSepsis-associated AKI remains a widespread and highly consequential complication, independently associated with higher mortality, greater organ support needs, prolonged hospitalization, increased financial burden, and poorer post-acute recovery. These findings underscore the need for early identification and prevention of AKI in sepsis and highlight the urgent need for early AKI mitigation strategies to improve clinical and recovery outcomes in sepsis.\u003c/p\u003e","manuscriptTitle":"Clinical and Resource Burden of Acute Kidney Injury Among Adults Hospitalized with Sepsis: A Retrospective Cross-Sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 17:16:42","doi":"10.21203/rs.3.rs-8264698/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-10T18:05:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-10T09:03:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-10T03:06:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260350343192814024036213656402963518167","date":"2026-02-01T06:41:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328097355151753879603976422349911508167","date":"2026-01-31T14:55:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"190966687111722419094101770806428277381","date":"2026-01-30T04:18:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48101399020543251037898521109835342894","date":"2026-01-29T17:29:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-18T06:30:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-18T06:23:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-08T05:36:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-05T23:30:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2025-12-05T23:25:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9c6d459f-3990-4646-aafa-3e0e920f7f47","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:29:52+00:00","versionOfRecord":{"articleIdentity":"rs-8264698","link":"https://doi.org/10.1186/s12882-026-04915-z","journal":{"identity":"bmc-nephrology","isVorOnly":false,"title":"BMC Nephrology"},"publishedOn":"2026-03-24 16:08:37","publishedOnDateReadable":"March 24th, 2026"},"versionCreatedAt":"2025-12-22 17:16:42","video":"","vorDoi":"10.1186/s12882-026-04915-z","vorDoiUrl":"https://doi.org/10.1186/s12882-026-04915-z","workflowStages":[]},"version":"v1","identity":"rs-8264698","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8264698","identity":"rs-8264698","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}