Investigating patients with acute kidney injury and sepsis in general wards

Introduction. Acute kidney injury (AKI) and sepsis are associated with a poor prognosis, but little research about their presence among hospital general ward patients has been conducted. This thesis aimed to review the current evidence and examine patient characteristics, variation of incidence, and outcomes of AKI and sepsis in general wards. Method. A systematic review on AKI and sepsis patients in general wards and a retrospective observational cohort study of 192,133 patients at one regional and three metropolitan hospitals in New South Wales, Australia, in 2009-2013 were conducted. Results. There was limited evidence about patients with AKI and sepsis in general wards in the literature, none from Australia. The observational study found that AKI and sepsis patients were older (median age: 72), had more with multiple comorbidities and had seven times longer length of stay (median:16.9 days) than patients without AKI and sepsis (p<0.001). During the study period, the incidence varied (1.62%-1.76%) across hospitals, was slightly higher in metropolitan (1.70%) than in regional (1.05%) hospitals, and AKI and sepsis admissions had tripled. Conclusions. There was little variation in the incidence of AKI and sepsis in the four Australian general wards. Patients with AKI and sepsis were associated with poor outcomes (longer hospital stays) compared to patients without AKI and sepsis. More studies on patients with AKI and sepsis in general wards from different hospitals and population groups are needed to improve the patient outcomes in Australia.