Progress of Severe AKI in Sepsis Patients Targeted by Iron Metabolism: A Retrospective Analysis of the MIMIC-IV Database

Abstract

Background

The maintenance of iron metabolism is pivotal in preventing sepsis-associated acute kidney injury (SA-AKI). However, the optimal iron metabolism has been controversial in maintaining renal perfusion. This study aims to explore the iron metabolism markers in severe SA-AKI.

Methods

Patients from MIMIC IV database retrieval, included in all sepsis correlation of acute kidney injury (aged > 18 years of age). Logistic regression and restricted cubic spline (RCS) regression were performed to explore the relationship between iron metabolism markers and severe SA-AKI.

Results

In total 3204 patients with sepsis were included in this study. There were 1452 (45.32%) patients in the severe SA-AKI group. According to the RCS analysis, a significant (P overall < .001, P nonlinearity < .001) non-linear U-shaped correlation was observed between all iron metabolism markers and severe SA-AKI. After adjustment for all potential covariates, multivariate logistic regression showed that low SI group (OR:1.238, 95% CI: 1.028-1.491), high SI group (OR:1.323, 95% CI: 1.088-1.609), low TRF group (OR: 1.331, 95% CI: 1.101-1.610), heigh TRF group (OR: 1.239, 95% CI: 1.024-1.499), low TIBC group (OR: 1.331, 95% CI: 1.101-1.610), heigh TIBC group (OR: 1.239, 95% CI: 1.024-1.499), and heigh SF group (OR: 1.219, 95% CI: 1.004-1.479) were independent risk factors for severe SA-AKI.

Conclusions

Iron metabolism markers have a non-linear U-shaped relationship with severe SA-AKI. Therefore, monitoring Iron Metabolism levels helps to dynamically identify patients with a higher risk of developing severe SA-AKI.